Aetna choice pos ii copay1/12/2024 ![]() Out-of-Pocket Maximum The maximum dollar amount you are required to pay out of pocket for medical, behavioral health Rx during the calendar year. Out-of-Network Physicians, hospitals, and other healthcare providers who are not contracted with Aetna ![]() UHealth providers are all within the Aetna network. Aetna has a national network with providers all over the country. In-Network Physicians, hospitals, and other healthcare providers who are contracted with Aetna. This amount is based on a national database, complexity of services, range of services and prevailing charge in the geographic area. Maximum Allowable Fee An amount determined by Aetna to be the prevailing charge for the service. In all of our plans, once the deductible is met for three members of a family, it is met for all other members of the same family. Copayments do not apply to the deductible.įamily A family plan consists of an employee, a spouse, and at least one dependent child. ![]() Copays vary depending on the service you’re receiving.ĭeductible The dollar amount you must pay for covered health care services before your insurance plan starts to pay. You are responsible for the difference between out-of-network billed charges and Aetna’s maximum allowable fee.Ĭoinsurance Your share of the costs of a covered healthcare expense calculated as a percent based on the contracted Aetna rate you pay for services after your deductible is metĬopayment (Copay) The fixed dollar amount you pay each time you receive certain types of medical services or prescriptions. *Note, any prescription NOT covered by AetnaRx is the full responsibility of the member and WILL NOT be applied toward your deductible or out-of-pocket maximum.īalance Billing Out-of-network providers may bill patients for the balances remaining on the charges associated with services rendered, after the insurance reimbursement amount is paid. HRA funds will be used for eligible medical and prescription expenses before flexible spending account funds are utilized. Note, if you participate in both the Aetna HRA medical plan and a health care FSA, you will receive one WageWorks Visa card with both HRA and FSA funds on the card. Click here to view a presentation explaining how the HRA Plan works and here for a Quick Start Guide. The unused funds roll over each year as long as you remain in this plan. The maximum fund a family will receive is $1,200. However, prescription drugs do not bypass the deductible, which must be met prior to copays. In-network preventive care is free and bypasses the deductible. Over the counter items are not considered pharmacy expenses. A pharmacy expense is a medication, prescribed by a licensed provider, which requires a prescription to obtain, is run through the Aetna insurance, and is applied to the deductible. The plan has a $400 per person health fund - paid by UM - to help pay for up front medical and pharmacy expenses, including the $1,500 per person deductible, up to $4,500 per family. The HRA plan offers access to a national network (Choice POS II Open Access) of providers and facilities and out-of-network benefits (at higher costs).
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