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Medical, continued
Here is an overview of our third medical plan, a PPO plan offered through Aetna.
Aetna Medical PPO Plan
In-Network
Out-Of-Network
Annual Deductible
$750 per individual
$1,500 family limit
$1,500 per individual
$3,000 family limit
Annual Out-of-Pocket Max
$3,000 per individual
$6,000 family limit
$6,000 per individual
$12,000 family limit
Lifetime Max
Unlimited
Unlimited
Office Visit
Primary Provider
$20 copay then plan pays 100%
Plan pays 60% after deductible
Specialist
$40 copay then plan pays 100%
Plan pays 60% after deductible
Preventive Services
Plan pays 100%
Plan pays 60% after deductible
Chiropractic Care
$40 copay then plan pays 100% (up to
20 visits per year)
Plan pays 60% after deductible (in-
network limitations apply)
Lab and X-ray
Complex imaging: plan pays 70% after
deductible; all other: plan pays 80% after
deductible
Complex imaging: plan pays 50% after
deductible; all other: plan pays 60% after
deductible
Inpatient Hospitalization
Plan pays 80% after deductible
Plan pays 60% after deductible
Outpatient Surgery
Plan pays 80% after deductible
Plan pays 60% after deductible
Urgent Care
$35 copay then plan pays 100%
Plan pays 60% after deductible
Emergency Room
$150 copay then plan pays 80% (copay
waived if admitted)
$150 copay then plan pays 80% (copay
waived if admitted)