Aetna Gold HMO Options
| Plan Info | Gold 3 Advanced: HMO + Rx Copay | Gold 10 Advanced: HMO | Gold S: HMO + Rx Copay |
|---|---|---|---|
| Benefits Summary | Benefits Summary | Benefits Summary | |
| Deductible – Individual/Family | $895 / $1,790 | $0 | $1,500 / $3,000 |
| Out of Pocket Max – Individual/Family | $9,195 / $18,390 | $6.595 / $13,190 | $7,800 / $15,600 |
| Primary Care/Specialist | $15 / $35 | No charge / $25 | $30 / $60 |
| Emergency Room Care | 45% coinsurance | $750/visit | 25% coinsurance |
| Urgent Care | $25 copay | $25/visit | $45 copay |
| Inpatient hospital stay | 45% coinsurance | $1,000/day days 1-5 | 25% coinsurance |
| Lab services / Xray | Lab: $25 copay X-ray: $50 copay | $20 / $35 | 25% coinsurance |
| Prescription Drugs | |||
| Preferred generic | Copay/ prescription, deductible does not apply: $7 for up to a 30 day supply, $17.50 for up to a 90 day supply | Copay/ prescription, deductible does not apply: $10 for up to a 30 day supply, $25 for up to a 90 day supply | Copay/ prescription, deductible does not apply: $15 for up to a 30 day supply, $37.50 for up to a 90 day supply |
| Preferred Brand Drugs | Copay/ prescription, deductible does not apply: $40 for up to a 30 day supply, $100 for up to a 90 day supply | Copay/ prescription, deductible does not apply: $35 for up to a 30 day supply, $87.50 for up to a 90 day supply | Copay/ prescription, deductible does not apply: $30 for up to a 30 day supply, $75 for up to a 90 day supply |
| Non-preferred generic/brand drugs | Copay/ prescription, deductible does not apply: $70 for up to a 30 day supply, $175 for up to a 90 day supply | 35% coinsurance for up to a 90 day supply, after specific deductible | Copay/ prescription, deductible does not apply: $60 for up to a 30 day supply, $150 for up to a 90 day supply |
| Preferred/non-preferred specialty drugs | Copay/prescription, deductible does not apply: $250 for up to a 30 day | 45% coinsurance for up to a 30 day supply, after specific deductible | Copay/prescription, deductible does not apply: $250 for up to a 30 day supply |
Every ACA plan covers 10 essential benefits:
- Prescription drugs
- Pregnancy, maternity and newborn care
- Pediatric services, including oral and vision care
- Mental health and substance use disorder services
- Preventive and wellness services, and chronic disease management
- Laboratory services
- Emergency services
- Hospitalization
- Ambulatory services
- Rehabilitative and habilitative services and devices
All Aetna individual plans in Illinois allow you to go directly to any recognized health care provider, including specialists, for covered expenses. The following are standard benefits included in all Aetna individual plans:
- Unlimited office visits to your primary care physician and specialists
- No referrals required
- No waiting periods to access preventive health and routine physicals
- Lab work and x-rays included in routine physicals
- 100% annual routine GYN exam coverage – no waiting period, copay, or deductible
- 100% coverage on in-network childhood immunizations
- Prescription drug coverage
Hospital Network Highlights – Hospitals include, but are not limited to:
Chicagoland Area Hospitals:
- Chicago Holy Cross Hospital
- Chicago Humboldt Park Health
- Chicago Insight Chicago, Inc.
- Chicago Jackson Park Hospital Foundation
- Chicago John H. Stroger Hospital of Cook County
- Chicago LaRabida Children’s Hospital
- Chicago Loretto Hospital
- Chicago Louis A. Weiss Memorial Hospital
- Chicago Methodist Hospital of Chicago
- Chicago Mount Sinai Hospital Medical Center
- Chicago Provident Hospital of Cook County
- Chicago Roseland Community Hospital
- Chicago Shriners Hospital for Children
- Chicago South Shore Hospital
- Chicago St. Anthony Hospital
- Chicago St. Bernard Hospital and Health Care Center
- Chicago Swedish Covenant Hospital
- Chicago Thorek Memorial Hospital
- Chicago University of Illinois at Chicago Hospital
Outside Chicagoland Area Hospitals:
- Alton Alton Memorial Hospital
- Alton OSF Saint Anthony’s Health Center
- Anna Deaconess Illinois Union County Hospital, Inc
- Arlington Heights Northwest Community Hospital
- Benton Franklin Hospital 201 Bailey Lane
- Bloomington OSF St. Joseph Medical Center
- Breese St. Joseph’s Hospital – Breese
- Canton Graham Hospital
- Carbondale Memorial Hospital of Carbondale
- Carlinville Carlinville Area Hospital
- Carrollton Thomas H. Boyd Memorial Hospital
- Centralia SSM Health St. Mary’s Hospital – Centralia
- Chester Memorial Hospital
- Clinton Warner Hospital and Health Services
- Danville OSF Sacred Heart Medical Center
- Decatur Decatur Memorial Hospital
- Decatur St. Mary’s Hospital
- Du Quoin Marshall Browning Hospital
- Edwardsville St. Louis Children’s Hospital
- Eldorado Ferrell Hospital
- Elgin Presence Saint Joseph Hospital – Elgin
- Elmhurst Elmhurst Memorial Hospital
- Evanston Northshore University Health System – Evanston Hospital
- Evergreen Park OSF Little Company of Mary Medical Center
- Fairfield Fairfield Memorial Hospital
- Flora Clay County Hospital
- Galesburg OSF Saint Mary Medical Center
- Geneseo Hammond-Henry Hospital
- Gibson City Gibson Area Hospital & Health Services
- Glenview NorthShore University HealthSystem Glenbrook Hospital
- Greenville HSHS Holy Family Hospital, INC
- Harrisburg Harrisburg Medical Center
- Harvard Mercy Harvard Hospital, Inc.
- Havana Mason District Hospital
- Herrin Herrin Hospital
- Highland St. Joseph’s Hospital-Highland
- Highland Park NorthShore University HealthSystem
- Hillsboro Hillsboro Area Hospital
- Jacksonville Jacksonville Memorial Hospital
- Jerseyville Jersey Community Hospital
- Kewanee OSF Saint Luke Medical Center
- Lawrenceville Lawrence County Memorial Hospital
- Lincoln Abraham Lincoln Memorial Hospital
- Litchfield St. Francis Hospital
- Marion Heartland Regional Medical Center
- Mattoon Sarah Bush Lincoln Health Center
- Mc Leansboro Hamilton Memorial Hospital
- Mendota OSF Saint Paul Medical Center
- Metropolis Massac Memorial Hospital
- Monmouth OSF Holy Family Medical Center
- Monticello Kirby Medical Center
- Mt. Carmel Wabash General Hospital District
- Mt. Vernon Crossroads Community Hospital
- Mt. Vernon SSM Health Good Samaritan Hospital – Mt. Vernon
- Murphysboro St. Joseph Memorial Hospital
- Naperville Edward Hospital
- Nashville Washington County Hospital
- New Lenox Silver Cross Hospital
- O Fallon St. Elizabeth’s Hospital
- Oak Park West Suburban Medical Center
- Olney Richland Memorial Hospital
- Ottawa OSF Saint Elizabeth Medical Center
- Pana Pana Community Hospital
- Paris Paris Community Hospital
- Peoria OSF HealthCare Transitional Care Hospital
- Peoria OSF Saint Francis Medical Center
- Pinckneyville Pinckneyville Community Hospital
- Pittsfield Illini Community Hospital
- Pontiac OSF Saint James Medical Center
- Princeton OSF Saint Clare Medical Center
- Quincy Blessing Hospital
- Red Bud Red Bud Regional Hospital
- Robinson Crawford Memorial Hospital
- Salem Salem Township Hospital
- Shelbyville HSHS Good Shepherd Hospital
- Shiloh Siteman Cancer Center – IL
- Shiloh The Rehabilitation Institute of Southern Illinois, LLC
- Skokie NorthShore University Health System – Skokie Hospital
- Sparta Sparta Community Hospital
- Springfield Memorial Medical Center
- Springfield St. John’s Hospital
- Staunton Community Hospital of Staunton
- Taylorville Taylorville Memorial Hospital
- Urbana OSF Heart of Mary Medical Center
- Vandalia Sarah Bush Lincoln Fayette County Hospital
- Watseka Iroquois Memorial Hospital
- Waukegan Vista Medical Center East