AETNA HMO / UHC Choice Plus Comparision - Episcopal Diocese of New York

The following table lays out some of the differences between the Aetna National HMO and the United Healthcare in 2013. The table is illustrative, not comprehensive; refer to the summaries of benefits of each plan.

Comparison of 2013 Coverage	Aetna HMO	United Healthcare Choice Plus POS
ANNUAL DEDUCTIBLE	None in Network	NETWORK ONLY None Out-of-network $500 per person $1,500 per family
Annual Out-of-Pocket Maximum (excludes deductible)	None in Network	Out-of-network$2,100 per family $6,300 per family
Routine and Preventive Services (include routine physicals, gynecological exams (1 per year) hearing exams (performed during a routine physical (1 per year) vaccinations, inoculations, immunizations Pap tests (1 per year) Mammograms (1 per year age 40+) PSA screenings (2 per year age 40+) and allrelated routine X Rays and labortaory services. Routine sigmoidoscopy (1 every 2 years age 40+) Routine colonoscopy (1 every 10 years, age $50+)	None in Network	$0 copay in Network 30% Out-of-Network
Primary care physician required	Yes	No
Referrals needed for network care	Yes	No
Pre-certification required for many services	Yes	Yes
Office copay – Primary care MD	$25	$25
After hours/ home visits	$25	$25 You pay 30% for out-of-network services
Routine physicals	$0	$0
Office copay- specialists	$25	$25You pay 30% for out-of-network services
Outpatient Mental Health	$25 copay [services provided only through CIGNA Behavioral Health not through AETNA] You pay 30% for out-of-network services [services provided only through CIGNA Behavioral Health not through AETNA]	$25 [services provided only through CIGNA Behavioral Health not through UHC] You pay 30% for out-of-network services [services provided only through CIGNA Behavioral Health not through UHC] copay
Inpatient Mental Health	Copay of $100 per day not to exceed $600 (services provided only through CIGNA Behavioral Health not through AETNA)	Copay of $100 per day not to exceed $600 (services provided only through CIGNA Behavioral Health not through UHC)No out of network benefit
Emergency room care [when not admitted to hospital]	$100 waived if admitted	$100 copay waived if admitted
Urgent care	$50	$35You pay 30% for out -of-network services
In-patient hospital admission	$150 per day to a maximum of $600	$100 per day to a maximum of $600
Outpatient surgery	$250	$200
Organ transplants	Hospital copay applies, then youpay 0% if an Institute of Excellence (IOE) facility is used	No CopayYou pay 30% for out -of-network services
Anesthesiology Services	No copay	No copay You pay 30% for out -of-network services
Ambulance Services(emergency only)	No copay	No copay
Maternity Prenatal Care	$25 copay for first office visit only	$25 copay for first office visit only
MaternityInpatient Services	Copay of $150 per day not to exceed $600	Copay of $100 per day not to exceed $600
Acunpunture	$20 copay	$25 copay
Allergy Testing (injections)	$20 copay	$25 copay
Durable Medical Equipment (DME)	No copay	$25 copay for diabetic supplies only
Outpatient Therapy	$20 copay (includes hearing/speech, physical and occupational) (60 visits per year per each type of therapy)	$25 copay (includes hearing/speech, physical and occupational) (60 visits per year per each type of therapy)
Smoking Cessation Program ($200 per person per year max.)	No Copay
Surgical Treatment of Morbid Obesity	$150 copay per day not to exceed $600	Same as inpatient hospital benefit – in network
Home Health Care	No copay (210 visits per year)	$25 copay (210 visits per year) in network You pay 30% for out-of-network service