Aetna Preventative and Hospitalization Health Insurance Plan

Plan Type: PPO

Physicians
Office Visit for Primary Doctor: Not Covered
Office Visit for Specialist: Not Covered
Coinsurance: 20% after deductible

Prescription Drugs
Generic: Aetna Discount Available
Brand: Aetna Discount Available
Non-Formulary: Aetna Discount Available
Separate Prescription Drugs Deductible: Not Applicable

Health Savings Account (HSA) Eligible: Yes
Out-of-Network Coverage: Yes
Out of Country Coverage: Yes. Paid as out-of-network benefits

Preventive Care Coverage
Periodic Health Exam: $35 Copay
Periodic OB-GYN Exam: No charge
Well Baby Care: $35 Copay

Hospital Services Coverage
Emergency Room: $100 Copay plus 20% Coinsurance after deductible
Outpatient Lab/X-Ray: Not Covered
Outpatient Surgery: 20% Coinsurance after deductible
Hospitalization: 20% Coinsurance after deductible

Maternity Coverage: Pre & Postnatal Office Visit
Not covered (except for pregnancy complications)
Labor & Delivery Hospital Stay: Not covered (except for pregnancy complications)

Additional Coverage
Chiropractic Coverage: Not Covered
Mental Health Coverage: Not Covered