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Aetna

Aetna CVS Silver 2: $0 MinuteClinic Visits, Telehealth, Store Discounts

Plan Overview

Combined Medical and Drug Deductible
  • Individual: $6,000.00
  • Family: $12,000
  • Per Person: $6,000
Combined Medical and Drug Out of Pocket Maximum
  • Individual: $8,700.00
  • Family: $17,400
  • Per Person: $8,700

Office Visit

Primary Doctor
  • CoPay: $25.00
  • CoInsurance: Not Applicable
  • Covered: Covered
Specialist
  • CoPay: $75.00
  • CoInsurance: Not Applicable
  • Covered: Covered

Prescription Drug Information

Preferred Brand Drugs
  • CoPay: $50.00 Copay after deductible
  • CoInsurance: No Charge after deductible
  • Covered: Covered
  • Benefit Explanation: Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.
Non Preferred Brand Drugs
  • CoPay: No Charge after deductible
  • CoInsurance: 40.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.
Generic Drugs
  • CoPay: $15.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Benefit Explanation: Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.
Specialty Drugs
  • CoPay: No Charge after deductible
  • CoInsurance: 50.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.

Inpatient Coverage

Hospital Services
  • CoPay: No Charge after deductible
  • CoInsurance: 40.00% Coinsurance after deductible
  • Covered: Covered
Inpatient Services
  • CoPay: No Charge after deductible
  • CoInsurance: 40.00% Coinsurance after deductible
  • Covered: Covered

Emergency and Urgent Care

Emergency Room
  • CoPay: No Charge after deductible
  • CoInsurance: 40.00% Coinsurance after deductible
  • Covered: Covered
  • Exclusions: No coverage for non-emergency use of the emergency room.
Urgent Care Facility
  • CoPay: $75.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Exclusions: No coverage for non-urgent care.

Maternity

Labor and Delivery Hospital Stay
  • CoPay: No Charge after deductible
  • CoInsurance: 40.00% Coinsurance after deductible
  • Covered: Covered
Pre and Postnatal Office Visit
  • CoPay: No Charge after deductible
  • CoInsurance: 40.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: Member cost sharing applies to postnatal care

Vision

Routine Eye Exams For Children
  • CoPay: No Charge after deductible
  • CoInsurance: 50.00% Coinsurance after deductible
  • Covered: Covered
  • Limit Quantity: 1
  • Limit Unit : Exam(s) per Year
  • Benefit Explanation: Coverage is limited to 1 exam every 12 months.

Major Dental Care

Routine Dental Checkups for Children
  • Covered: Not Covered
Routine Dental Checkups for Adults
  • Covered: Not Covered
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