Aetna Executive
PPO Plan
You can choose any in-network or out-of-network provider each time you receive care. But keep in mind, you will generally receive higher benefits with lower out-of-pocket costs when you use in-network providers.
How the Aetna PPO works
- Copay: You pay a small amount at the time of service for in-network doctor visits and prescriptions. Copays count towards your deductible.
- Deductible: For care that doesn’t charge a copay, such as hospital services, you pay 100% of the costs until you meet the annual deductible.
- Coinsurance: After meeting the deductible, you and the plan share the cost of certain services, with the plan paying the majority.
- Out-of-Pocket Maximum: You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.
Keep in mind
You pay nothing for in-network preventive care — it’s covered in full.
Contact Info
Documents
Aetna Executive PPO
| Aetna Executive PPO | ||
|---|---|---|
| In-Network | Out-of-Network | |
| Annual Deductible | ||
| Individual | $200 | $200 |
| Family | $600 | $600 |
| Out of Pocket Maximum | ||
| Individual | $2,000 | $6,000 |
| Family | $4,000 | $12,000 |
| Coinsurance | 10% | 30% |
| Services | ||
| Preventive Care | Covered 100%; deductible waived | 30%; after deductible |
| Office Visit - PCP | $20 copay; deductible waived | 30%; after deductible |
| Office Visit - Specialist | $30 copay; deductible waived | 30%; after deductible |
| X-ray | 10%; after deductible | 30%; after deductible |
| Laboratory | 10%; after deductible | 30%; after deductible |
| Diagnostic Complex Imaging | 10%; after deductible | 30%; after deductible |
| Inpatient Hospitalization | 10%; after deductible | 30% after $250 copay; after deductible |
| Outpatient - Ambulatory Surgical Center | 10%; after deductible | 30%; after deductible |
| Outpatient - Hospital | 10%; after deductible | 30%; after deductible |
| Urgent Care | $25 copay; deductible waived | 30%; after deductible |
| Emergency Room | 10% after $100 copay; deductible waived | |
| Ambulance | 10%; after deductible | |
| Physical Therapy | $30 copay; deductible waived | 30%; after deductible |
| Chiropractic | $30 copay; deductible waived | 30%; after deductible |
| Pharmacy - Retail | ||
| Generic | $10 / $30 / $45 deductible waived | 30% coinsurance, deductible waived |
| Preferred | ||
| Non-Preferred | ||
| Pharmacy - Mail Order | ||
| Generic | $20 / $60 / $90 through Aetna Mail Order deductible waived | Not covered |
| Preferred | ||
| Non-Preferred | ||
| Specialty Drugs | ||
| 20% (max $250) deductible waived | Not covered | |