Independent Insurance Agency
Arizona Health Insurance Quotescontact us
Arizona Health, Life, & Travel Insurance
Call 800.884.2343 or
541.434.9613
FAX - 541.284.2994

Arizona Health Insurance > Aetna > PPO High Deductible 3000 (HSA Compatible) Benefits

Aetna

Quote & Apply - Electronic Application
 
PPO High Deductible 3000 (HSA Compatible)
Member Benefits In-Network Out-of-Network+
Deductible Individual / Family $3,000/$6,000 $6,000/$12,000
Coinsurance (Member’s Responsibility) 0%
after deductible		 50%
after deductible
Coinsurance Maximum Individual / Family $0/$0 $6,500/$13,000
Out-of-Pocket Maximum Individual / Family (Includes Deductible) $3,000/$6,000 $12,500/$25,000
Lifetime Maximum* $5,000,000 $5,000,000
Non-specialist Office Visit
(General Physician, Family Practitioner, Pediatrician or Internist)		 0%
after deductible		 50%
after deductible
Specialist Visit
(Aexcel Network available in specified counties.)		 0%
after deductible		 50%
after deductible
Hospital Admission 0%
after deductible		 50%
after deductible
Outpatient Surgery 0%
after deductible		 50%
after deductible
Urgent Care Facility 0%
after deductible		 50%
after deductible
Emergency Room
0% after deductible
Annual Routine GYN Exam
(Annual Pap / Mammogram)		 $0
ded. waived		 50%
after deductible
Maternity
Not covered (except for pregnancy complications)
Preventive Health
(Routine Physical) ($200 maximum*)		 $20 copay
ded. waived		 50%
after deductible
Lab / X-Ray 0%
after deductible		 50%
after deductible
Skilled Nursing (In Lieu of Hospital)
(30 days per calendar year*)		 0%
after deductible		 50%
after deductible
Physical / Occupational Therapy & Chiropractic Care
($25 Max - 24 visits per calendar year*)		 0%
after deductible		 50%
after deductible
Home Health Care (In Lieu of Hospital)
(30 visits per calendar year*)		 0%
after deductible		 50%
after deductible
Durable Medical Equipment
($2,000 per calendar year*)		 0%
after deductible		 50%
after deductible
Pharmacy
Pharmacy Deductible per Individual Integrated Medical/Rx Deductible Integrated Medical/Rx Deductible
Generic
(Oral Contraceptives included)		 0% after Medical/Rx deductible 50% after Medical/Rx deductible
Preferred Brand copay
(Oral Contraceptives included)		 0% after Medical/Rx deductible 50% after Medical/Rx deductible
Non-Preferred Brand copay
(Oral Contraceptives included)		 0% after Medical/Rx deductible 50% after Medical/Rx deductible
Calendar Year Maximum per Individual* $5,000 $5,000

* Maximum applies to combined in and out-of-network benefits.
** Copay is billed separately and not due at time of service. Copay does not count towards coinsurance or out-of-pocket maximum.
*** Aetna discount available.
+ Payment for out-of-network facility care is determined based upon Aetna’s Allowable Fee Schedule. Payment for other out-of-network facility care is determined based upon the negotiated charge that would apply if such services or supplies were received from a Preferred Provider.
++ Coverage will be provided for care and treatment of mastectomy reconstruction and diabetes; this includes coverage for equipment and supplies used exclusively with diabetes management and outpatient self-management training.

 
Privacy Policy | Contact Us | ©1998-2008 CDA Insurance LLC