Individual $6,750 / family $13,500 Individual $20,250 / family $60,750 Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. Cy, oral fertility drugs, diabetic supplies Summary of benefits and coverage What this plan covers & what you pay for covered services
Afa cposii 100/50 $25 $500d cy v23 coverage period All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies. Contraceptive drugs and devices obtainable from a pharmacy, oral fertility drugs, diabetic supplies Preventive and s asonal vaccinations covere not all drugs are covered Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of.
3 exams in the second year 3 exams in the third year And 1 exam per 12 months from age 3 to age 22 Includes routine tests and related lab fees Limited to 1 exam every 12 months. Aetna complies with applicable federal civil rights laws and does not discriminate, exclude or treat people differently based on their race, color, national origin, sex, age, or disa bility
Aetna provides free aids/services to people with disabilities and to people who need language assistance. Stop loss insurance coverage is offered by aetna life insurance company All services are subject to the deductible unless noted otherwise Some benefits are subject to age and frequency schedules, limitations or visit maximums.
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