Medical
Quick Reference
Website
Call Aetna customer service: 888-267-2637 or 800-225-1263
Find a provider (choose the Aetna Choice POS II Plan)
Machine-readable files for in-network rates and out-of-network allowable charges
Minute Clinic Overview and Services Brochure
Highlights
- No primary care provider (PCP) is required, although it’s recommended.
- You can choose an Aetna network or non-network provider.
- Your costs are generally lower when you use an Aetna network provider.
- The plan covers massage therapy—visit the Forms page for a claim form.
| In-Network | Out-of-Network | |
|---|---|---|
| Annual Deductible (Individual/Family) |
None | $200/$400 |
| Annual Out-of-Pocket Maximum—Medical and Prescription Drugs (Individual/Family) |
$2,000/$4,000 | $4,000/$8,000 |
| Preventive Care Visit | No charge | Deductible, then 20% |
| Office Visit (in person) | $25 copay | Deductible, then 20% |
| Office Visit (via telemedicine/Teledoc, by video or phone) | $25 copay | Deductible, then 20% |
| X-ray and Other Imaging | $25 copay | Deductible, then 20% |
| Hospital Admission | $250 copay | Deductible, then 20% |
| Emergency (ER) (copay waived if admitted) |
$235 copay | Medical emergency: $235 copay
All other services at an emergency room: deductible, then 20% |
| Urgent Care | $40 copay | Medical emergency: $35 copay
All other services at an urgent care facility: deductible, then 20% |
Details
Summary of Benefits and Coverage (SBC)
Schedule of Benefits January, 2023
Schedule of Benefits January 2023 – Spanish