Program Overview
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Health Plan Overview: 2025 Aetna Choice POS II
Aetna Choice POS II
Network of doctors
Choice POS II
What is the program?
Our Aetna Choice POS II plan is our most traditional health plan, geared toward those who have fairly regular ongoing medical care or prescription drug needs.
| 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. |
Key program benefits:
- Fixed copays for in-network services ($35 primary care, and $50 for specialists).
- For lab, x-ray, or any procedure you would pay the first $600 in costs and then 20% for any amounts above that.
- The most any one person in the plan would pay out of your pocket for in-network services in this plan is $4,000 after which the plan would pick up 100% of the costs.