IN-NETWORK BENEFITS |
Aetna Choice POS 1500 |
Deductible |
Individual: $1,500
|
Coinsurance |
You pay 20% (after deductible)
|
Out of Pocket Maximum |
Individual: $5,500
|
Office Visit Copay |
$25 Primary care physician (PCP)$75 Specialist$75 Urgent Care |
Preventive Office Copay |
Covered at 100% |
Emergency Room Copay |
You pay $300 copay after deductible, then 20% |
Prescription Drug |
Tier 1A: $3 copayTier 1: $10 copayTier 2: $45 copayTier 3: $75 copay/ prescriptionSpecialty Preferred: 20% coinsurance up to a $250Specialty Non-preferred: 40% coinsurance up to a $500 |





































