Innovation Health – Aetna Silver 5: HMO – HMO

Network type: HMO
Coverage tier: Silver
Primary care visit: $50 copay
Specialist visit: $80 copay
Urgent care visit: $50 copay

Description

Health Care Plan Details

Network type HMO
Deductible $8,395 per person $8,395 per person
Out-of-pocket max $8,885 per person $17,770 per family
Metal tier Silver

Visit Copay

Primary care visit $50 copay
Specialist visit $80 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $50 copay
Emergency room 50% after deductible
Ambulance 50% after deductible
Hospital stay (facility) 50% after deductible
Hospital stay (physician) 50% after deductible
Outpatient procedure (facility) 50% after deductible
Outpatient procedure (physician) 50% after deductible
Physical rehabilitation $45 copay

Maternitowny and Pregnancy

Labor, delivery, hospital stay 50% after deductible

Pharmacy, Drugs, and Medication

Generic $25 per script copay
Brand 40% coinsurance
Non-preferred Brand 45% after deductible
Specialty 50% after deductible

Lab Tests and Diagnostic Procedures

X-rays $30 copay after deductible
Imaging (CT/PET/MRI) 50% after deductible
Blood work $25 copay

Mental and Psychiatric Health Care

Mental Health outpatient services $50 copay
Psychiatric hospital stay 50% after deductible

Health Plan Provider Information

Health Plan Benefits https://d2ed110nmrd591.cloudfront.net/blobs/ytwm6XcACwB7eGU1c7VBJLPj.pdf
Drug and medication plan formulary https://client.formularynavigator.com/Search.aspx?siteCode=6179884039