Meritain Medical
Standard EPO
Base HDHP
Enhanced POS
Preventive
100% Covered
100% Covered
100% Covered
Primary & Specialist Visit
After Deductible: 10%
$25 / $40
$25 / $40
Deductible (Plan Year)
$2,850 / $5,700
$1,000 / $2,000
$1,000 / $2,000
Deductible Assistance (HRA)
$1,500 / $3,000
None
None
Coinsurance
10%
20%
10%
Inpatient & Outpatient Hospital
After Deductible: 10% After Deductible: 20% After Deductible: 10%
Emergency Room
$200 Copay
$200 Copay
$200 Copay
Rx
Ded. then $15 / $35 / $75
$100 then $15 / $35 / $75 $100 then $15 / $35 / $75
Gross Max Out of Pocket
$4,000 / $8,000
$5,000 / $10,000
$3,000 / $6,000
Net Max Out of Pocket
$2,500 /$5,000
$5,000 / $10,000
$3,000 / $6,000
Deductible
$2,000 / $4,000
No out of network coverage
Coinsurance
30%
Max Out of Pocket
$6,000 / $12,000
80 th
Reimbursements*
* Paid according to reasonable percentile. Excess charges are the patient’s responsibility
The best way to verify whether your doctor, lab or hospital participates in the Aetna Choice POS II network is to call the provider and ask. You can also search online at www.aetna.com/docfind/custom/mymeritain/ or call customer service at 1.800.925.2272 .
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