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Aetna EPO Plan
Physicians Directory

To view a quote for this plan visit our Free Group Health Insurance Quotes section.

Plan Name Aetna EPO
Plan Type Elect Choice EPO
Deductible None
Coinsurance N/A
Out of Pocket Limit $2500 per member, two member max
Lifetime Maximum $5,000,000
 Primary Benefits
Office Visit $15 copay
Specialist Office Visit $30 copay
Chiropractic Services $30 copay (12 visits per year)
Outpatient Lab and X-ray 10%
Complex Imaging (CAT, MRI, MRA/MRS and PET scans)
Outpatient PHysical, Occupational, Speech Therapy HMO: 20 visits per year PT/OT aggregate, 20 visits ST
$30 copay
Physical Exams (age and frequency schedules apply)
$15 copay
Well-Child Exams $15 copay
Routine GYN (Frequency schedules apply)
$30 copay
Hospital - Inpatient 10%
Outpatient Surgery 10%
Emergency Room (copay waived if admitted; non-emergency use of ER is not covered)
10% after $100 copay
Urgent Care $50 copay
Prescription Drugs Retail: per 30-day supply; Mail Order: two times retail copay, (31-90 day supply available)
$15/$35/$50 with $150 Brand Name Deductible


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Authorized Agent For:

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