Aetna BRONZE HMO Plans
| Plan Info | Bronze 1 | Bronze 4 | Bronze S |
|---|---|---|---|
| Benefits Summary | Benefits Summary | Benefits Summary | |
| Deductible – Individual/Family | $8,995 / $17,990 | $0 | $7,500 / $15,000 |
| Out of Pocket Max – Individual/Family | $9,395 / $18,790 | $9,400 / $18,800 | $9,400 / $18,800 |
| Primary Care/Specialist | $55 / $125 | $15 / $100 | $50 / $100 |
| Emergency Room Care | 50% coinsurance | $2,200 copay/visit | 50% coinsurance |
| Urgent Care | $60 copay | $50 copay/visit | $75 copay |
| Inpatient hospital stay | 50% coinsurance | $2,500 copay/day, days 1-3 | 50% coinsurance |
| Lab services / Xray | 50% coinsurance | Lab: $50 copay / visit X-ray: $75 copay / visit | 50% coinsurance |
| Prescription Drugs | |||
| Preferred generic | Tier 1A: $5 copay/ $12.50 copay Tier 1: $40 copay/ $100 copay deductible does not apply | Tier 1A: $5 copay/ $12.50 copay/ Tier 1: $40 copay/ $100 copay | $25 copay/ $62.50 copay deductible does not apply (preferred and non preferred) |
| Preferred Brand Drugs | $70 copay/$175 copay deductible does not apply | 40% coinsurance for up to a 90 day supply | $50 copay / $125 copay |
| Non-preferred generic/brand drugs | $95 copay / $237.50 copay deductible does not apply | 45% coinsurance for up to a 90 day supply | $100 copay/ $250 copay |
| Preferred/non-preferred specialty drugs | $500 copay deductible does not apply | 50% coinsurance for up to a 30 day supply | $500 copay |
Every ACA plan covers 10 essential benefits:
- Prescription drugs
- Pregnancy, maternity and newborn care
- Pediatric services, including oral and vision care
- Mental health and substance use disorder services
- Preventive and wellness services, and chronic disease management
- Laboratory services
- Emergency services
- Hospitalization
- Ambulatory services
- Rehabilitative and habilitative services and devices
Aetna CVS Health Plans – 2024 Illinois HMO Hospital Network
Hospital Network Highlights – Hospitals include, but are not limited to:
- Edward Hospital
- Elmhurst Memorial Hospital
- Holy Cross Hospital
- Humboldt Park Health
- Insight Chicago, Inc.
- Jackson Park Hospital Foundation
- John H. Stroger Hospital of Cook County
- LaRabida Children’s Hospital
- Loretto Hospital
- Louis A. Weiss Memorial Hospital
- Mercy Harvard Hospital, Inc.
- Methodist Hospital of Chicago
- Mount Sinai Hospital Medical Center
- Northshore University Health System – Evanston Hospital
- NorthShore University HealthSystem – Glenbrook Hospital
- NorthShore University HealthSystem – Highland Park
- NorthShore University Health System – Skokie Hospital
- Northwest Community Hospital
- OSF Little Company of Mary Medical Center
- Provident Hospital of Cook County
- Roseland Community Hospital
- Shriners Hospital for Children-Chicago IL
- South Shore Hospital