AETNA CHOICE POINT OF SERVICE (POS) II PLAN
In a point-of-service (POS) plan, you do not have to select a primary care physician or obtain a referral to see a specialist, although there are advantages to doing so. You also have the choice of seeking care from in-network or out-of-network providers, although cost of services will vary. All in-network preventive services will be covered at 100% with no cost sharing.
SUMMARY OF PLAN AND COVERAGE
The following table shows the Aetna Choice POS II Plan details.
| Plan Features |
In-Network Services |
Out-of-Network Services |
| Annual Deductible (individual/family) |
$600/$1,200 |
$1,200/$2,400 |
| Annual Medical Out-of-Pocket Maximum (individual/family) |
$4,000/$8,000 |
$8,000/$16,000 |
| Lifetime Maximum |
Unlimited |
| MEDICAL SERVICES |
| Coinsurance |
80% |
60% after deductible (all services) |
| Primary Care Copay |
$35 copay |
60% after deductible |
Specialty Care
Copay/Urgent Care |
$50 copay |
60% after deductible |
| Preventive Office Visit – Adult (per calendar year) |
100% |
60% after deductible |
| Preventive Office Visit – Child (per calendar year) |
100% |
60% after deductible |
| Immunizations |
100% |
60% after deductible |
| Lab Work/X-Ray/Mammography (related to preventive exams) |
100%
|
60% after deductible |
| Lab Work/X-Ray (when not related to preventive exams) |
80% after deductible |
60% after deductible |
| Routine OB/GYN Exam |
100% |
60% after deductible |
| Routine Prenatal OB |
100% |
60% after deductible The key attributes of this plan are: |
| Delivery and Postpartum |
80% after deductible |
60% after deductible |
| Female Sterilization |
100% |
60% after deductible |
| Routine Mammography Exam |
100% |
60% after deductible |
| HOSPITAL SERVICES |
| Inpatient Coverage (semi-private room) |
80% after deductible |
60% after deductible |
| Outpatient Coverage |
80% after deductible |
60% after deductible |
| Emergency Room – True Emergency (in- and out-of-network) |
80% after $300 copay |
| Emergency Room – Non-True Emergency (in- and out-of-network) |
80% after $300 copay |
| Hearing Exams (one exam every two calendar years unless otherwise noted) |
$50 copay |
60% after deductible |
| Hearing Aids (up to $5,000 every three calendar years) |
80% after deductible |
60% after deductible |
| MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES |
| Inpatient Coverage |
80% after deductible |
60% after deductible |
| Outpatient Coverage |
$35 copay |
60% after deductible |
To view our SBC (Summary of Benefit Coverage) for the Aetna Choice POS II plan, click here.
