BannerAetna Silver 2: No PCP required + Unlimited $0 MinuteClinic + free 98point6 virtual care 24/7 – HMO

Description

Health Care Plan Details

Network type	HMO
Deductible	$5,000 per person $5,000 per person
Out-of-pocket max	$8,000 per person $16,000 per family
Metal tier	Silver

Visit Copay

Primary care visit	$35 copay
Specialist visit	$50 copay
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$50 copay
Emergency room	40% coinsurance after deductible
Ambulance	40% coinsurance after deductible
Hospital stay (facility)	40% coinsurance after deductible
Hospital stay (physician)	40% coinsurance after deductible
Outpatient procedure (facility)	40% coinsurance after deductible
Outpatient procedure (physician)	40% coinsurance after deductible
Physical rehabilitation	40% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	40% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$25 copay
Brand	$55 copay
Non-preferred Brand	40% coinsurance after deductible
Specialty	50% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	40% coinsurance after deductible
Imaging (CT/PET/MRI)	40% coinsurance after deductible
Blood work	40% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	$35 copay
Psychiatric hospital stay	40% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://www.banneraetna.com/en/documents/2024-IFP-769287_23435AZ0040009-01_SBC.pdf
Drug and medication plan formulary	http://aet.na/azbhaivl24
Search doctor list	https://www.myplanportal.com/dsepublic/#/contentPage?page=providerSearchLanding&site_id=banneraetnaivlexchange