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 |