Insure With Carriers

Category3
Aetna Open Access MC 1750 In-Network Out-Of-Network Annual Deductible Individual: $1,750 Family: $3,500 Individual: $5,000 Family: $10,000 Out of Pocket Maximum Individual: $12,500 Family: $25,000 Individual: $12,500 Family: $25,000 Lifetime Maximum Not Applicable Not Applicable Doctors' Office Visits Non-Specialist: $40 (Deductible Waived) Specialist: $50 (Deductible Waived) 50% after Deductible Rx Copay/Coinsurance Generic: $15 (Deductible Waived), Preferred Brand: $35 after Deductible, Non-Preferred Brand: $60 after Deductible ($750 Brand Deductible) 50% plus (Generic: $15 Deductible Waived, Preferred Brand: $35 after Deductible Non-Preferred Brand: $60 after Deductible) $750 Brand Deductible X-ray and laboratory 30% after Deductible (Non-Preventive) 50% after Deductible (Non-Preventive) Annual Physical Exam No Charge 50% after Deductible Annual Routine Gyn Exam No Charge 50% after Deductible Well Baby Care No Charge (Age and frequency limits apply) No Charge for Immunizations up to the age of 18 50% after Deductible (Age and frequency limits apply) No Charge for Immunizations up to the age of 18 Outpatient Surgery 40% after Deductible 50% after Deductible Emergency Room Services $350 (waived if admitted) $350 (waived if admitted) Ambulance Services 30% after Deductible 30% after Deductible Home Health Care 30% after Deductible (30 visits/calendar year; In and Out-of-Network combined) 50% after Deductible (30 visits/calendar year; In and Out-of-Network combined) Mental Health - Outpatient Inpatient and Outpatient: coverage is only provided for severe mental or nervous disorders. Deductible and co-insurance/copay apply. Inpatient and Outpatient: coverage is only provided for severe mental or nervous disorders. Deductible and co-insurance/copay apply. Mental Health - Inpatient Inpatient and Outpatient: coverage is only provided for severe mental or nervous disorders. Deductible and co-insurance/copay apply. Inpatient and Outpatient: coverage is only provided for severe mental or nervous disorders. Deductible and co-insurance/copay apply. Chiropractic care 30% after Deductible (24 visit max; $25/visit max) 50% after Deductible (24 visit max; $25/visit max) Acupuncture See Brochure See Brochure Inpatient Hospital 40% after Deductible 50% after Deductible Maternity Not Covered (except for pregnancy complications) Not Covered (except for pregnancy complications) Chemical Dependency Services Inpatient and Outpatient: coverage is only provided for treatment of drug and alcohol dependencies associated with severe, biologically based mental or nervous disorders. Deductible and co-insurance/copay apply. Inpatient and Outpatient: coverage is only provided for treatment of drug and alcohol dependencies associated with severe, biologically based mental or nervous disorders. Deductible and co-insurance/copay apply. Additional Plan Information