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.
(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 CareCopay/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.