2025 benefit highlights
| Aetna Choice POS II – Gold | In-network | Out-of-network**** |
|---|---|---|
| Deductible | In-Network: EE Only $1,650; EE+ Family $3,300. | Out-of-Network: EE Only $3,200; EE+ Family $6,400. |
| Annual out-of-pocket maximum | In-Network: EE Only $2,800; EE+ Family $5,600 | Out-of-Network: EE Only $5,600; EE+ Family $11,200. |
| Office Visits | 15% coinsurance – Primary Care Physician 15% coinsurance – Specialist | 50% coinsurance, after deductible – Primary Care Physician and Specialist |
| Preventive Care | 100% covered, deductible waived | 50% coinsurance |
| Inpatient Hospital | 15% coinsurance | 50% coinsurance |
| Urgent Care | 15% coinsurance | 50% coinsurance |
| Emergency Room | 15% coinsurance | 15% coinsurance |
| Ambulance | 15% coinsurance | 15% coinsurance |
| Chiropractor | 15% coinsurance | 50% coinsurance |
| Rehabilitation (60 visits/calendar year for Physical, Occupational & Speech Therapy combined, including outpatient hospital services. Includes treatment of Autism & habilitation services) |
15% coinsurance | 50% coinsurance |
*Deductible: The amount you pay for covered services before your health plan begins to pay.
**Copay: This is the dollar amount you pay for health care expenses after you meet your deductible limit.
***Coinsurance: This is the percentage of health care expenses you pay after your deductible. Your health plan pays the rest up to any benefit or lifetime maximum.
****Note: The plan pays benefits for out-of-network services based on the allowable charge for a service. If your out-of-network provider charges more than the allowable charge, you will be responsible for any expenses incurred that are above this amount, in addition to your out-of-network deductible and coinsurance/copay. Any amount that you pay above the allowable charge will not apply to your out-of-pocket maximum.
