Aetna Managed Choice Open Access 7500 with Unlimited Primary Care Visits plus Dental – North Carolina Health Insurance Plan
A detailed comparison of the Aetna Managed Choice Open Access 7500 with Unlimited Primary Care Visits plus Dental health insurance plan as offered in North Carolina is listed below for both Network and Non-Network coverage. This is a review of the coverage for this specific Aetna plan. However, GoHealthInsurance offers a large variety of health insurance options to fit your needs. If you wish, get a new Aetna health insurance quote for North Carolina now or view all of our Aetna health insurance quotes.
| Network | Non-Network | |
|---|---|---|
| Copay | Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $30 copay, deductible waived (Unlimited visits), Specialist Visit: 20% after deductible (Unlimited visits) | Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits), Specialist Visit: 50% after deductible (Unlimited visits) |
| OfficeVisit | Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $30 copay, deductible waived (Unlimited visits), Specialist Visit: 20% after deductible (Unlimited visits) | Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits), Specialist Visit: 50% after deductible (Unlimited visits) |
| Deductible true | Individual: $7,500, Family: $15,000 | Individual: $10,000, Family: $20,000 |
| Coinsurance | 20% 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: $2,500, Family: $5,000 | Individual: $2,500, Family: $5,000 |
| Out-of-Pocket Maximum | N/A | N/A |
| Lifetime Maximum | Unlimited | Unlimited |
| Prescription Drugs | Pharmacy Deductible (per individual): Not Applicable (Does not apply to generic); Generic (Oral Contraceptives Included): $15 copay, deductible waived; Preferred Brand (Oral Contraceptives Included): Not covered; Non-Preferred Brand (Oral Contraceptives I | Pharmacy Deductible (per individual): Not Applicable (Does not apply to generic); Generic (Oral Contraceptives Included): $15 copay plus 50%, deductible waived; Preferred Brand (Oral Contraceptives Included): Not covered; Non-Preferred Brand (Oral Contrac |
| Emergency Room | $350 copay (waived if admitted) | $350 copay (waived if admitted) |
| Adult Preventative Care | Annual Routine Gyn Exam (No waiting period, Annual Pap/Mammogram): $0 copay, deductible waived; Preventive Health - Routine Physical (No waiting period): $0 copay, deductible waived (Includes lab work and X-rays) | Annual Routine Gyn Exam (No waiting period, Annual Pap/Mammogram): 50% after deductible; Preventive Health - Routine Physical (No waiting period): 50% after deductible (Includes lab work and X-rays) |
| Child Preventative Care | $0 copay (Age and frequency schedule apply); No charge for immunizations up to the age of 18 | 50% after deductible (Age and frequency schedule apply); No charge for immunizations up to the age of 18 |
| Lab / X-Ray | 20% after deductible (Non-Preventive) | 50% after deductible (Non-Preventive) |
| Maternity | Not covered (Except for pregnancy complications) | Not covered (Except for pregnancy complications) |
| Physical Therapy | Physical/Occupational Therapy (24 visits per calendar year, Maximum applies to combined in and out-of-network): 20% after deductible | Physical/Occupational Therapy (24 visits per calendar year, Maximum applies to combined in and out-of-network): 50% after deductible |
| Home Health Care | 20% after deductible (instead of hospital, 30 visits per calendar year, Maximum applies to combined in and out-of-network benefits) | 50% after deductible (instead of hospital, 30 visits per calendar year, Maximum applies to combined in and out-of-network benefits) |
| Mental Health | Not covered | Not covered |
| Hospital Care | Hospital Admission: 20% after deductible; Outpatient Surgery: 20% after deductible; Urgent Care Facility: $50 copay, deductible waived | Hospital Admission: 50% after deductible; Outpatient Surgery: 50% after deductible; Urgent Care Facility: 50% after deductible |
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