Aetna Gold HMO Options
| Plan Info | Gold 3 | Gold S |
|---|---|---|
| Benefits Summary | Benefits Summary | |
| Deductible – Individual/Family | $795 / $1,590 | $1,500 / $3,000 |
| Out of Pocket Max – Individual/Family | $9,195 / $18,390 | $8,700 / $17,400 |
| Primary Care/Specialist | $15 / $35 | $30 / $60 |
| Emergency Room Care | 50% coinsurance | 25% coinsurance |
| Urgent Care | $25 copay | $45 copay |
| Inpatient hospital stay | 50% coinsurance | 25% coinsurance |
| Lab services / Xray | Lab: $20 copay X-ray: $35 copay | 25% coinsurance |
| Prescription Drugs | ||
| Preferred generic | Tier 1A: $5 copay / $12.50 copay Tier 1: $10 copay/ $25 copay ded does not apply | $15 copay/ $37.50 copay ded does not apply |
| Preferred Brand Drugs | $40 copay / $100 copay ded does not apply | $30 copay / $75 copay ded does not apply |
| Non-preferred generic/brand drugs | $70 copay / $175 copay ded does not apply | $60 copay / $150 copay ded does not apply |
| Preferred/non-preferred specialty drugs | $250 copay ded does not apply | $250 copay ded does not apply |
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
All Aetna individual plans in Illinois allow you to go directly to any recognized health care provider, including specialists, for covered expenses. The following are standard benefits included in all Aetna individual plans:
- Unlimited office visits to your primary care physician and specialists
- No referrals required
- No waiting periods to access preventive health and routine physicals
- Lab work and x-rays included in routine physicals
- 100% annual routine GYN exam coverage – no waiting period, copay, or deductible
- 100% coverage on in-network childhood immunizations
- Prescription drug coverage
Aetna CVS Health Plans – 2024 Illinois PPO 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
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