Aetna emergency room copay choice pos ii

Q: What is the difference between copay and deductible?

Whats the Difference Between a Deductible and a Copay? A deductible is the set amount of money you pay out of pocket for covered services per plan year before your insurance plan starts to pay. A copay is also a set amount of money, but its the fixed fee attached to certain covered services.

Q: What does after deductible mean?

Some services may be covered at a certain percentage after deductible,” which means you will pay for the cost of that service until you have reached your deductible amount for the plan year.

Our Aetna Choice POS II plan is our most traditional health plan, geared toward those who have fairly regular ongoing medical care or prescription drug needs.

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SUMMARY OF PLAN AND COVERAGE
What is a POS 2?
What is out
What is the difference between copay and deductible?
What does after deductible mean?

HIGHLIGHTS OF OUR PLANNetworkAetna Choice POS IIThis is the network you would ask your doctor if she or he accept to make sure they are “in-network”Can you use out of network doctors?YesBut out of network services will cost moreTax Advantaged AccountN/AN/AIn-Network Deductible$600 / $1,200
(Individual / Family)In the POS any member of a family only has the “individual” deductible to get through. The family deductible is the maximum amount in deductibles a family will pay across all members.Out-of-Network Deductible$1,200 / $2,400
(Individual / Family)In the POS any member of a family only has the “individual” deductible to get through. The family deductible is the maximum amount in deductibles a family will pay across all members.Copay for In-Network Office Visits$35 Primary Care Physician
$50 SpecialistIn-Network Coinsurance – Amount you pay20%This amount is capped at the plan’s Out of Pocket MaximumOut-of-Network Coinsurance – Amount you pay40% of reasonable and customaryReasonable and Customary is the prevailing charge for a service in a geographic area.In-Network Out of Pocket Maximum$4,000 / $8,000
(Individual / Family)Does not include Prescription Drug benefits.Out-of-Network Out of Pocket Maximum$8,000 / $16,000
(Individual / Family)Does not include any amounts in excess of the reasonable and customary limitCopay for Emergency Room$300 + 20% of remaining costsAll Emergency Rooms are considered in network for true emergenciesGeneric Prescription Drugs$10 for a 30 day supply
$20 for a 90 days mail order supplyMail order drugs come direct from Caremark.Formulary Brand Prescription Drugs30% ($30 minimum / $75 maximum) for a 30 day supply
30% ($60 minimum / $150 maximum) for a 90 days mail order supplyFormulary Drugs are discounted Brand Drugs. To find the Caremark formulary list – log on to www.caremark.comNon-Formulary Brand Prescription Drugs50% ($50 minimum / $100 maximum) for a 30 day supply
50% ($100 minimum / $200 maximum) for a 90 days mail order supplyThese are fully patented brand drugs with no discount.Prescription Drug Out of Pocket Maximum$3,000 Individual / $6,000 FamilyThis is in addition to the Medical Out of Pocket Maximum above

The key attributes of this plan are:

You pay a higher per-paycheck deduction for the benefit of lower out of pocket costs per service.
Fixed copays for in-network services ($35 primary care, and $50 for specialists).
For lab, x-ray, or any procedure you would pay the first $600 in costs and then 20% for any amounts above that.
The most any one person in the plan would pay out of your pocket for in-network services in this plan is $4,000 after which the plan would pick up 100% of the costs.

In a point-of-service (POS) plan, you do not have to select a primary care physician or obtain a referral to see a specialist, although there are advantages to doing so. You also have the choice of seeking care from in-network or out-of-network providers, although cost of services will vary. All in-network preventive services will be covered at 100% with no cost sharing.

SUMMARY OF PLAN AND COVERAGE

The following table shows the Aetna Choice POS II Plan details.

Plan FeaturesIn-Network ServicesOut-of-Network ServicesAnnual Deductible (individual/family)$600/$1,200$1,200/$2,400Annual Medical Out-of-Pocket Maximum (individual/family)$4,000/$8,000$8,000/$16,000Lifetime MaximumUnlimitedMEDICAL SERVICESCoinsurance80%60% after deductible (all services)Primary Care Copay$35 copay60% after deductibleSpecialty Care
Copay/Urgent Care$50 copay60% after deductiblePreventive Office Visit – Adult (per calendar year)100%60% after deductiblePreventive Office Visit – Child (per calendar year)100%60% after deductibleImmunizations100%60% after deductibleLab Work/X-Ray/Mammography (related to preventive exams)100%60% after deductibleLab Work/X-Ray (when not related to preventive exams)80% after deductible60% after deductibleRoutine OB/GYN Exam100%60% after deductibleRoutine Prenatal OB100%60% after deductible The key attributes of this plan are:Delivery and Postpartum80% after deductible60% after deductibleFemale Sterilization100%60% after deductibleRoutine Mammography Exam100%60% after deductibleHOSPITAL SERVICESInpatient Coverage (semi-private room)80% after deductible60% after deductibleOutpatient Coverage80% after deductible60% after deductibleEmergency Room – True Emergency (in- and out-of-network)80% after $300 copayEmergency Room – Non-True Emergency (in- and out-of-network) 80% after $300 copayHearing Exams (one exam every two calendar years unless otherwise noted)$50 copay60% after deductibleHearing Aids (up to $5,000 every three calendar years)80% after deductible60% after deductibleMENTAL HEALTH AND SUBSTANCE ABUSE SERVICESInpatient Coverage80% after deductible60% after deductibleOutpatient Coverage$35 copay60% after deductible

What is a POS 2?

According to the CMS, the new explanation of POS 2 now reads as: “The location where health services and health-related services are provided or received, through telecommunication technology.

What is out

The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits. The out-of-pocket limit doesn't include: Your monthly. premiums.

What is the difference between copay and deductible?

What's the Difference Between a Deductible and a Copay? A deductible is the set amount of money you pay out of pocket for covered services per plan year before your insurance plan starts to pay. A copay is also a set amount of money, but it's the fixed fee attached to certain covered services.

What does after deductible mean?

Some services may be covered at a certain percentage “after deductible,” which means you will pay for the cost of that service until you have reached your deductible amount for the plan year.