Quick Links
See how easy it is to get free quotes…
Safe, Secure & Absolutely FreeThis website's security is certifed by:
Aetna – PPO 2500 with Medical $50K CYM – TEXAS
A comparison of the PPO 2500 with Medical $50K CYM offered by Aetna is detailed out below for both Network and Non-Network coverage.
| Network | Non-Network | |
|---|---|---|
|
||
| Network | See Provider | See Provider |
| Application | PPO 2500 with Medical $50K CYM Application | PPO 2500 with Medical $50K CYM Application |
| Brochure | PPO 2500 with Medical $50K CYM Brochure | PPO 2500 with Medical $50K CYM Brochure |
| Copay | Non-Specialist Office Visit: $25 copay (Unlimited visits), Specialist Office Visit: $50 copay (Unlimited visits) | Non-Specialist Office Visit: 50% after deductible (Unlimited visits), Specialist Office Visit: 50% after deductible (Unlimited visits) |
| Office Visit | Non-Specialist Office Visit: $25 copay (Unlimited visits), Specialist Office Visit: $50 copay (Unlimited visits) | Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist: 50% after deductible (unlimited visits) |
| Deductible | Individual: $2,500, Family: $5,000 | Individual: $5,000, Family: $10,000 |
| Coinsurance | 80% after deductible $0 once out-of-pocket max is satisfied. | 50% after deductible $0 once out-of-pocket max is satisfied. |
| Coinsurance Limit | Individual: $2,500, Family: $5,000 | Individual: $5,000, Family: $10,000 |
| Out-of-Pocket Maximum | (Deductible Included) Individual: $5,000, Family: $10,000 | (Deductible Included) Individual: $10,000, Family: $20,000 |
| Lifetime Maximum | $5,000,000 (Maximum applies to combined in and out of network benefits) | $5,000,000 (Maximum applies to combined in and out of network benefits) |
| Prescription Drugs | Pharmacy Deductible per insured: $500, Generic (Oral Contraceptives Included): $15 copay deductible waived, Preferred Brand (Oral Contraceptives Included): $35 copay after deductible, Non-Preferred Brand (Oral Contraceptives Included): $60 copay after deductible, Calendar year Maximum per insured (Maximum applies to combined in and out-of-network benefits): $2,500 | Pharmacy Deductible per insured- $500, Generic (Oral Contraceptives Included): $15 copay plus 50% deductible waived, Preferred Brand (Oral Contraceptives Included): $35 copay plus 50% after deductible, Non-Preferred Brand (Oral Contraceptives Included): $60 copay plus 50% after deductible, Calendar Year Maximum per insured (Maximum applies to combined in and out-of-network benefits): $2,500 |
| Emergency Room | $150 copay (waived if admitted), 80% coinsurance after deductible | $150 copay (waived if admitted), 80% coinsurance after deductible |
| Adult Preventative Care | Annual Routine Gyn Exam (Annual Pap/Mammogram, no waiting period, no calendar year max.): $50 copay deductible waived, Preventive Health - Routine Physical: $25 copay deductible waived, Aetna will pay up to $200 per exam max (maximum applies to combined in and out-of-network benefits, no waiting period, includes lab work and x-rays). | 100% after deductible (Age and frequency schedule apply). |
| Child Preventative Care | $0 copay deductible waived (Age and frequency schedule apply). | 100% after deductible (Age and frequency schedule apply). |
| Lab / X-Ray | 80% after deductible | 50% after deductible |
| Maternity | Not covered (Except for pregnancy complications) | Not covered (Except for pregnancy complications) |
| Physical Therapy | Physical/Occupational Therapy and Chiropractic: 80% after deductible (Aetna will pay up to $25 per visit max, 24 visits per calendar year, maximum applies to combined in and out-of-network benefits). | Physical/Occupational Therapy and Chiropractic: 50% after deductible (Aetna will pay up to $25 per visit max, 24 visits per calendar year, maximum applies to combined in and out-of-network benefits). |
| Skilled Nursing | 80% after deductible (in lieu of hospital), 30 days per calendar year, maximum applies to combined in and out-of-network benefits. | 50% after deductible (in lieu of hospital), 30 days per calendar year, maximum applies to combined in and out-of-network benefits. |
| Home Health Care | 80% (in lieu of hospital) 30 visits per calendar year, maximum applies to combined in and out-of-network benefits. | 50% (in lieu of hospital) 30 visits per calendar year, maximum applies to combined in and out-of-network benefits. |
| Mental Health | Not covered except for severe, biologically based mental or nervous disorders and associated treatment of drug and alcohol dependencies | Not covered except for severe, biologically based mental or nervous disorders and associated treatment of drug and alcohol dependencies |
| Hospital Care | Hospital Admission: 80% after deductible, Outpatient Surgery: 80% after deductible | Hospital Admission: 50% after deductible, Outpatient Surgery: 50% after deductible |
| Optional Benefits | Individual Dental PPO Max Plan | Individual Dental PPO Max Plan |