(January 1, 2023 through December 31, 2023)
The Network Core Plan offers in-network coverage only. That is to say that your provider must be contracted through the Aetna Elect Choice Network, which is a national network (in-network providers are available nation-wide).
The features of this plan include:
- $30 co-payment to visit a Primary Care Physician, $50 to see a Specialist.
- No referrals are needed.
- In-network mental health and substance abuse outpatient visits are covered at the primary office visit copayment ($30). Previously, these services were covered at the specialist office visit copayment ($50).
- The annual (calendar year) Out-of-Pocket Maximum is $2,000 for individual coverage and $4,000 for employee +1 and family coverage.
- Preventive care exams (PDF) are covered at 100%.
- No charge for in-network hospitalization.
- $85 Emergency Room co-payment, which is waived if you (or a covered dependent) are admitted to the hospital.
- In-network prescription co-payments of: $20 for generic medications, $45 for preferred brand medications, and $70 for non-preferred brand medications, after the calendar year deductible for non-generic prescriptions ($125 per person, $375 for +1 and family) has been satisfied. $0 co-payments for generic preventive medications on this list (PDF).
- Please review the Aetna Advance Control Plan Drug Guide brochure (PDF).
- Coverage for acupuncture – coverage is limited to 10 visits per calendar year, $30 copayment per visit under the Network Core plan.
- Coverage for hearing aids (for medical plan sitused in NY) – coverage is limited to 1 hearing aid per ear every 3 years, covered at 100% under the Network Core plan.
There is no coverage for out-of-network services.