| Network | Aetna Choice POS II | This is the network you world ask your doctor id she or he accepts; make sure they are "in-network" |
| Can you use out of net work doctors? | Yes | But out of network services will cost more |
| Tax Advantage Account | N/A | N/A |
| In-Network Deductible | $600 / $1,200
(Individual / Family) | In the POS any member of a family only has the "indivisual" deductible to get through. The family deductible is the maximum amount in deductibles a family will pay across all members. |
| Out-of-Network Deductible | $1,200 / $2,400
(Individual / Family) | In the POS any member of a family only has the “individual” deductible to get through. The family deductible is the maximum amount in deductibles a family will pay across all members. |
| Copay for In-Network Office Visits | $35 Primary Care Physician
$50 Specialist | |
| In-Network Coinsurance - Amount you pay | 20% | The amount is capped at the plan's Out of Pocket Maximum |
| Out-of-Network Coinsurance - Amount you pay | 40% of resonable and customary | Reasonable and Customary is the prevailing charge for a service in a geographic area. |
| In-Network Out of Pocket Maximum | $4,000 / $8,000
(Individual / Family) | Does not include Prescription Drug benefits |
| Out-of-Network Out of Pocket Maximum | $8,000 / $16,000
(Individual / Family) | Does not include any amounts in excess of the reasonable and customary limit |
| Copay for Emergency Room | $300 + 20% of remaining costs | All Emergency Rooms are considered in network for true emergencies |
| Generic Prescription Drugs | $10 for a 30 day supply
$20 for a 90 day mail order supply | Mail order drugs come direct from Caremark. |
| Formulary Brand Prescription Drugs | 30% ($30 minimum / $75 maximum) for a 30 day supply
30% ($60 minimum / $150 maximum) for a 90 day mail order supply | Formulary Drugs are discounted Brand Drugs. To find the Caremark formulary list - log on to www.caremark.com |
| Non-Formulary Brand Prescription Drugs | 50% ($50 minimum / $100 maximum) for a 30 day supply
50% ($100 minimum / $200 maximum) for a 90 day supply | These are full patented brand drugs with no discount |
| Prescription Drug Out of Pocket Maximum | $3,000 Individual / $6,000 Family | This is in addition to the Medical Out of Pocket Maximum above. |
