Bronze 1 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay – PPO
Network type: PPO
Coverage tier: Expanded Bronze
Primary care visit: $55 copay
Specialist visit: $125 copay
Urgent care visit: $60 copay
Description
Health Care Plan Details
| Network type | PPO |
| Deductible | $8,995 per person $8,995 per person |
| Out-of-pocket max | $9,395 per person $18,790 per family |
| Metal tier | Expanded Bronze |
Visit Copay
| Primary care visit | $55 copay |
| Specialist visit | $125 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $60 copay |
| Emergency room | 50% coinsurance after deductible |
| Ambulance | 50% coinsurance after deductible |
| Hospital stay (facility) | 50% coinsurance after deductible |
| Hospital stay (physician) | 50% coinsurance after deductible |
| Outpatient procedure (facility) | 50% coinsurance after deductible |
| Outpatient procedure (physician) | 50% coinsurance after deductible |
| Physical rehabilitation | 50% coinsurance after deductible |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 50% coinsurance after deductible |
Pharmacy, Drugs, and Medication
| Generic | $40 copay |
| Brand | $70 copay |
| Non-preferred Brand | $95 copay |
| Specialty | $500 copay |
Lab Tests and Diagnostic Procedures
| X-rays | 50% coinsurance after deductible |
| Imaging (CT/PET/MRI) | 50% coinsurance after deductible |
| Blood work | 50% coinsurance after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $55 copay |
| Psychiatric hospital stay | 50% coinsurance after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://www.aetnacvshealth.com/documents/2024-IFP-769377_72547IL0170001-01_SBC.pdf |
| Drug and medication plan formulary | http://aet.na/ilivl24 |
| Search doctor list | https://www.aetna.com/dsepublic/#/contentPage?page=providerSearchLanding&site_id=aetnaivlexchange |
