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Home   >  Health Insurance Companies   >   Aetna Plans   >   Aetna MC Open Access Value 5000
 
 

Aetna - California Plans

Managed Choice Open Access Value 5000 Health Insurance Plan

A plan summary of the Aetna California Managed Choice Open Access Value 5000 Plan is detailed out below for both In Network and Out of Network coverage.

                                                In Network Out of Network

  Copay

30%

50% or Not Covered

  Office Visits

Visits 1-3: $50 (Deductible Waived) Visits 4+ Aetna discount applies; Specialist and non-Specialist do not share visits 50% after Deductible

  Annual Deductible

Individual: $5,000 Family: $10,000

Individual: $10,000 Family: $20,000

  Annual Out-Of-Pocket  Limit

Individual: $10,000 Family: $20,000

Individual: $12,500 Family: $25,000

  Lifetime Maximum

Not Applicable Not Applicable

  Prescription Drugs

Generic: $20 (Deductible Waived)

50% plus Generic: $20 (Deductible Waived)

  Laboratory & X-Ray

30% after Deductible (Non-Preventive) 50% after Deductible (Non-Preventive)

  Annual Physical Exam

No Charge 50% after Deductible

  Annual OB-GYN Exam

No Charge 50% after Deductible

  Well Baby Care

No Charge (Age and frequency limits apply) 50% after Deductible (Age and frequency limits apply)

  Outpatient Surgery

40% after Deductible 50% after Deductible

  Emergency Room

$100 (waived if admitted) plus 30% after Deductible $100 (waived if admitted) plus 30% after Deductible

  Inpatient Hospital

40% after Deductible 50% after Deductible

  Ambulance

30% after Deductible 30% after Deductible

  Home Health Care

30% after Deductible (30 visits/calendar year; In and Out-of-Network combined) 50% after Deductible (30 visits/calendar year; In and Out-of-Network combined)

  Mental Health - Outpatient

Not Covered Not Covered

  Chiropractic Care

30% (24 visit max; $25 per visit max) 50% (24 visit max; $25 per visit max)

  Acupuncture

See Brochure See Brochure

  Mental Health - Inpatient

Not Covered Not Covered

  Chemical Dependency

30% 50%

  Maternity Care

Not Covered (except for pregnancy complications) Not Covered (except for pregnancy complications)

                                                              


To learn more about your individual and family California health insurance options, the price of each plan and/or a detailed benefit summary of the plans, visit us here.

NOTICE! Final rates and benefits are based on actual plan selection (including plan riders you may request) and the assignment of any rate adjustment factors due to the health plan's underwriting guidelines.

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