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Aetna – Preventative and Hospital Care 3000 (HSA Compatible) – WEST VIRGINIA
A comparison of the Preventative and Hospital Care 3000 (HSA Compatible) offered by Aetna is detailed out below for both Network and Non-Network coverage.
| Network | Non-Network | |
|---|---|---|
|
||
| Network | See Provider | See Provider |
| Application | Preventative and Hospital Care 3000 (HSA Compatible) Application | Preventative and Hospital Care 3000 (HSA Compatible) Application |
| Brochure | Preventative and Hospital Care 3000 (HSA Compatible) Brochure | Preventative and Hospital Care 3000 (HSA Compatible) Brochure |
| Copay | Not Covered | Not Covered |
| Office Visit | Not Covered | Not Covered |
| Deductible | Individual: $3,000, Family: $6,000 | Individual: $6,000, Family: $12,000 |
| Coinsurance | 80% after deductible up to out of pocket max. $0 once out of pocket max is satisfied. | 50% after deductible up to out of pocket max. $0 once out of pocket max is satisfied. |
| Coinsurance Limit | Individual: $2,000, Family: $4,000 | Individual: $4,000, Family: $8,000 |
| Out-of-Pocket Maximum | (Deductible included) Individual: $5,000, Family: $10,000 | (Deductible included) Individual: $10,000, Family: $20,000 |
| Lifetime Maximum | $1,000,000 (Maximum applies to combined in and out of network benefits) | $1,000,000 (Maximum applies to combined in and out of network benefits) |
| Prescription Drugs | Pharmacy Deductible per Individual- Not Applicable. Generic (Oral Contraceptives included)- Not covered (Aetna Discount Available). Preferred Brand Name (Oral Contraceptives Included)- Not covered (Aetna Discount Available). Non-Preferred Brand (Oral Contraceptives included)- Not covered (Aetna Discount Available). Calendar Year Maximum per Individual (Maximum applies to combined in and out of network benefits)- Not Applicable. | Pharmacy Deductible per Individual- Not Applicable. Generic (Oral Contraceptives included)- Not covered. Preferred Brand Name (Oral Contraceptives Included)- Not covered. Non-Preferred Brand (Oral Contraceptives included)- Not covered. Calendar Year Maximum per Individual (Maximum applies to combined in and out of network benefits)- Not Applicable. |
| Emergency Room | $100 Copay (waived if admitted) 80% after deductible | $100 Copay (waived if admitted) 80% after deductible |
| Adult Preventative Care | Annual Routine Gyn Exam (Annual Pap/Mammogram): $0 copay deductible waived. Preventive Health (Routine Physical)(Aetna will pay up to $200 per exam): $35 copay deductible waived. | 50% after deductible (Age and frequency schedule apply). |
| Child Preventative Care | $35 copay (Age and frequency schedule apply). | 50% after deductible (Age and frequency schedule apply). |
| Lab / X-Ray | Not Covered | Not Covered |
| Maternity | Not Covered | Not Covered |
| Physical Therapy | Not Covered | Not Covered |
| 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% after deductible, 30 visits per person per calendar year. Maximum applies to combined in and out of network benefits. | 50% after deductible, 30 visits per person 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 | ||