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 |
Plan Documents and Resources