Aetna Basic and
Basic Plus Plans
The Aetna Basic Plans require the lowest per-paycheck contribution of all of the Allied Universal® medical plans. However, these plans pay you or your provider certain amounts only for specific covered services, as shown below. These plans are not comprehensive medical benefits plans. Please keep in mind that these plans do not pay the full cost of medical care. You are responsible for ensuring your doctor is paid.
How it works
- You may use any provider, but your out-of-pocket expenses may be lower when you use Aetna providers. Because Aetna providers agree to contracted rates for Aetna plan members, your out-of-pocket expenses may be lower than when you use non-network providers.
- No claims to file, if you use Aetna providers. The plan pays you up to certain amounts for basic covered services, such as doctor’s office visits, urgent care visits, and prescription drugs. If you use an Aetna provider, you don’t have to file claims to be paid for covered services. The payment will go directly to the provider. If you use out-of-network providers, you must file a claim to be paid for covered services.
- Benefits are very limited with this plan, so please review all covered services and exclusions found in the plan summary.
Important note for California and Massachusetts residents: The Aetna Basic Plans do not meet the California and Massachusetts state requirements for residents to have Creditable Coverage for health care. If you live in California or Massachusetts, you may want to choose a different coverage option in order to avoid the California and Massachusetts penalty for not having Creditable Coverage.
Limited payment.
The plan pays you a certain amount only for specific health care services, as shown in the charts below. Aetna network providers charge discounted rates for their services, which means your out-of-pocket cost would be lower when you use an Aetna provider.
Contact Info
Documents
Aetna Basic Plan & Aetna Basic Plus
| Aetna Basic | Aetna Basic Plus | |
|---|---|---|
| Non-Major Medical | Non-Major Medical | |
| Annual Deductible | ||
| Individual | None | None |
| Family | None | None |
| Out of Pocket Maximum | ||
| Individual | None | None |
| Family | None | None |
| Coinsurance | None | None |
| Services | ||
| Preventive Care | Health Screening Benefits of $50 payable for 1 eligible screening per plan year | Health Screening Benefits of $50 payable for 1 eligible screening per plan year |
| Office Visit - PCP | $50 payable per day 5 Days Max | $80 payable per day 7 Days Max |
| Office Visit - Specialist | Combined with PCP Office Visit | Combined with PCP Office Visit |
| X-ray and Laboratory | Combined X-ray and Lab - $25 payable per day 3 Days Max | Combined X-ray and Lab - $110 payable per day 3 Days Max |
| Diagnostic Complex Imaging | $150 payable 1 Day Max | $150 payable per test 1 Day Max |
| Inpatient Hospitalization | Hospital Admission: $200 payable per admission; 2 stays per year Max / $400 payable per ICU admission; 2 stays per year Max Hospital Daily Rate: $200 payable per day / $400 payable per ICU day; 365 days per plan year Max, beginning on day 2 Newborn routine care: $100 payable per day; 1 day Max IP Surgery: $200 payable per day; 1 day Max | Hospital Admission: $1,500 payable per admission; 2 stays per year Max / $1,500 payable per ICU admission; 2 stays per year Max Hospital Daily Rate: $650 payable per day / $1300 payable per ICU day; 365 days per plan year Max, beginning on day 2 Newborn routine care: $400 payable per day; 1 day Max IP Surgery: $600 payable per day; 2 day Max |
| Outpatient Hospital and Ambulatory Surgical Center | $200 payable per day 1 Day Max | $600 payable per day 2 Day Max |
| Outpatient Physician Office, Urgent or Hosp ER | $25 payable per day 1 Day Max | $100 payable per day 2 Day Max |
| Urgent Care | Combined with PCP Office Visit $50 payable per day 5 Days Max | Combined with PCP Office Visit $80 payable per day 7 Days Max |
| Emergency Room | $100 payable per day 2 Days Max | $350 payable per day 2 Days Max |
| Ambulance | Ground: $100 payable per day, 1 day max Air: $500 payable per day, 1 day max | Ground: $100 payable per day, 1 day max Air: $500 payable per day, 1 day max |
| Physical Therapy | Not covered | Not covered |
| Chiropractic | Combined with PCP Office Visit | Combined with PCP Office Visit |
| Pharmacy - Retail | ||
| Generic | $20 payable per day 12 Prescriptions Max (Member submitted) | $30 payable per day 18 Prescriptions Max (Member submitted) |
| Preferred | ||
| Non-Preferred | ||
| Pharmacy - Mail Order | ||
| Generic | Not covered | Not covered |
| Preferred | ||
| Non-Preferred | ||
| Specialty Drugs | ||
| See Retail Pharmacy Benefit | See Retail Pharmacy Benefit | |