Aetna EPO Zero Copay Plan – Open Access Select
SUMMARY OF COVERAGE
Plan Features
Base EPO Plan
IN NETWORK
OUT OF NETWORK
Deductibles (Indiv / Family)
None
Out-of-Pocket Max (Indiv/ Family) Plan Cost Sharing
Individuals: $5,000 Families: $10,000
Covered 100%
Primary Care Visit
Covered 100%
Preventive Care
Covered 100%
N/A
Labs/Diagnostic & Imaging Services
Covered 100%
Outpatient Procedure
Covered 100%
Emergency Room
Covered 100%*
Urgent Care
Covered 100%*
Inpatient Visit
Covered 100%
*Non Urgent Use of Urgent Care Provider & Non Emergency Care in an Emergency Room/Ambulance are not covered
Your medical plan includes certain services that are not routinely covered. Please speak to HR for more info.
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MEDICAL PLAN I
Callen Lorde BENEFITS GUIDE
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