Aetna of Colorado Managed Choice Open Access High Deductible 3000 (HSA Compatible) Plan Information

MEMBER BENEFITS

Deductible : Individual $3,000 Family $6,000
Coinsurance (Member’s responsibility) : 0% after deductible up to out-of-pocket max $0 once out-of-pocket max. is satisfied
Coinsurance Maximum: Individual $0 Family $0
Out-of-Pocket Maximum: Individual $3,000 Family $6,000
Lifetime Maximum $5,000,000
Non-Specialist Office Visit (Unlimited visits): 0% after deductible
Specialist Visit (Unlimited visits): 0% after deductible
Hospital Admission: 0% after deductible
Outpatient Surgery: 0% after deductible
Urgent Care Facility: 0% after deductible
Emergency Room: $0 copay
Annual Routine Gyn Exam: $0 copaydeductible waived
Maternity: Not covered (Except for pregnancy complications)
Preventive Health — Routine Physical: $20 copay deductible waived
Lab/X-Ray: 0% after deductible
Skilled Nursing : 0% after deductible
Physical/Occupational Therapy and Chiropractic Care: Aetna will pay up to $25 per visit max 0% after deductible
Home Health Care: 0% after deductible
Durable Medical Equipment: 0% after deductible


PHARMACY

Pharmacy Deductible: Integrated Medical/Rx Deductible
Generic (Oral Contraceptives Included): 0% after Medical/Rx deductible
Preferred Brand (Oral Contraceptives Included): 0% after Medical/Rx deductible
Non-Preferred Brand (Oral Contraceptives Included): 0% after Medical/Rxdeductible
Calendar Year Maximum: Unlimited

Other Aetna of Colorado health insurance plans:

YES NO


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