Plan Summary - AnyHealthInsurance.com

MANAGED CHOICE OPEN ACCESS VALUE 8000

Amounts shown for covered services are your share of costs In-Network Benefits
	MANAGED CHOICE OPEN ACCESS VALUE 8000
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Insurance Company
Plan Type - PPO \| HMO \| HSA	PPO
Annual Deductible	$8,000 individual; $16,000 family
Annual Out-Of-Pocket (includes Annual Deductible)	$12,500 individual; $25,000 family
Doctor Visit	Non-specialist: First 5 visits: $50 copay (deductible waived), then 0% coinsurance after out-of-pocket maximum; Specialist: First 5 visits: $50 copay (deductible waived), then 0% coinsurance after out-of-pocket maximum
Lifetime Maximum	$5,000,000
Inpatient	40% coninsurance after deductible
Outpatient	30% coinsurance after deductible
Maternity	Not covered (except for pregnancy complications)
Emergency Services	$100 copay (waived if admitted to inpatient) + 30% coinsurance after deductible
Ambulance	30% coinsurance after deductible
X-Ray & Lab	30% coinsurance after deductible
Annual Check up	$50 copay (deductible waived), Aetna will pay up to $250 per exam
Pap Smear/Mammogram	$0 copay (deductible waived)
Physical Therapy	30% coinsurance after deductible (24 visits per year combined with occupational therapy and chiropratic care, Aetna will pay up to $25 per visit max)
Acupuncture	Not covered
Chiropractic Care	30% coinsurance after deductible (24 visits per year combined with physical and occupational therapy, Aetna will pay up to $25 per visit max)
Generic Rx	$20 copay (deductible waived)
Brand Name Rx	Not covered
Term Life Coverage	Not covered
Dental	Optional
Vision	Not covered
Eligibility	Reside in California at least 6 months
Available Effective Date	1st or 15th of the month
Plan Limitations And Restrictions	PDF
Insurance Company
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	MANAGED CHOICE OPEN ACCESS VALUE 8000