*AETNA IS NOW OFFERING PPO PLANS*
What is a PPO? PPO stands for Preferred Provider Organization. Just like an HMO, or health maintenance organization, a PPO plan offers a network of healthcare providers you can use for your medical care. These providers have agreed to provide care to the plan members at a certain rate. Unlike an HMO, a PPO offers you the freedom to receive care from any provider—in or out of your network. This means you can see any doctor or specialist, or use any hospital.
⬤ Gold PPO – Gold plans will have the highest premiums, but the lowest out-of-pocket costs as well as the lowest deductibles.
⬤ Silver PPO – Silver plans will have moderate premiums, moderate out-of-pocket-costs, and will have deductibles that are lower than Bronze plan options.
⬤ Bronze PPO – Bronze plans will have the lowest premiums, but the highest out-of-pocket costs as well as the highest deductibles
See the table below for our TOP recommended Aetna PPO Plan options
| Plan Info | Gold 3 | Silver 7 | Bronze S |
|---|---|---|---|
| Benefits Summary | Benefits Summary | Benefits Summary | |
| Deductible – Individual/Family | $795 / $1,590 | $7,795 / $15,590 | $7,500 / $15,000 |
| Out of Pocket Max – Individual/Family | $9,195 / $18,390 | $8,845 / $17,690 | $9,400 / $18,800 |
| Coinsurance | 40% | 40% | 50% |
| Primary Care/Specialist | $15 / $35 | $30 / $60 | $50 / $100 |
| Emergency Room Care | 50% coinsurance | 50% coinsurance | 50% coinsurance |
| Urgent Care | $25 copay | $50 copay | $75 copay |
| Inpatient hospital stay | 40% coinsurance | 40% coinsurance | 50% coinsurance |
| Lab services / Xray | Lab: $20 copay/visit X-ray: $35 copay/visit ded does not apply | Lab: $30 copay/visit X-ray: $50 copay ded does not apply | 50% coinsurance |
| Preferred generic | Tier 1A: $5 copay/ $12.50 copay Tier 1: $10 copay/ $25 copay ded does not apply | Tier 1A: $5 copay / $12.50 copay Tier 1: $25 copay / $62.50 copay ded does not apply | $25 copay/ $62.50 copay deductible does not apply (preferred and non preferred) |
| Preferred Brand Drugs | $40 copay/ $100 copay ded does not apply | $60 copay / $150 copay ded does not apply | $50 copay / $125 copay |
| Non-preferred generic/brand drugs | $70 copay/ prescription for up to a 30 day supply, $175 copay ded does not apply | $125 copay/ $312.50 copay/ | $100 copay/ $250 copay |
| Preferred/non-preferred specialty drugs | $250 copay/ ded does not apply | $400 copay ded does not apply | $500 copay ded does not apply |
Aetna CVS Health Plans – 2024 Illinois PPO Hospital Network
Hospital Network Highlights – Hospitals include, but are not limited to:
Chicago:
- Northshore Hospital
- Northwestern Hospital
- Lurie’s Children’s HospitalJackson Park Hospital Foundation
- Holy Cross Hospital
- Humbolt Park Health
- John H. Stroger Hospital of Cook County
- La Rabida Children’s Hospital
- Loretto Hospital
- Louis Weiss Memorial Hospital
- Mercy Harvard Hospital
- Insight Chicago
- Methodist Hospital of Chicago
- Mount Sinai Hospital and Medical Center
- Rush University Hospital
- University of Chicago Hospital
Northshore University Health System:
- Northshore University Health System – Chicago
- Northshore University Health System – Glenbrook
- Northshore University Health System – Highland Park
- Northshore University Health System – Evanston
- Northshore University Health System – Skokie
- Edward Hospital
- Elmhurst Memorial Hospital
- Northwest Community Hospital
- Swedish Covenant Hospital
- OSF Little Company of Mary Hospital
- Provident Hospital of Cook County
- Roseland Community Hospital
- Schwab Rehabilitation Hospital
- South Shore Hospital
- St. Anthony Hospital
- St. Bernard Hospital
- Swedish Covenant Hospital
- Thorek Hospital and Medical Center
- Vista Medical Center East
- Vista Medical Center West
- University of Illinois at Chicago Medical Center
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