2016 Small Group Medical Network Plan Benefits Carrier
Network Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Full Full Full Full Full Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Full Full Full
Product HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO
Metal Tier Bronze Bronze Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Platinum Platinum Platinum Silver Silver Silver Silver Silver Silver Gold Gold Gold Gold Platinum Bronze Bronze Bronze Gold Gold Gold Platinum Platinum Silver Silver Silver Silver Silver Bronze Bronze Platinum Platinum Gold
Plan Name Basic HMO Ded. 5500 HMO Ded. 5500 AVN HMO 10 AVN HMO 20 AVN HMO 30 AVN HMO 35 Basic HMO 10 Basic HMO 20 Basic HMO 30 Basic HMO 35 Basic HMO Ded. 500 80 HMO Deductible 250 HMO Deductible 500 80 AVN HMO 20 Copay Plan Basic HMO 20 Copay Plan Vitalidad HMO $15 Basic HMO Ded. 1500 Copay Plan Basic HMO Ded. 1100 Basic HMO Ded. 2000 HMO Ded. 1500 Copay Plan HMO Ded. 1100 HMO Ded. 2000 HMO 10 HMO 20 HMO 30 HMO 35 Copay HMO 20 Copay Savings Plus 4000 Copay Plan Savings Plus 6500 Plan Savings Plus 6850 100/50 Saving Plus 0 Copay Plan Savings Plus 500 80/50 Savings Plus 750 80/50 Savings Plus 0 Copay Plan Savings Plus 250 90/60 Savings Plus 1000 60/50 Savings Plus 1000 75/50 Savings Plus 1500 60/50 Savings Plus1500 60/50 Coins Plan Savings Plus 2000 60/50 Savings Plus 5000 70/50 HSA Savings Plus 6450 100/50 HSA MC 250 90/60 MC 0 Copay MC 500 80/50
Plan Ded. $5,500 $5,500 $0 $0 $0 $0 $0 $0 $0 $0 $500 $250 $500 $0 $0 $0 $1,500 $1,000 $2,000 $1,500 $1,000 $2,000 $0 $0 $0 $0 $0 $4,000 $6,000 $6,850 $0 $500 $0 $0 $250 $1,000 $1,000 $1,500 $1,500 $2,000 $5,000 $6,450 $250 $0 $500
OOP Max. $6,600 $6,600 $5,000 $6,000 $6,000 $6,200 $5,000 $6,000 $6,000 $6,200 $5,500 $5,500 $5,500 $4,000 $4,000 $3,000 $6,500 $6,850 $6,000 $6,500 $6,850 $6,000 $5,000 $6,000 $6,000 $6,200 $4,000 $6,600 $6,500 $6,850 $6,200 $5,000 $5,500 $4,000 $4,000 $6,500 $6,500 $6,500 $6,500 $6,500 $6,450 $6,450 $4,000 $4,000 $5,000
Office Visit $50/$75 $50/$75 $10/$30 $20/$60 $30/$60 $35/$55 $10/$30 $20/$60 $30/$60 $35/$55 $20/$40 $20/$40 $20/$40 $20/$40 $20/$40 $15/$15 $45/$70 $40/$60 $40/$60 $45/$70 $40/$60 $40/$60 $10/$30 $20/$60 $30/$60 $35/$55 $20/$40 $50/$75 $70/$90 $30/$150 $35/$55 $35/$35 $30/$40 $20/$40 $15/$25 $30/$40 $30/$40 $30/$50 $45/$70 $30/$50 30% 0% $15/$25 $20/$40 $35/$35
This is an overview for comparison purposes only. Please refer to carrier benefit summaries for full details.
Inpatient 50% 50% $750/admit $750/admit $500/day (max 5) $600/day (max 5) $750/admit $750/admit $500/day (max 5) $600/day (max 5) 20% $500/day (max 3) 20% $250/day $250/day $100/day (max 7) 20% $500/day (max 3) $500/day (max 3) 20% $500/day (max 3) $500/day (max 3) $750/admit $750/admit $500/day (max 5) $600/day (max 5) $250/day (max.5) $750/admit 100% 0% $600/day (max 5) 20% 20% $250/day (max 5) 10% 40% 25% 40% 20% 40% 30% 0% 10% $250/day (max 5) 20%
Rx $35/$75/$150 $35/$75/$150 $30/$60/$90 $20/$50/$100 $20/$50/$70 $15/$50/$70 $30/$60/$90 $20/$50/$100 $20/$50/$70 $15/$50/$70 $10/$50/$70 $25/$40/$90 $10/$50/$70 $5/$15/$25 $5/$15/$25 $25/$50 $15/$55/$75 $25/$50/$100 $15/$50/$70 $15/$55/$75 $25/$50/$100 $15/$50/$70 $30/$60/$90 $20/$50/$100 $20/$50/$70 $15/$50/$70 $5 /$15/$25 $35/$100/$150 0%/0%/0% $35/0%/0% $15/$50/$70 $15/$50/$70 $15/$50/$ $5/$15/$25 $5/$25/$70 $25/$50/$70 $30/$60/$70 $10/$50/$70 $15/$55/$75 $15/$50/$70 $25/$50/$100 0%/0%/0% $5/$25/$70 $5/$15/$25 $15/$50/$70
Rx Ded. *$250 *$250 *$250 *$250 *$250 $0 *$250 *$250 *$250 $0 *Plan ded. *Plan ded. *Plan ded. $0 $0 $0 *$250 $0 $0 *$250 $0 $0 *$250 *$250 *$250 $0 $0 *$400 $500 *Plan ded. $0 $0 $0 $0 $0 *$250 *$250 *$250 *$250 *$150 *Plan ded. *Plan ded. $0 $0 $0
2016 Small Group Medical Network Plan Benefits
Aetna (continued)
Carrier
Network Full Full Full Full Full Full Full Full Full Full Full Full Full
Product PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO
Metal Tier Gold Gold Gold Silver Silver Silver Silver Silver Bronze Bronze Bronze Bronze Bronze
Plan Name MC 750 80/50 MC 0 Copay PPO 750 80/50 MC 1000 75/50 MC 1000 60/50 MC 1500 60/50 MC 2000 60/50 MC 1500 80 Coins Plan MC 4000 Copay MC 6850 100/50 MC 6500 Plan MC 5000 70/50 HSA MC 6450 100/50 HSA
Plan Ded. $750 $0 $750 $1,000 $1,000 $1,500 $0 $1,500 $4,000 $6,850 $6,000 $5,000 $6,450
OOP Max. $5,500 $6,200 $5,500 $6,500 $6,500 $6,500 $6,500 $6,500 $6,600 $6,850 $6,500 $6,450 $6,450
Office Visit $30/$40 $35/$55 $30/$40 $30/$40 $30/$40 $30/$60 $30/$50 $45/$70 $50/$75 $30/$150 $70/$90 30% 0%
* Rx deductible applies only to tiers 2 & 3
This is an overview for comparison purposes only. Please refer to carrier benefit summaries for full details.
Inpatient 20% $600/day (max 5) 20% 25% 40% 40% 40% 20% $750/admit 0% 100% 30% 0%
Rx $15/$50/$70 $15/$50/$70 $15/$50/$100 $30/$60/$70 $25/$50/$70 $10/$50/$70 $15/$50/$70 $15/$55/$75 $35/$100/$150 $35/0%/0% 100% ($500 max) $25/$50/$100 0%/0%/0%
Rx Ded. $0 $0 $0 *$250 *$250 *$250 *$250 *$250 *$400 *Plan ded Plan ded Plan ded Plan ded
