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Pennsylvania Aetna plans provide comprehensive healthcare coverage to Pa residents. As the leading trusted resource for single and family coverage in the Keystone State, we specialize in finding the policies that pay your claims at a price you can afford. Senior Medigap options are offered to persons that have reached age 65 and are eligible for Medicare. Supplement, Advantage, and Part D prescription drug plans are available.

As one of the nation’s largest providers, they feature an extensive Network of doctors, hospitals and facilities. Their rates are typically very competitive throughout most of the state. In some areas, Coventry plans are offered where coverage is not available. Aetna withdrew from the private individual medical market in the Keystone State four years ago. Although Group, Senior, and ancillary products continue to be offered, Marketplace and off-Exchange plans are no longer available. Group coverage to small and large employers provides many attractive options. National General underwrites a short-term policy that utilizes the Aetna PPO network. However, the plan is no longer approved in the Keystone State.

 

Aetna Senior Health Insurance In Pennsylvania

 

Medicare Supplement Plans

Available plans are A, B, F. G (HD), G, and N. Basic benefits include medical costs (Part B coinsurance and hospital outpatient services, hospitalization, hospice, and blood). Listed below are current estimated monthly rates (preferred) for an applicant aged 65, 66, or 67. Premiums can periodically change, and usage of tobacco products within the last 12 months may slightly increase rates. A household discount was included.

Female In Zip Codes 150-154, and 156

Plan A – $110

Plan B – $123

Plan F – $158

Plan G (HD) – $44

Plan G – $123

Plan N – $85

 

Male In Zip Codes 150-154, and 156

Plan A – $127

Plan B – $147

Plan F – $181

Plan G (HD) – $50

Plan G – $141

Plan N – $98

 

Female In Zip Codes 189-194

Plan A – $119

Plan B – $132

Plan F – $170

Plan G (HD) – $47

Plan G – $132

Plan N – $92

 

Male In Zip Codes 189-194

Plan A – $137

Plan B – $152

Plan F – $196

Plan G (HD) – $54

Plan G – $152

Plan N – $106

 

Female In All Other Zip Codes

Plan A – $96

Plan B – $107

Plan F – $137

Plan G (HD) – $38

Plan G – $107

Plan N – $74

 

Male In All Other Zip Codes

Plan A – $1104

Plan B – $123

Plan F – $158

Plan G (HD) – $44

Plan G – $123

Plan N – $85

MA plans are issued by private insurers that contract with Medicare to provide Parts A and B coverage. Premiums are often less than the cost of a Supplement contract, and additional benefits, including prescription drugs, are often included. HMO, PPO, Special Needs, and Medical Savings Accounts are offered. Dental, vision, and hearing coverage is often included. Listed below are Pa Medicare Advantage Prescription Drug plans offered in Allegheny County. Rates are monthly. Plan benefits and prices can vary, depending upon your county of residence.

Advantra Cares (HMO D-SNP) H3959-036-0 – $0 per month with $0 deductible. Office visit copays are $0 with ER copay of $0. The inpatient hospital copay is $0 and the  ambulance copay is $0. X-rays are subject to a $0 copay and CT scans and diagnostic radiology is subject to a $0 copay. Lab services also receive a $0 copay. Prescription drug copays for 30 days are $0 (Tier 1), $0 (Tier 2), $0 (Tier 3), $0 (Tier 4), and $0 (Tier 5). Prescription drug copays for 90 days (mail order) are $0 (Tier 1), $0 (Tier 2), $0 (Tier 3), and $0 (Tier 4). The summary star rating is 4.5 and 24,449 members are enrolled in this plan statewide. 3,633 formulary drugs available.

Advantra Eagle (HMO) H3959-041-0 – $0 per month and $3,900 maximum out-of-pocket expenses. Office visit copays are $0 and $10 with ER copay of $120. The inpatient hospital copay is $350, and the ambulance copay is $250. X-rays are subject to a $0 copay and CT scans and diagnostic radiology is subject to a $0-$250 copay. Lab services receive a $0 copay. Prescription drug benefits are not included. The summary star rating is 4.5 and 4,445 members are enrolled in this plan statewide.

Advantra Silver (HMO) H3959-010-0 – $0 per month with $0 deductible and $5,500 maximum out-of-pocket expenses. Office visit copays are $0 and $35 with ER copay of $120. The inpatient hospital copay is $145 for the first four days, and the ambulance copay is $225. X-rays are subject to a $20 copay and CT scans and diagnostic radiology is subject to a $0-$225 copay. Prescription drug copays for 30 days are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). Prescription drug copays for 90 days (mail order) are $0 (Tier 1), $0 (Tier 2), $141 (Tier 3), and $300 (Tier 4). The summary star rating is 4.5 and 8,037 members are enrolled in this plan statewide. 3,658 formulary drugs available.

Advantra Silver (PPO) H5522-004-0 – $0 per month with $0 deductible and $7,550 maximum out-of-pocket expenses. Office visit copays are $0 and $40 with ER copay of $110. The inpatient hospital copay is $145 for the first four days, and the ambulance copay is $225. X-rays are subject to a $25 copay and CT scans and diagnostic radiology is subject to a $0-$225 copay. Prescription drug copays for 30 days are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). Prescription drug copays for 90 days (mail order) are $0 (Tier 1), $0 (Tier 2), $141 (Tier 3), and $300 (Tier 4). The summary star rating is 4.5 and 7,935 members are enrolled in this plan statewide. 3,647 formulary drugs available.

Advantra Gold (HMO) H3959-001-0 – $35 per month with $0 deductible and $5,500 maximum out-of-pocket expenses. Office visit copays are $0 and $30 with ER copay of $110. The inpatient hospital copay is $250, and the ambulance copay is $225. X-rays are subject to a $20 copay and CT scans and diagnostic radiology is subject to a $0-$220 copay. Prescription drug copays for 30 days are $0 (Tier 1), $0 (Tier 2), $37 (Tier 3), $99 (Tier 4), and 33% (Tier 5). Prescription drug copays for 90 days (mail order) are $0 (Tier 1), $0 (Tier 2), $111 (Tier 3), and $297 (Tier 4). The summary star rating is 4.5 and 17,578 members are enrolled in this plan statewide. 3,664 formulary drugs available.

Value (PPO) H5521-263-0 – $0 per month with $0 deductible and $7,550 maximum out-of-pocket expenses. Office visit copays are $10 and $50 with ER copay of $95. The inpatient hospital copay is $255 for the first eight days, and the ambulance copay is $265. X-rays are subject to a $30 copay and CT scans and diagnostic radiology is subject to a $0-$295 copay.  Prescription drug copays for 30 days are $0 (Tier 1), $5 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). Prescription drug copays for 90 days (mail order) are $0 (Tier 1), $10 (Tier 2), $141 (Tier 3), and $300 (Tier 4). The summary star rating is 3.5 and 7,464 members are enrolled in this plan statewide. 3,647 formulary drugs available.

Gold (PPO) H5521-122-0 – $176 per month with $0 deductible and $7,550 maximum out-of-pocket expenses. Office visit copays are $10 and $35 with ER copay of $95. The inpatient hospital copay is $400 and the ambulance copay is $250. X-rays are subject to a $15 copay and CT scans and diagnostic radiology is subject to a $0-$250 copay.  Prescription drug copays for 30 days are $0 (Tier 1), $5 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). Prescription drug copays for 90 days (mail order) are $5 (Tier 1), $10 (Tier 2), $141 (Tier 3), and $300 (Tier 4). The summary star rating is 3.5 and 1,636 members are enrolled in this plan statewide. 3,664 formulary drugs available.

Silver (HMO) H3931-070-0 – $47 per month with $0 deductible and $7,550 maximum out-of-pocket expenses. Office visit copays are $15 and $45 with ER copay of $95. The inpatient hospital copay is $195 for 7 days and the ambulance copay is $250. X-rays are subject to a $25 copay and CT scans and diagnostic radiology is subject to a $0-$255 copay.  Prescription drug copays for 30 days are $0 (Tier 1), $5 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). Prescription drug copays for 90 days (mail order) are $0 (Tier 1), $10 (Tier 2), $141 (Tier 3), and $300 (Tier 4). The summary star rating is 3.5 and 804 members are enrolled in this plan statewide. 3,647 formulary drugs available.

Advantra Credit Value (PPO) H5522-017-0 – $0 per month with $0 deductible and $7,550 maximum out-of-pocket expenses. Office visit copays are $10 and $50 with ER copay of $90. The inpatient hospital copay is $360 for first five days and the ambulance copay is $270. X-rays are subject to a $50 copay and CT scans and diagnostic radiology is subject to a $0- $350 copay. Lab services receive a $0- $5 copay. Prescription drug copays for 30 days are $0 (Tier 1), $5 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). Prescription drug copays for 90 days (mail order) are $0 (Tier 1), $10 (Tier 2), $141 (Tier 3), and $300 (Tier 4). The summary star rating is 4.5 and and 804 members are enrolled in this plan statewide. 3,647 formulary drugs available.

Advantra Premier (PPO) H5522-018-0 – $20 per month with $0 deductible and $5,900 maximum out-of-pocket expenses. Office visit copays are $5 and $35 with ER copay of $90. The inpatient hospital copay is $300 and the ambulance copay is $275. X-rays are subject to a $25 copay and CT scans and diagnostic radiology is subject to a $0- $275 copay. Lab services receive a $0-$5 copay. Prescription drug copays for 30 days are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). Prescription drug copays for 90 days (mail order) are $0 (Tier 1), $0 (Tier 2), $141 (Tier 3), and $300 (Tier 4). The summary star rating is 5.0.

Advantra Premier Plus (PPO) H5522-002-0 – $48 per month with $0 deductible and $4,500 maximum out-of-pocket expenses. Office visit copays are $0 and $30 with ER copay of $90. The inpatient hospital copay is $250 and the ambulance copay is $225. X-rays are subject to a $20 copay and CT scans and diagnostic radiology is subject to a $0- $225 copay. Lab services receive a $0 copay. Prescription drug copays for 30 days are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), $99 (Tier 4), and 33% (Tier 5). Prescription drug copays for 90 days (mail order) are $0 (Tier 1), $0 (Tier 2), $111 (Tier 3), and $297 (Tier 4). The summary star rating is 5.0.

Advantra Premier (HMO) H3959-039-0 – $25 per month with $0 deductible and $7,550 maximum out-of-pocket expenses. Office visit copays are $5 and $35 with ER copay of $90. The inpatient hospital copay is $375 and the ambulance copay is $260. X-rays are subject to a $25 copay and CT scans and diagnostic radiology is subject to a $0- $275 copay. Lab services receive a $0 copay. Prescription drug copays for 30 days are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). Prescription drug copays for 90 days (mail order) are $0 (Tier 1), $0 (Tier 2), $141 (Tier 3), and $300 (Tier 4). The summary star rating is 4.5.

 

Part D Prescription Drug Plans Through CVS Health

SilverScript Choice (PDP S5601-012) – cost is $40.70 per month and Medicare Star Rating is 3.0. Deductible is $545. Preferred pharmacy 30-day copays are $2 (Tier 1), $7 (Tier 2), 16% (Tier 3), 35% (Tier 4), and 25% (Tier 5). Mail-order pharmacy 90-day copays are $6 (Tier 1), $21 (Tier 2), 16% (Tier 3), and 35% (Tier 4). 3,505 formulary drugs are available and 114,705 members are enrolled in the plan in Pennsylvania. 1,785,538 members are enrolled in the US.

SilverScript Plus (PDP S5601-013) – cost is $99.60 per month and Medicare Star Rating is 3.5. Deductible is $200. Preferred pharmacy 30-day copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 30% (Tier 5). Mail-order pharmacy 90-day copays are $0 (Tier 1), $0 (Tier 2), $141 (Tier 3), and 50% (Tier 4). 3,585 formulary drugs are available and 7,477 members are enrolled in the plan in Pennsylvania. 326,575 members are enrolled in the US.

SilverScript SmartSaver (PDP S5601-181) – cost is $9.90 per month and Medicare Star Rating is 3.0. Deductible is $280. Preferred pharmacy 30-day copays are $0 (Tier 1), $5 (Tier 2), 24% (Tier 3), 50% (Tier 4), and 29% (Tier 5). Mail-order pharmacy 90-day copays are $0 (Tier 1), $15 (Tier 2), 24% (Tier 3), and 50% (Tier 4). 3,634 formulary drugs are available and 44,025 members are enrolled in the plan in Pennsylvania. 1,608,021 members are enrolled in the US.

 

How An HMO Works

Individuals who join an Aetna HMO are classified as its members. Your primary care physician (PCP) is selected from a large Network list. Your physician will coordinate and supervise all of your medical care and you can change your choice at any time. There are no claim forms when you visit a network provider and no waiting period for routine physical exams or most preventive services. Internal medicine and pediatric services will also be provided, if needed. It’s essentially a “hassle-free” way to be treated. Most Marketplace and Exchange plans are HMOs.

NOTE: Treatment of prescriptions often changes (what is generic, what is non-generic etc…) and the Aetna Pharmacy Plan Drug List will help you stay updated regarding any changes.Thousands of drugs are included, and by choosing the plan name and plan year, the full list can be viewed. Medical exceptions for non-covered drugs including expedited medical exceptions are available. For life-threatening situations, a faxed, written, or phone request can be submitted, and a decision will be made within 24 hours.

You can also contact us for an explanation. All plans are available, including Advance Control, Funding Advantage, Performance, Standard Opt Out, Standard, Premier, Premier Plus, Value, Value Plus, and Commercial. If non-Aetna options are more cost-effective, they will be presented.

Typically, you present your ID card and your physician or hospital will handle the paperwork. You then receive quality medical treatment at a reduced cost. This is because of the negotiation that is done on your behalf by the carrier. All Keystone State residents benefit by paying less, and the insurer and doctors are happy since they have more customers. If you travel outside of the area, depending on the policy, you can still be treated and receive the negotiated cost reduction.

Leap Network

Aetna previously utilized the Leap Network in Pennsylvania. Generally, you could easily find a doctor, specialist, medical facility, treatment center, or hospital close to your work or home. Listed below are the seven provider networks and the counties of coverage:

Aetna Savings Plus – Bucks, Chester, Delaware, Montgomery, and Philadelphia.

Commonwealth Health – Columbia, Lackawanna, Luzerne, Wayne, and Wyoming.

Lehigh Valley Health Network – Lehigh and Northampton.

Penn Highlands Healthcare – Clearfield, Elk, and Jefferson.

Pinnacle Health – Cumberland, Dauphin, and Perry.

Uniontown Hospital – Fayette.

Aetna – Adams, Bradford, Cameron, Clinton, Franklin, Lycoming, McKean, Mercer, Monroe, Potter, Sullivan, Susquehanna, Tioga, Vernando, Warren, and York.

 

Impact Of The Affordable Care Act (Obamacare)

With the creation of the “Marketplace” concept of buying subsidized coverage, many companies (including Aetna) no longer offer plans in all parts of the US. Also, it is possible that availability of policies may be different, depending where you live. And of course, federal subsidies can potentially reduce your premiums, if your household income meets Federal Poverty Level guidelines. NOTE: The Pa Health Insurance Exchange offers single, family and small business coverage. You can view all available options directly through our website and enroll in 10 minutes. Pennie is the state-based marketplace in the Keystone State.

Previous private plans were available and eligible for financial assistance to help reduce premiums. However, Aetna, like many carriers, does not currently offer individual (non-Group) coverage in the Keystone State. It is expected that by 2024, single and family coverage may return if individual states are given more control over offered plans and policy benefits.

We have listed below the previously-offered Pa Aetna HMO plans with a brief description. Dental and vision benefits are typically available as riders or stand-alone policies. These policies were purchased on or “off-Exchange” and federal subsidies applied.

Aetna Pa HMO Plans

Bronze Tier

$15 Copay Savings Plus – $15 primary care physician copay. Specialist visits subject to the deductible ($5,000). $20 generic drug copay.

Deductible Only HSA Eligible –  $6,300 deductible but can be used as an HSA. The investment account is optional.

$20 Copay –  Similar to previous plan with $20 pcp copay and $15 generic drug copay. Deductible is also higher ($5,750).

 

Silver Tier (Eligible for cost-sharing)

$10 Copay –  $3,750 deductible with $10 and $60 copays on office visits.

$5 Copay $2500 Savings Plus – $2,500 deductible with $5 and $50 copay on office visits. Popular with household with multiple children.

$10 Copay –  $3,750 deductible with $10 and $75 office visit copays.

$5 Copay –  $2,750 deductible with $5 and $75 copays on office visits. This plan is the most expensive HMO in the Silver tier.

 

Gold Tier

$0 Copay Savings Plus –  Low $1,250 deductible with $0 and $40 office visit copays. Both generic and brand drugs not subject to deductible.

$5 Copay – $1,400 deductible with $5 and $40 office visit copays. Brand drugs have a copay and deductible to meet.

 

Popular Non-HMO Plans

Bronze Deductible Only HSA Eligible OAMC POS – Identical to Deductible Only HMO option.

Bronze Deductible $20 Copay OAMC-POS –  Identical to $20 Copay HMO option.

Silver $10 Copay OAMC-POS – Identical to second $10 Copay (Silver-tier).

Aetna Pa Small Group (1-50 Employees) Plans

Pa Platinum PPO 100/50 200D – $0 deductible with $5,000 maximum out-of-pocket expenses. Office visit copays are $20 and $40 with $20 walk-in clinic copay. Diagnostic lab and x-ray testing are covered at 100%. Inpatient hospital facility copay is $200 per day for the first 5 days. Urgent Care and ER copays are $75 and $200. Outpatient surgeries have a $200 copay. Prescription drug copays are $3 (low-cost generic), $10 (generic), $35 (preferred brand), and $60 (non-preferred).

Pa Gold PPO 100/50 600D – $0 deductible with $6,850 maximum out-of-pocket expenses. Office visit copays are $45 and $75 with $45 walk-in clinic copay. Diagnostic lab and x-ray testing copays are $45 and $75. Inpatient hospital facility copay is $600 per day for the first 5 days. Urgent Care and ER copays are $80 and $300. Outpatient surgeries are covered at 100%. Prescription drug copays are $3 (low-cost generic), $10 (generic), $50 (preferred brand), and $100 (non-preferred).

Pa Gold PPO 1000 100/50 – $1,000 deductible with $6,850 maximum out-of-pocket expenses. Office visit copays are $25 and $50 with $25 walk-in clinic copay. Diagnostic lab and x-ray testing copays are $10 and $50. Inpatient hospital facility visits are subject to deductible. Urgent Care and ER copays are $75 and $300. Outpatient surgeries are covered at 100% after the deductible. Prescription drug copays are $3 (low-cost generic), $10 (generic), $35 (preferred brand), and $60 (non-preferred).

Pa Gold PPO 2000 100/50 – $2,000 deductible with $6,850 maximum out-of-pocket expenses. Office visit copays are $25 and $50 with $25 walk-in clinic copay. Diagnostic lab and x-ray testing are covered at 100% after the deductible. Inpatient hospital facility visits are subject to deductible. Urgent Care and ER copays are $75 and $250. Outpatient surgeries are covered at 100% after the deductible. Prescription drug copays are $3 (low-cost generic), $10 (generic), $35 (preferred brand), and $60 (non-preferred).

Pa Silver PPO 3000 100/50 – $3,000 deductible with $6,850 maximum out-of-pocket expenses. Office visit copays are $25 and $75 with $25 walk-in clinic copay. Diagnostic lab and x-ray testing copays are $25. Inpatient hospital facility visits are subject to deductible. Urgent Care and ER copays are $75 and $250. Outpatient surgeries are covered at 100% after the deductible. Prescription drug copays are $3 (low-cost generic), $10 (generic), $50 (preferred brand), and $75 (non-preferred).

Pa Silver PPO 4000 100/50 – $4,000 deductible with $6,850 maximum out-of-pocket expenses. Office visit copays are $30 and $60 with $30 walk-in clinic copay. Diagnostic lab and x-ray testing copays are covered at 100% after the deductible. Inpatient hospital facility visits are subject to deductible. Urgent Care and ER copays are $75 and $200. Outpatient surgeries are covered at 100% after the deductible. Prescription drug copays are $3 (low-cost generic), $10 (generic), $50 (preferred brand), and $75 (non-preferred).

Pa Silver PPO 5000 100/50 – $5,000 deductible with $6,850 maximum out-of-pocket expenses. Office visit copays are $25 and $50 with $25 walk-in clinic copay. Diagnostic lab and x-ray testing copays are covered at 100% after the deductible. Inpatient hospital facility visits are subject to deductible. Urgent Care and ER copays are $75 and $250. Outpatient surgeries are covered at 100% after the deductible. Prescription drug copays are $3 (low-cost generic), $10 (generic), $35 (preferred brand), and $60 (non-preferred).

Pa Bronze PPO 7000 100/50 – $7,000 deductible with $7,150 maximum out-of-pocket expenses. Pcp Office visit and walk-in clinic copay is $75. Diagnostic lab and x-ray testing copays are covered at 100% after the deductible. Inpatient hospital facility visits are subject to deductible. Urgent Care copay is $150. Outpatient surgeries are covered at 100% after the deductible. Prescription drug copays are $15 (low-cost generic) and $35 (generic).

Pa Bronze HMO 5580 80 HSA – $5,550 deductible with $6,550 maximum out-of-pocket expenses. HSA-eligible plan. Prescription drug copays are $3 (low-cost generic), $10 (generic), $50 (preferred brand), and $75 (non-preferred).

Pa Silver Indemnity Silver 2000 80% – $2,000 deductible with $6,000 maximum out-of-pocket expenses. 20% coinsurance. Prescription drug copays are $3 (low-cost generic), $15 (generic), $50 (preferred brand), and $100 (non-preferred).

Pa Gold QPOS 100/50 600D – $0 deductible with $6,850 maximum out-of-pocket expenses. Office visit copays are $45 and $75 with $45 walk-in clinic copay. Diagnostic lab and x-ray testing copays are $45 and $75. Inpatient hospital facility visits are subject to $600 copay for 5 days. Urgent Care and ER copays are $80 and $300. Outpatient surgeries are covered at 100%. Prescription drug copays are $3 (low-cost generic), $10 (generic), $50 (preferred brand), and $100 (non-preferred).

 

Aetna Pa Small Group (51-100 Employees) Plans

Pa PPO 100/50 500D – $0 deductible with $5,000 maximum out-of-pocket expenses. Office visit copays are $40 and $50 with $40 walk-in clinic copay. Diagnostic lab and x-ray testing are covered with $40 and $60 copays. Inpatient hospital facility copay is $500 per day for the first 5 days. Urgent Care and ER copays are $60 and $200. Outpatient surgeries have a $500 copay. Prescription drug copays are $3 (low-cost generic), $10 (generic), $50 (preferred brand), and $75 (non-preferred).

Pa PPO 100/50 750D – $0 deductible with $5,000 maximum out-of-pocket expenses. Office visit copays are $50 and $75 with $50 walk-in clinic copay. Diagnostic lab and x-ray testing are covered with $50 and $75 copays. Inpatient hospital facility copay is $750 per day for the first 5 days. Urgent Care and ER copays are $75 and $200. Outpatient surgeries have a $750 copay. Prescription drug copays are $3 (low-cost generic), $10 (generic), $50 (preferred brand), and $75 (non-preferred).

Pa PPO 1000 100/50 $25 – $1,000 deductible with $5,000 maximum out-of-pocket expenses. Office visit copays are $25 and $50 with $25 walk-in clinic copay. Diagnostic lab and x-ray testing are covered with $30 and $50 copays. Inpatient hospital facility copay is $750 per day for the first 5 days. Urgent Care and ER copays are $50 and $200. Outpatient surgeries are covered at 100% after the deductible. Prescription drug copays are $3 (low-cost generic), $10 (generic), $50 (preferred brand), and $75 (non-preferred).

Pa PPO 2000 100/50 $30 – $2,000 deductible with $6,550 maximum out-of-pocket expenses. Office visit copays are $30 and $50 with $30 walk-in clinic copay. Diagnostic lab and x-ray testing are covered with $30 (deductible does not apply) and $50 copays. Inpatient hospital facility copay is $500 after the deductible. Urgent Care and ER copays are $50 and $200 (after the deductible). Outpatient surgeries are covered with a $250 copay after the deductible. Prescription drug copays are $3 (low-cost generic), $10 (generic), $50 (preferred brand), and $75 (non-preferred).

Pa PPO 2000 100/50 $35 – $2,000 deductible with $5,000 maximum out-of-pocket expenses. Office visit copays are $35 and $60 with $35 walk-in clinic copay. Diagnostic lab and x-ray testing are covered with $35 and $60 copays. Inpatient hospital facility covered at 100% after the deductible. Urgent Care and ER copays are $60 and $200. ER is subject to the deductible. Outpatient surgeries are covered at 100% after the deductible. Prescription drug copays are $3 (low-cost generic), $10 (generic), $50 (preferred brand), and $75 (non-preferred).

Pa PPO 2500 100/50 $30 – $2,500 deductible with $5,000 maximum out-of-pocket expenses. Office visit copays are $30 and $50 with $30 walk-in clinic copay. Diagnostic lab and x-ray testing are covered with $30 and $50 copays (x-rays subject to deductible). Inpatient hospital facility covered at 100% after the deductible and $500 copay. Urgent Care and ER copays are $50 and $200 after the deductible. Outpatient surgeries are covered at 100% after a $250 copay and the deductible. Prescription drug copays are $3 (low-cost generic), $10 (generic), $50 (preferred brand), and $75 (non-preferred).

Pa PPO 3000 100/50 $30 – $3,000 deductible with $6,000 maximum out-of-pocket expenses. Office visit copays are $30 and $50 with $30 walk-in clinic copay. Diagnostic lab and x-ray testing are covered with $30 and $50 copays. Inpatient hospital facility copay is $500 after the deductible. Urgent Care and ER copays are $50 and $200 (after the deductible). Outpatient surgeries are covered with a $250 copay after the deductible. Prescription drug copays are $3 (low-cost generic), $10 (generic), $50 (preferred brand), and $75 (non-preferred).

Pa PPO 5000 100/50 $25 – $5,000 deductible with $6,550 maximum out-of-pocket expenses. Office visit copays are $25 and $50 with $25 walk-in clinic copay. Diagnostic lab and x-ray testing are covered with $25 and $50 copays. Inpatient hospital facility covered in full after the deductible. Urgent Care and ER copays are $50 and $200 (after the deductible). Outpatient surgeries are covered in full after the deductible. Prescription drug copays are $3 (low-cost generic), $10 (generic), $50 (preferred brand), and $75 (non-preferred).

Pa PPO 5000 100/50 HSA – $5,000 deductible with $6,550 maximum out-of-pocket expenses. HSA-eligible plan. Prescription drugs are subject to deductible.

Pa PPO 3000 100/50 HSA – $3,000 deductible with $6,550 maximum out-of-pocket expenses. HSA-eligible plan. Prescription drugs are subject to deductible.

 

Small Group Dental Voluntary And Non-Voluntary Plans

Preventative Care

DMO

Freedom-Of-Choice

PPO Max

PPO High-Option Plan

PPO 1500

DMO 100/90/60

PPO Max 100/80/0

Active PPO Max

PPO 1000

Copay 42

DMO 100/80/50

DMO 100/90/60

DMO 100/100/60

Copay 56

PPO Max 100/70/40

PPO 100/80/50

Preferred 100/90/60

Preferred 100/80/50

Preferred 100/100/60

International Travel And Medical Coverage For Company Employees

International business travelers, students, third-country nationals, and expatriates can secure excellent benefits at a fair and affordable price. Coverage for your company employees is professionally administered with a wide variety of doctors, hospitals and medical facilities. Available policy options are listed below:

Indemnity – Treatment is provided by a provider you choose. Services are paid at the time of treatment, and a claim is subsequently submitted for reimbursement. Worldwide benefits are included.

PPO – A preferred provider organization also allows the covered individual or family member to pick their provider. While back in the US, staying within the network will result in lower out-of-pocket expenses. Thus, there is great incentive to choose network providers.

HRA (Health Reimbursement Arrangement) – A deposit is made into the HRA each year to assist paying healthcare expenses. Qualified preventative expenses are 100% covered. When no funds remain, and the deductible is paid, the contract covers remaining medical expenses according to the policy provisions.

Group Trust – Designed for a business with expatriate 2-50 employees. Comprehensive benefits that is typically only offered to larger companies.

International Expatriate Trust – PPO option with emergency evacuation and assistance. Prescription, vision, and mental health counseling also included. Dental, life, and disability options can be added.

World Traveler – Ideal for travelers that need coverage for business trips less than six months.

International World Traveler – More extensive benefits than previous plan. Several extras include political and natural disaster help, lost checked-in baggage protection, trip interruption and evacuation coverage.

International Ascent – For groups of 2-10 employees. Six different plans that include global and wellness benefits.

Two mobile plans (Classic and Exclusive) are also offered. Both policies provide up to $2 million of benefits. The Exclusive plan provides more extensive coverage.

 

Aetna Summit Plans – Coverage for Europe, Singapore, Hong Kong, And The Middle East

Summit plans provide multilingual case managers that can help customize the most appropriate coverage. Crisis management experts are also provided, if needed. A wide selection of hospitals and policy deductibles add additional flexibility. Plan descriptions are listed below:

Aetna Summit 1750 – $1,750,000 plan limit. Inpatient and day care treatment, parent hospital accommodation, outpatient post-hospitalization (90 days), outpatient surgical procedures, and outpatient dental treatment resulting from an injury are covered in full. Emergency medical evaluation, repatriation, local ambulance and cancer care are also fully covered. Inpatient treatment of acute conditions for newborns is covered up to $150,000 and emergency and daycare treatment outside network area is covered up to $5,000. Durable medical equipment is covered up to $1,000 and $125 of hospital cash for 20 days is available. Emergency assistance services paid in full.

Aetna Summit 2500 – $2,500,000 plan limit. Inpatient and day care treatment, parent hospital accommodation, outpatient post-hospitalization (90 days), outpatient surgical procedures, and outpatient dental treatment resulting from an injury are covered in full. Emergency medical evaluation, repatriation, local ambulance and cancer care are also fully covered. Inpatient treatment of acute conditions for newborns is covered up to $150,000 and emergency and daycare treatment outside network area is covered up to $5,000. Durable medical equipment is covered up to $1,000 and $125 of hospital cash for 20 days is available. Emergency assistance services include online and telephonic support. Outpatient services include consultations, treatments, and tests ($5,000), complementary medicine ($1,500), traditional Chinese medicine ($300), and psychiatric treatment ($1,000). Medical complications of maternity ($15,000) and congenital abnormalities ($25,000) are also covered.

We realize that it’s sometimes not easy to fully understand all of the specifics of medical coverage. We’ll be happy to take the time to review the coverage and determine if a policy is best for you. If it isn’t, we’ll consider hundreds of other options from the top companies and together, we’ll compare your best choices. Remember that it’s very important to review your existing policy before every annual Open Enrollment.

We provide all the tools you need (along with personal service) to easily view benefits and apply for coverage. Call or email us any time for additional information. Purchasing a policy is an easy process.