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Aetna BRONZE PPO Plans
Plan Info | Bronze 1 | Bronze 4 | Bronze S |
---|---|---|---|
Benefits Summary | Benefits Summary | Benefits Summary | |
Deductible – Individual/Family | $8,995 / $17,990 | $0 | $7,500 / $15,000 |
Out of Pocket Max – Individual/Family | $9,395 / $18,790 | $9,400 / $18,800 | $9,400 / $18,800 |
Coinsurance | 50% | 50% | 50% |
Primary Care/Specialist | $55 / $125 | $15 / $100 | $55 / $100 |
Emergency Room Care | 50% coinsurance | $2,200 copay/visit | 50% coinsurance |
Urgent Care | $60 copay | $50 copay/visit | $75 copay |
Inpatient hospital stay | 50% coinsurance | $2,500 copay/day, days 1-3 | 50% coinsurance |
Lab services / Xray | 50% coinsurance | Lab: $50 copay / visit X-ray: $75 copay / visit | 50% coinsurance |
Prescription Drugs | |||
Preferred generic | Tier 1A: $5 copay/ $12.50 copay Tier 1: $40 copay/ $100 copay deductible does not apply | Tier 1A: $5 copay/ $12.50 copay/ Tier 1: $40 copay/ $100 copay | $25 copay/ $62.50 copay deductible does not apply (preferred and non preferred) |
Preferred Brand Drugs | $70 copay/$175 copay deductible does not apply | 40% coinsurance for up to a 90 day supply | $50 copay / $125 copay |
Non-preferred generic/brand drugs | $95 copay / $237.50 copay deductible does not apply | 45% coinsurance for up to a 90 day supply | $100 copay/ $250 copay |
Preferred/non-preferred specialty drugs | $500 copay deductible does not apply | 50% coinsurance for up to a 30 day supply | $500 copay |
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
- 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
Aetna CVS Health Plans – 2024 Illinois PPO Hospital Network
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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 – 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