• $2500 Deductible per family member (maximum of 2)
• 80% Co-Insurance
• $30 CoPay for Routine Physical - Aetna will pay up to $200 per exam including lab and x-ray (covered under the co-pay if preformed in office and billed under the office visit co-pay)
• $0 CoPay Deductible Waived for Annual GYN Exam for Annual Pap and Mammogram
• $40 CoPay for Non-specialist Office Visit (6 visits per member per year combined non-specialist/specialist)
• $50 CoPay for Specialist Office Visit (6 visits per member per year combined non-specialist/specialist)
• $300 CoPay for ER (not billable at the time of service)
• $50 CoPay for Urgent Care visit
  
  Prescription Drug Card featuring:
• $15 CoPay for generic drugs with NO drug deductible 
• $25/$40 CoPay for brand name drugs after you meet a $500 drug deductible
• Mail order available

• No Maternity Coverage
• Eyecare Savings
• Dental available separately

Look up your Doctors - Click Here.  Be sure to use plan name ”PPO” or "Managed Choice Open Access" depending on your area when using the Docfind.

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