Silver 6: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 – HMO

87% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $25 copay
Specialist visit: $45 copay
Urgent care visit: $20 copay

SKU: 38927UT038000805 Category:

Description

This plan has 87% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type HMO
Deductible $0 per person $0 per person
Out-of-pocket max $3,045 per person $6,090 per family
Metal tier Silver

Visit Copay

Primary care visit $25 copay
Specialist visit $45 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $20 copay
Emergency room 50% coinsurance
Ambulance 50% coinsurance
Hospital stay (facility) 35% coinsurance
Hospital stay (physician) 35% coinsurance
Outpatient procedure (facility) 35% coinsurance
Outpatient procedure (physician) 35% coinsurance
Physical rehabilitation $30 copay

Maternitowny and Pregnancy

Well baby care No charge
Labor, delivery, hospital stay 35% coinsurance

Pharmacy, Drugs, and Medication

Generic $15 copay
Brand $30 copay
Non-preferred Brand 40% coinsurance
Specialty 50% coinsurance

Lab Tests and Diagnostic Procedures

X-rays $40 copay
Imaging (CT/PET/MRI) 35% coinsurance
Blood work $35 copay

Mental and Psychiatric Health Care

Mental Health outpatient services $25 copay
Psychiatric hospital stay 35% coinsurance

Health Plan Provider Information

Health Plan Benefits https://www.aetnacvshealth.com/documents/2024-IFP-769462_38927UT0380008-05_SBC.pdf
Drug and medication plan formulary http://aet.na/utivl24
Search doctor list https://www.aetna.com/dsepublic/#/contentPage?page=providerSearchLanding&site_id=aetnaivlexchange