Aetna PPO 5000 with Dental – South Carolina Health Insurance Plan
A detailed comparison of the Aetna PPO 5000 with Dental health insurance plan as offered in South 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 South 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): $40 copay, deductible waived (Unlimited visits); Specialist Visit: $50 copay, deductible waived (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): $40 copay, deductible waived (Unlimited visits); Specialist Visit: $50 copay, deductible waived (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: $5,000, Family: $10,000 | 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: $5,000, Family: $10,000 | Individual: $2,500, Family: $5,000 |
| Out-of-Pocket Maximum | N/A | N/A |
| Lifetime Maximum | Unlimited | Unlimited |
| Prescription Drugs | Pharmacy Deductible (per individual): $500 (Does not apply to generic); Generic (Oral Contraceptives Included): $15 copay, deductible waived; Preferred Brand (Oral Contraceptives Included): $35 copay after deductible; Non-Preferred Brand (Oral Contracepti | Pharmacy Deductible (per individual): $500 (Does not apply to generic); Generic (Oral Contraceptives Included): $15 copay plus 50%, deductible waived; Preferred Brand (Oral Contraceptives Included): $35 copay plus 50% after deductible; Non-Preferred Brand |
| Emergency Room | $100 copay (waived if admitted), 20% coinsurance after deductible | $100 copay (waived if admitted), 20% coinsurance after deductible |
| Adult Preventative Care | Annual Routine Gyn Exam (No waiting period, no calendar year max., 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, no calendar year max., 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 benefits): 20% after deductible | Physical/Occupational Therapy (24 visits per calendar year, maximum applies to combined in and out-of-network benefits): 50% after deductible |
| Home Health Care | 20% after deductible (in lieu of hospital, 30 visits per calendar year, maximum applies to combined in and out-of-network benefits) | 50% after deductible (in lieu of hospital, 30 visits per calendar year, maximum applies to combined in and out-of-network benefits) |
| Mental Health | Inpatient and Outpatient: Coverage is only provided for severe, biologically based mental or nervous disorders (Deductible and coinsurance/copay apply) | Inpatient and Outpatient: Coverage is only provided for severe, biologically based mental or nervous disorders (Deductible and coinsurance/copay apply) |
| 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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