Silver 1: Aetna Whole Health network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 – EPO

Network type: EPO
Coverage tier: Silver
Primary care visit: $50 copay
Specialist visit: $75 copay
Urgent care visit: $75 copay

SKU: 89217NJ0130004 Category:

Description

Health Care Plan Details

Network type EPO
Deductible $2,350 per person $2,350 per person
Out-of-pocket max $8,850 per person $17,700 per family
Metal tier Silver

Visit Copay

Primary care visit $50 copay
Specialist visit $75 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $75 copay
Emergency room $100 plus 40% after deductible copay, $100 plus 40% after deductible
Ambulance 40% after deductible
Hospital stay (facility) 40% after deductible
Hospital stay (physician) 40% after deductible
Outpatient procedure (facility) 40% after deductible
Outpatient procedure (physician) 40% after deductible
Physical rehabilitation 40% after deductible

Maternitowny and Pregnancy

Labor, delivery, hospital stay 40% after deductible

Pharmacy, Drugs, and Medication

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

Lab Tests and Diagnostic Procedures

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

Mental and Psychiatric Health Care

Mental Health outpatient services $50 copay
Psychiatric hospital stay 40% after deductible

Health Plan Provider Information