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Aetna HMO

Aetna
800-445-5299
Group Number: 237642 

Employees can access Aetna Health Maintenance Organization (HMO) Plans provide a high-quality network of doctors and hospitals and allows members to enjoy the freedom to choose from a variety of care options. Both Aetna AWH and Aetna HMO require members to select an in-network Primary Care Provider (PCP). These plans are ideal if you prefer a lower payroll deduction and are comfortable with a PCP directing member's care. Both plans may provide coverage in California only. 

 

Medical Plan Comparisons:

2025 MEDICAL PLANS 

Aetna AWH

Aetna HMO

Annual Deductible    
Individual None None
Individual within Family None None
Family None None
Annual Out of Pocket Maximum    
Individual  $2,000 $2,000
Family $4,000 $4,000
Lifetime Maximum Unlimited Unlimited

Medical Services

Primary Care Visit $20 copay $20 copay
Specialist Office Visit $20 copay with PCP Referral $20 copay with PCP referral
Routine Physical Exam / Preventative Care No Copay No Copay
Diagnostic X-ray / Laboratory No Copay No Copay
Inpatient Hospital $250 copay per admission $250 copay per admission
Outpatient Hospital $20 Copay $20 Copay
Emergency Room (waived if admitted) $100 copay $100 copay
Urgent Care $20 copay $20 copay
Chiropractic $15 copay per visit to 
20 visits per year
$15 copay per visit to 
20 visits per year
Acupuncture $20 copay per visit to 
20 visits per year
$20 copay per visit to 
20 visits per year
Hearing Aid 20% coinsurance, $4,000 benefit maximum every 24 months 20% coinsurance, $4,000 benefit maximum every 24 months
Prescription Drugs    
Contraceptive Drugs No Charge No Charge
Generic / Tier 1 (30-day supply) $5 copay $5 copay
Formulary / Tier 2 (30-day supply) $20 copay $20 copay
Non-Formulary / Tier 3 (30-day supply) $40 copay $40 copay
Specialty / Tier 4 (30-day supply) 20% up to $200 Copay 20% up to $200 Copay
Mail Order (90-day supply) Tiers 1, 2 &3: 2x Retail Copay Tiers 1, 2 &3: 2x Retail Copay