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BannerAetna Bronze (Unlimited Free 98point6 Telehealth & MinuteClinic Visits)

23435AZ0040003
Expanded Bronze
HMO

BannerAetna Bronze (Unlimited Free 98point6 Telehealth & MinuteClinic Visits) is an Expanded Bronze HMO plan by BannerAetna.

IMPORTANT: You are viewing the 2023 version of BannerAetna Bronze (Unlimited Free 98point6 Telehealth & MinuteClinic Visits) 23435AZ0040003. You can enroll in this plan if you qualify for special enrollment until the end of 2023.

Locations

BannerAetna Bronze (Unlimited Free 98point6 Telehealth & MinuteClinic Visits) is offered in the following counties.

Plan Overview

This is a plan overview for 2023 version of BannerAetna Bronze (Unlimited Free 98point6 Telehealth & MinuteClinic Visits) 23435AZ0040003.
Insurer: BannerAetna
Network Type: HMO
Metal Type: Expanded Bronze
HSA Eligible?: No
Plan ID: 23435AZ0040003

Cost-Sharing Overview

BannerAetna Bronze (Unlimited Free 98point6 Telehealth & MinuteClinic Visits) offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for BannerAetna Bronze (Unlimited Free 98point6 Telehealth & MinuteClinic Visits)?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

BannerAetna Bronze (Unlimited Free 98point6 Telehealth & MinuteClinic Visits) offers the following features and referral requirements.

Wellness Program: Yes
Disease Program: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
Notice Pregnancy: No
Referral Specialist: No
Specialist Requiring Referral:
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what BannerAetna Bronze (Unlimited Free 98point6 Telehealth & MinuteClinic Visits) covers when you are out of the service area or out of the country.

Out of Country Coverage: No
Out of Country Coverage Description:
Out of Service Area Coverage: No
Out of Service Area Coverage Description: Except for Emergencies
National Network: No

Additional Benefits and Cost-Sharing

BannerAetna Bronze (Unlimited Free 98point6 Telehealth & MinuteClinic Visits) includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Prescription Drugs Other
Covered
45.00% Coinsurance after deductible 100.00% Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.
Routine Hearing Exam
Covered
$80.00 100.00%1 Visit(s) per Year $80 ded waived/visits 1-5, $80 after ded/visit 6+
Primary Care Visit to Treat an Injury or Illness
Covered
$40.00 100.00% $40 ded waived/visits 1-5, $40 after ded/visit 6+
Specialist Visit
Covered
$80.00 100.00% $80 ded waived/visits 1-5, $80 after ded/visit 6+
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
$40.00 100.00% $40 ded waived/visits 1-5, $40 after ded/visit 6+
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
50.00% Coinsurance after deductible 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
50.00% Coinsurance after deductible 100.00%
Hospice Services
Covered
50.00% Coinsurance after deductible 100.00% Member cost share based on place and type of service.
Routine Dental Services (Adult)
Not Covered
Infertility Treatment
Not Covered
Coverage limited to diagnosis and treatment of the underlying medical condition. Member cost share based on place and type of service.
Long-Term/Custodial Nursing Home Care
Not Covered
Private-Duty Nursing
Not Covered
Private hospital rooms and/or private duty nursing are only available during inpatient stays and determined to be medically appropriate. Private duty nursing is available only in an inpatient setting when skilled nursing is not available from the facility. Custodial Nursing is not covered.
Routine Eye Exam (Adult)
Not Covered
Urgent Care Centers or Facilities
Covered
50.00% Coinsurance after deductible 100.00%
Home Health Care Services
Covered
50.00% Coinsurance after deductible 100.00%42 Visit(s) per Year
Emergency Room Services
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible No coverage for non-emergency use of the emergency room.
Emergency Transportation/Ambulance
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
50.00% Coinsurance after deductible 100.00%
Inpatient Physician and Surgical Services
Covered
50.00% Coinsurance after deductible 100.00%
Bariatric Surgery
Covered
50.00% Coinsurance after deductible 100.00% Pre-certification is required. Surgery for obesity will be a Covered Service only when required due to morbid obesity. The participant meets the current NIH (National Institutes of Health) surgical criteria.
Cosmetic Surgery
Not Covered
Cosmetic surgery or procedures excluded, other than to treat congenital defects and birth abnormalities
Skilled Nursing Facility
Covered
50.00% Coinsurance after deductible 100.00%90 Days per Year
Prenatal and Postnatal Care
Covered
50.00% Coinsurance after deductible 100.00% Member cost sharing applies to postnatal care
Delivery and All Inpatient Services for Maternity Care
Covered
50.00% Coinsurance after deductible 100.00%
Mental/Behavioral Health Outpatient Services
Covered
$40.00 100.00% $40 ded waived/visits 1-5, $40 after ded/visit 6+
Mental/Behavioral Health Inpatient Services
Covered
50.00% Coinsurance after deductible 100.00%
Substance Abuse Disorder Outpatient Services
Covered
$40.00 100.00% $40 ded waived/visits 1-5, $40 after ded/visit 6+
Substance Abuse Disorder Inpatient Services
Covered
50.00% Coinsurance after deductible 100.00%
Generic Drugs
Covered
$25.00 Copay after deductible 100.00% Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.
Preferred Brand Drugs
Covered
35.00% Coinsurance after deductible 100.00% Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.
Non-Preferred Brand Drugs
Covered
45.00% Coinsurance after deductible 100.00% Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.
Specialty Drugs
Covered
50.00% Coinsurance after deductible 100.00% Coinsurance up to applicable maximum per prescription. Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.
Outpatient Rehabilitation Services
Covered
50.00% Coinsurance after deductible 100.00%60 Visit(s) per Year Coverage is limited to 60 visits per calendar year PT/OT/ST combined.
Habilitation Services
Covered
50.00% Coinsurance after deductible 100.00% Speech therapy is not covered to improve speech skills that have not fully developed or when “not restorative in nature.”
Chiropractic Care
Covered
50.00% Coinsurance after deductible 100.00%20 Visit(s) per Year HMO coverage is limited to 20 visits per calendar year. No visit limits on PPO IN or OON. HMOs may limit chiropractic visits to 20; PPOs must cover medically necessary chiropractic visits.
Durable Medical Equipment
Covered
50.00% Coinsurance after deductible 100.00%
Hearing Aids
Covered
50.00% Coinsurance after deductible 100.00%1 Item(s) per Year Coverage is limited to one hearing aid per ear per year.
Imaging (CT/PET Scans, MRIs)
Covered
50.00% Coinsurance after deductible 100.00%
Preventive Care/Screening/Immunization
Covered
No Charge No Charge 100.00% Age and frequency schedules may apply.
Routine Foot Care
Not Covered
$80 ded waived/visits 1-5, $80 after ded/visit 6+
Acupuncture
Covered
$40.00 100.00%10 Visit(s) per Year Coverage is limited to 10 visits per calendar year. $40 ded waived/visits 1-5, $40 after ded/visit 6+
Weight Loss Programs
Not Covered
Online weight loss programs are available.
Routine Eye Exam for Children
Covered
50.00% Coinsurance after deductible 100.00%1 Visit(s) per Year Coverage is limited to 1 exam per calendar year age 0-19.
Eye Glasses for Children
Covered
50.00% Coinsurance after deductible 100.00%1 Item(s) per Year Coverage is limited to 1 set of frames and 1 set of contact lenses or eyeglass lenses per calendar year age 0-19.
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
50.00% Coinsurance after deductible 100.00%60 Visit(s) per Year Coverage is limited to 60 visits per calendar year PT/OT/ST combined. Benefit limits are separate for rehabilitation and habilitation services. Speech therapy is not covered when: a. Used to improve speech skills that have not fully developed; b. Considered custodial or educational; c. Intended to maintain speech communication; or d. Not restorative in nature.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
50.00% Coinsurance after deductible 100.00%60 Visit(s) per Year Coverage is limited to 60 visits per calendar year PT/OT/ST combined. Benefit limits are separate for rehabilitation and habilitation services.
Well Baby Visits and Care
Covered
No Charge No Charge 100.00% Coverage is limited to 7 exams in the first year of life; 3 exams in the second year of life; 3 exams in the third year of life; 1 exam per year thereafter to age 22. Well Child visits and immunizations are covered through 47 months as recommended by the American Academy of Pediatrics.
Laboratory Outpatient and Professional Services
Covered
50.00% Coinsurance after deductible 100.00%
X-rays and Diagnostic Imaging
Covered
50.00% Coinsurance after deductible 100.00%
Basic Dental Care – Child
Not Covered
Orthodontia – Child
Not Covered
Major Dental Care – Child
Not Covered
Basic Dental Care – Adult
Not Covered
Orthodontia – Adult
Not Covered
Major Dental Care – Adult
Not Covered
Abortion for Which Public Funding is Prohibited
Not Covered
Transplant
Covered
50.00% Coinsurance after deductible 100.00% Member cost share based on place and type of service. Network benefits must be received within the transplant network.
Accidental Dental
Covered
$80.00 100.00% Member cost share based on place and type of service. Benefits are payable for the services of a Physician, dentist, or dental surgeon, provided the services are rendered for treatment of an accidental injury to sound natural teeth where the continuous course of treatment is started within six (6) months of the accident. $80 ded waived/visits 1-5, $80 after ded/visit 6+
Dialysis
Covered
50.00% Coinsurance after deductible 100.00% Member cost share based on place and type of service.
Allergy Testing
Covered
$80.00 100.00% Member cost share based on place and type of service. $80 ded waived/visits 1-5, $80 after ded/visit 6+
Chemotherapy
Covered
50.00% Coinsurance after deductible 100.00% Member cost share based on place and type of service.
Radiation
Covered
50.00% Coinsurance after deductible 100.00% Member cost share based on place and type of service.
Diabetes Education
Covered
$80.00 100.00% Member cost share based on place and type of service. $80 ded waived/visits 1-5, $80 after ded/visit 6+
Prosthetic Devices
Covered
50.00% Coinsurance after deductible 100.00%
Infusion Therapy
Covered
50.00% Coinsurance after deductible 100.00% Member cost share based on place and type of service.
Treatment for Temporomandibular Joint Disorders
Covered
$80.00 100.00% Member cost share based on place and type of service. Coverage is limited to accident, trauma, congenital/developmental defects or pathology.$80 ded waived/visits 1-5, $80 after ded/visit 6+
Nutritional Counseling
Covered
No Charge No Charge 100.00%
Reconstructive Surgery
Covered
50.00% Coinsurance after deductible 100.00% Member cost share based on place and type of service.
Gender Affirming Care
Clinical Trials
Covered
$80.00 100.00% Member cost share based on place and type of service. $80 ded waived/visits 1-5, $80 after ded/visit 6+
Diabetes Care Management
Covered
$80.00 100.00% Member cost share based on place and type of service. $80 ded waived/visits 1-5, $80 after ded/visit 6+
Inherited Metabolic Disorder – PKU
Covered
25.00% 100.00% Coverage is limited to formulas, both tube-fed and oral, when medically necessary for the treatment of Eosinophilic Gastrointestinal Disorder and inherited metabolic disease.
Off Label Prescription Drugs
Covered
45.00% Coinsurance after deductible 100.00% Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.

Free Preventive Services

There is no copayment or coinsurance for any of the following BannerAetna Bronze (Unlimited Free 98point6 Telehealth & MinuteClinic Visits) preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Additional Resources

Below are additional resources for BannerAetna Bronze (Unlimited Free 98point6 Telehealth & MinuteClinic Visits) including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.

Summary of Benefits: Summary of Benefits Link
Plan Brochure: Plan Brochure Link
Formulary: Formulary Link
Premium Payment Website: Premium Payment Link
Ready to sign up for BannerAetna Bronze (Unlimited Free 98point6 Telehealth & MinuteClinic Visits)?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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