Aetna POS Plan – Choice POS II
SUMMARY OF COVERAGE
Plan Features
Buy Up POS Plan
IN NETWORK
OUT OF NETWORK Individuals: $500 Families: $1,000 Individuals: $1,250 Families: $2,500 20% coinsurance
Deductibles (Indiv / Family)
None
Out-of-Pocket Max (Indiv/ Family) Plan Cost Sharing
Individuals: $1,250 Families: $2,500
Covered 100%
Primary Care Visit
$25 copay per Primary Care visit
20% coinsurance
Specialist Care Visit
$40 copay per Specialist visit
20% coinsurance
Preventive Care Labs/Diagnostic & Imaging Services Outpatient Procedure
Covered 100%
20% coinsurance
Covered 100%
20% coinsurance
Covered 100%
20% coinsurance
$100 copay per visit; Copay waived if admitted
$100 copay per visit; Copay waived if admitted
Emergency Room
Urgent Care
$40 copay per visit;
20% coinsurance
Inpatient Visit
Covered 100%
20% coinsurance
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MEDICAL PLAN I
Callen Lorde BENEFITS GUIDE
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