Live Chat Software

Aetna Advantage Managed Choice OA and PPO Out-of-Network Benefit Summary* (click here for In-Network benefit summary)
Description of Benefits		MC OA/PPO 1500	MC OA/PPO 2500	MC OA/PPO 3500	MC OA/PPO 5000	MC OA/PPO Value 2000	MC OA/PPO Value 5000
Lifetime Maximum Per Member		$5,000,000	$5,000,000	$5,000,000	$5,000,000	$5,000,000	$5,000,000
Annual Deductible Per Member (2 person maximum)		$3,000	$5,000	$7,000	$10,000	$4,000	$10,000
Annual Out-of-Pocket Maximum (2 person family maximum)		$4,500 per member-Includes deductible	$7,500 per member-Includes deductible	$10,000 per member-Includes deductible	$12,500 per member-Includes deductible	$6,000 per member-Includes deductible	$12,500 per member-Includes deductible
Office Visits - (PPO Physicians/Specialists -includes X-ray and lab work when performed and billed by the physician's office)		Plan pays 70% after deductible	Plan pays 70% after deductible	Plan pays 70% after deductible	Plan pays 70% after deductible	Plan pays 70% after deductible	Plan pays 70% after deductible
Preventive Care for Babies and Children (through age 5)		Plan pays 70% after deductible	Plan pays 70% after deductible	Plan pays 70% after deductible	Plan pays 70% after deductible	Plan pays 70% after deductible	Plan pays 70% after deductible
Preventive Care for Adults and Children Over 5 Years of Age ($200 benefit max. per year) -		Plan pays 70% after deductible	Plan pays 70% after deductible	Plan pays 70% after deductible	Plan pays 70% after deductible	Plan pays 70% after deductible	Plan pays 70% after deductible
Professional Services Including surgery, anesthesia, in-hospital physician care, diagnostic X-ray and lab processed outside of the doctors office.		Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible
Inpatient Hospital Services Surgery, x-ray, in-hospital physician visits		Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible
Maternity		Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered
Outpatient Medical Care		Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible
Physical/Occupational Therapy, Chiropractic (Limited to 24 visits per year combined)		Plan pays 60% after deductible Aetna pays up to Max of $25 per visit	Plan pays 60% after deductible Aetna pays up to Max of $25 per visit	Plan pays 60% after deductible Aetna pays up to Max of $25 per visit	Plan pays 60% after deductible Aetna pays up to Max of $25 per visit	Plan pays 60% after deductible Aetna pays up to Max of $25 per visit	Plan pays 60% after deductible Aetna pays up to Max of $25 per visit
Mental, Emotional or Functional Nervous Disorders - Hospital Inpatient - 30 day maximum per calendar year		Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible
Mental, Emotional or Functional Nervous Disorders - Outpatient care - 48 visit maximum per calendar year		Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible
Infusion Therapy and Chemotherapy		Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible
Emergency Room Care For Medical Emergency or Serious Accidental Injury (copay is waived if admitted)		$150 copay after Deductible	$150 copay after Deductible	$150 copay after Deductible	$150 copay after Deductible	$150 copay after Deductible	$150 copay after Deductible
Ambulatory Surgical Center		Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible
Ambulance Service - $1000 maximum per trip		Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible
Home Health Care Maximum of 30 visits per year for preferred and non-preferred providers combined		Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible
Skilled Nursing (in lieu of hospital stay) Maximum of 30 days per year		Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible
Hospice Maximum lifetime covered expense of $10,000		Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible
Home Health Care - Maximum of 30 visits per calendar year		Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible
Durable Medical Equipment and Prosthetics - $2,000 maximum per year		Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible	Plan pays 60% after deductible
Prescription Drugs		$250- does not apply to generic prescriptions	$500- does not apply to generic prescriptions	$500- does not apply to generic prescriptions	$500- does not apply to generic prescriptions	$200- does not apply to generic prescriptions	$500- does not apply to generic prescriptions
	Drug Deductible (does not apply to generic drugs)
	Generic - (no yearly deductible)	$15 copay + 30%	$15 copay + 30%	$15 copay + 30%	$15 copay + 30%	$15 copay + 30%	$15 copay + 30%
	Brand Formulary	$25 copay + 30%	$25 copay + 30%	$25 copay + 30%	$25 copay + 30%	$25 copay + 30%	$25 copay + 30%
	Non-Brand Formulary	$40 copay + 30%	$40 copay + 30%	$40 copay + 30%	$40 copay + 30%	$40 copay + 30%	$40 copay + 30%
	Calendar Year Pharmacy Maximum per Individual (in and out of network combined)	Unlimited	Unlimited	Unlimited	Unlimited	Unlimited	Unlimited
* If you live in Areas 1, 3, or 5 you will use the Aetna Managed Choice Network- Areas 1 & 3 also use the Aexcel Specialist Network If you live in Areas 2, 4 or 6, you will use the Aetna PPO Network-See list below to find your area and rates For a full list of benefit coverage and exclusions, refer to the plan documents
Area 1 Counties - Banks, Barrow, Bartow, Butts, Catoosa, Chattooga, Cherokee, Clarke, Clayton, Cobb, Coweta, Dawson, Dekalb, Douglas, Fayette, Floyd, Forsyth, Fulton, Gordon, Gwinnett, Hall, Haralson, Henrey, Jackson, Jasper, Lamar, Madison, Newton, Oconee, Oglethorpe, Paulding, Pickens, Pike, Polk, Rockdale, Spalding, Walton - Click here for Area 1 Rates Area 2 Counties - Carroll, Chattahoochee, Dade, Harris, Heard, Muscogee, Troup, Walker - Click here for Area 2 Rates Area 3 Counties - Elbert, Fannin, Franklin, Gilmer, Habersham, Lumpkin, Murray, Rabun, Stephens, Towns, Union, White, Whitfield - Click here for Area 3 Rates Area 4 Counties - Atkinson, Bacon, Baker, Ben Hill, Berrien, Bleckley, Brantley, Brooks, Burke, Calhoun, Camden, Charlton, Clay, Clinch, Colquitt, Columbia, Cook, Crisp, Decatur, Dooly, Early, Echols, Emmanuel, Glascock, Glynn, Grady, Greene, Hancock, Hart, Irwin, Jeff Davis, Jefferson, Jenkins, Johnson, Lanier, Lincoln, Lowndes, Macon, Marion, McDuffie, McIntosh, Meriwether, Miller, Mitchell, Montgomery, Morgan, Pierce, Putnam, Quitman, Randolph, Richmond, Schey, Screven, Seminole, Stewart, Sumter, Talbot, Taliaferro, Taylor, Telfair, Terrell, Thomas, Tift, Toombs, Treutlen, Turner, Upson, Ware, Warren, Wayne, Webster, Wheeler, Wilcox, Wilkes, Wilkinson, Worth - Click here for Area 4 Rates Area 5 Counties - Appling, Baldwin, Bibb, Bryan, Bulloch, Candler, Chatham, Coffee, Crawford, Dougherty, Effingham, Evans, Houston, Jones, Laurens, Lee, Liberty, Long, Monroe, Peach, Pulaski, Tattnall, Twiggs, Washington - Click here for Area 5 Rates Area 6 County - Douglas - Click here for Area 6 Rates Click here to have an enrollment kit mailed or e-mailed to you (be sure to specify which plan)
Click here to download the free Adobe Acrobat reader

9 Dunwoody Pk., Suite 136 Atlanta, GA 30338	Call Holly, Bob, Chris at (770) 396-9517 Outside of the Atlanta area, call toll-free: 1-877-711-8376. Email: holly@insurance-now.com