Aetna Gold PPO 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 |
| Coinsurance | 40% | 25% |
| Primary Care/Specialist | $15 / $35 | $30 / $60 |
| Emergency Room Care | 50% coinsurance | 25% coinsurance |
| Urgent Care | $25 copay | $45 copay |
| Inpatient hospital stay | 40% 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:
Chicago:
- Northshore Hospital
- Northwestern Hospital
- Lurie’s Children’s HospitalJackson Park Hospital Foundation
- Holy Cross Hospital
- Humbolt Park Health
- John H. Stroger Hospital of Cook County
- La Rabida Children’s Hospital
- Loretto Hospital
- Louis Weiss Memorial Hospital
- Mercy Harvard Hospital
- Insight Chicago
- Methodist Hospital of Chicago
- Mount Sinai Hospital and Medical Center
- Rush University Hospital
- University of Chicago Hospital
Northshore University Health System:
- Northshore University Health System – Chicago
- Northshore University Health System – Glenbrook
- Northshore University Health System – Highland Park
- Northshore University Health System – Evanston
- Northshore University Health System – Skokie
- Edward Hospital
- Elmhurst Memorial Hospital
- Northwest Community Hospital
- Swedish Covenant Hospital
- OSF Little Company of Mary Hospital
- Provident Hospital of Cook County
- Roseland Community Hospital
- Schwab Rehabilitation Hospital
- South Shore Hospital
- St. Anthony Hospital
- St. Bernard Hospital
- Swedish Covenant Hospital
- Thorek Hospital and Medical Center
- Vista Medical Center East
- Vista Medical Center West
- University of Illinois at Chicago Medical Center