Aetna $1,000 POS Plan
Aetna $1,000 POS Plan
Although services are covered both in-network and out-of-network, your benefits are greater when you choose in-network providers. Benefit Tip: This plan features the lowest annual deductible of the four plan options in exchange for higher per-paycheck premiums.
| $1,000 POS Plan |
||
|---|---|---|
| IN-NETWORK | OUT-OF-NETWORK | |
| CALENDAR YEAR DEDUCTIBLE | ||
| Individual | $1,000 | $2,000 |
| Family | $2,000 | $4,000 |
| CALENDAR YEAR OUT OF POCKET MAXIMUM (INCLUDES DEDUCIBLE) | ||
| Individual | $3,000 | $5,000 |
| Family | $6,000 | $10,000 |
| COINSURANCE | YOU PAY | YOU PAY |
| Preventive Care | $0 | 40%* |
| Virtual Visits | $25 copay | Not Covered |
| Primary Care Physician | $25 copay | 40%* |
| Specialist | $60 copay | 40%* |
| Urgent Care | $50 copay | 40%* |
| Emergency Room | $400 copay + 20% | $400 copay + 20% |
| PHARMACY | ||
| RETAIL RX (UP TO 30-DAY SUPPLY) | ||
| Generic | $10 copay | $10 copay |
| Preferred | $30 copay | $30 copay |
| Non-Preferred | $50 copay | $50 copay |
| Specialty | 50% up to $150 maximum | 50% up to $150 maximum |
| MAIL ORDER RX (UP TO 90-DAY SUPPLY) | ||
| Generic | $20 copay | $20 copay |
| Preferred | $60 copay | $60 copay |
| Non-Preferred | $100 copay | $100 copay |
| Specialty | 50% up to $250 maximum | 50% up to $250 maximum |