The Aetna Choice Open Access Plan
When using in-network providers, Aetna’s Choice Open Access Plan offers small or zero dollar copay for your Primary Care Provider (PCP) or specialist visits within the Aetna network (without a referral from your PCP)|
IMPORTANT: The benefits listed in this chart are for illustrative purposes only. Specific benefit coverage information for your plan may vary. Please consult your Plan Document for particulars. All payments are based on reasonable and customary fees for the service provided. |
Please note that this plan is NOT available to all participants. Please contact your BMED consultant for more information.
| Type of Service | In Network w/ referral |
Out of Network |
| Deductible | ||
| Individual | None | $200/cal year |
| Family | None | $500/cal year |
| Coinsurance | None | 80/20 |
| Annual Out Of Pocket Max | ||
| Individual | N/A | $400 |
| Family | N/A | $1,200 |
| Lifetime Maximum | None | None |
| Primary/Preventive Care | ||
| PCP Office Visits | 100% | Deductible & Coinsurance |
| Physical Exams | 100% (cal year limit of $600) | Not Covered |
| Routine WellBaby Care | 100% (cal year limit of $600) | Not Covered |
| Immunizations | 100% | 100% |
| Routine Eye Exams | Not Covered | Not Covered |
| Eyeglasses/Contact Lenses | Not Covered | Not Covered |
| Specialty Care | ||
| Office Visits | 100% | Deductible & Coinsurance |
| Maternity Care | 100% | Deductible & Coinsurance |
| X-Rays and Lab Tests | 100% | Deductible & Coinsurance |
| Speech Therapy | 100% | Deductible & Coinsurance |
| Physical Therapy | 100% | Deductible & Coinsurance |
| Chiropractic | 100% | Deductible & Coinsurance |
| Hospice | 100% | 100% |
| Durable Medical Equipment | 100% | Deductible & Coinsurance |
| Radiation/Chemotherapy Outpatient | 100% | Deductible & Coinsurance |
| Inpatient Services | ||
| Hospital Inpatient | 100% | Deductible & Coinsurance |
| X-Rays and Lab Tests | 100% | Deductible & Coinsurance |
| Skilled Nursing Facility | 100% | Deductible & Coinsurance |
| Surgery and Anesthesia | ||
| Preadmission Testing | 100% | Deductible & Coinsurance |
| Physician Charges | 100% | Deductible & Coinsurance |
| Alcohol Dependency Treatment | ||
| Inpatient | 100% | Deductible & Coinsurance |
| Outpatient | 100% | Deductible & Coinsurance |
| Inpatient Drug Dependency Treatment | ||
| Detoxification | 100% | 100% (max 7 days) |
| Inpatient Rehab | 100% (30 days) | 100% (30 days) |
| Outpatient Rehab | 100% (30 visits) | Deductible & Coinsurance (30 visits) |
| Outpatient Drug Dependency Treatment | ||
| Outpatient | 100% (30 visits) | Deductible & Coinsurance (20 visits) |
| Mental Health Treatment | ||
| Inpatient Treatment | 100% (35 days) | Deductible & Coinsurance (35 days) |
| Outpatient Treatment | $25 Co-pay (20 visits) | Deductible & Coinsurance |
| Emergency Care | ||
| Emergency Room | 100% | 100% |
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Note: This is only intended to be a general outline of some of the benefits when using the network of the Aetna Open Access PPO Plan and is not a binding schedule of benefits, fees or allowances. Consult your Plan Document for complete details of referral process, maximum visits permitted and other allowances |