Gold 1: Aetna Whole Health network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 – EPO
Network type: EPO
Coverage tier: Gold
Primary care visit: $10 copay
Specialist visit: $50 copay
Urgent care visit: $50 copay
Description
Health Care Plan Details
Network type | EPO |
Deductible | $1,500 per person $1,500 per person |
Out-of-pocket max | $7,250 per person $14,500 per family |
Metal tier | Gold |
Visit Copay
Primary care visit | $10 copay |
Specialist visit | $50 copay |
Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
Urgent care | $50 copay |
Emergency room | $100 plus 20% after deductible copay, $100 plus 20% after deductible |
Ambulance | 20% after deductible |
Hospital stay (facility) | 20% after deductible |
Hospital stay (physician) | 20% after deductible |
Outpatient procedure (facility) | 20% after deductible |
Outpatient procedure (physician) | 20% after deductible |
Physical rehabilitation | 20% after deductible |
Maternitowny and Pregnancy
Labor, delivery, hospital stay | 20% after deductible |
Pharmacy, Drugs, and Medication
Generic | $10 copay |
Brand | $50 copay |
Non-preferred Brand | 40% after deductible |
Specialty | 40% after deductible |
Lab Tests and Diagnostic Procedures
X-rays | $50 copay |
Imaging (CT/PET/MRI) | 20% after deductible |
Blood work | $25 copay |
Mental and Psychiatric Health Care
Mental Health outpatient services | $10 copay |
Psychiatric hospital stay | 20% after deductible |