Silver 6: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 – HMO

94% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $5 copay
Specialist visit: $15 copay
Urgent care visit: $5 copay

SKU: 38927UT038000806 Category:

Description

This plan has 94% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type HMO
Deductible $0 per person $0 per person
Out-of-pocket max $925 per person $1,850 per family
Metal tier Silver

Visit Copay

Primary care visit $5 copay
Specialist visit $15 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $5 copay
Emergency room 50% coinsurance
Ambulance 50% coinsurance
Hospital stay (facility) 25% coinsurance
Hospital stay (physician) 25% coinsurance
Outpatient procedure (facility) 25% coinsurance
Outpatient procedure (physician) 25% coinsurance
Physical rehabilitation $15 copay

Maternitowny and Pregnancy

Well baby care No charge
Labor, delivery, hospital stay 25% coinsurance

Pharmacy, Drugs, and Medication

Generic $10 copay
Brand $20 copay
Non-preferred Brand 40% coinsurance
Specialty 50% coinsurance

Lab Tests and Diagnostic Procedures

X-rays $25 copay
Imaging (CT/PET/MRI) 25% coinsurance
Blood work $15 copay

Mental and Psychiatric Health Care

Mental Health outpatient services $5 copay
Psychiatric hospital stay 25% coinsurance

Health Plan Provider Information

Health Plan Benefits https://www.aetnacvshealth.com/documents/2024-IFP-769463_38927UT0380008-06_SBC.pdf
Drug and medication plan formulary http://aet.na/utivl24
Search doctor list https://www.aetna.com/dsepublic/#/contentPage?page=providerSearchLanding&site_id=aetnaivlexchange