Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7

99129IL0120002
Expanded Bronze
HMO

Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7 is an Expanded Bronze HMO plan by Aetna.

IMPORTANT: You are viewing the 2023 version of Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7 99129IL0120002. You can enroll in this plan if you qualify for special enrollment until the end of 2023.

Locations

Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7 is offered in the following counties.

Plan Overview

This is a plan overview for 2023 version of Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7 99129IL0120002.
Insurer: Aetna
Network Type: HMO
Metal Type: Expanded Bronze
HSA Eligible?: Yes
Plan ID: 99129IL0120002

Cost-Sharing Overview

Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7 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 Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7?

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

Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7 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: Yes
Specialist Requiring Referral: Referral required for all physicians EXCEPT PCP, OB/GYN, Pediatrician and MH/SUD providers.
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7 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

Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7 includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Primary Care Visit to Treat an Injury or Illness
Covered
50.00% Coinsurance after deductible 100.00%
Specialist Visit
Covered
50.00% Coinsurance after deductible 100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
50.00% Coinsurance after deductible 100.00%
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%
Routine Dental Services (Adult)
Not Covered
Infertility Treatment
Covered
50.00% Coinsurance after deductible 100.00% Limited to 4 attempts, if live birth, 2 additional attempts covered.
Long-Term/Custodial Nursing Home Care
Not Covered
Private-Duty Nursing
Covered
50.00% Coinsurance after deductible 100.00% Inpatient Private Duty Nursing Services are 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%
Emergency Room Services
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible
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
Covered
50.00% Coinsurance after deductible 100.00% Cosmetic surgery for the correction of the congenital deformities or for conditions resulting from accidental injuries, scars, tumors or disease is covered.
Skilled Nursing Facility
Covered
50.00% Coinsurance after deductible 100.00%
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
50.00% Coinsurance after deductible 100.00%
Mental/Behavioral Health Inpatient Services
Covered
50.00% Coinsurance after deductible 100.00%
Substance Abuse Disorder Outpatient Services
Covered
50.00% Coinsurance after deductible 100.00%
Substance Abuse Disorder Inpatient Services
Covered
50.00% Coinsurance after deductible 100.00%
Generic Drugs
Covered
50.00% Coinsurance 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
40.00% 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
50.00% 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% 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%
Habilitation Services
Covered
50.00% Coinsurance after deductible 100.00% Treatment must be medically necessary and therapeutic and not investigational.
Chiropractic Care
Covered
50.00% Coinsurance after deductible 100.00%25 Visit(s) per Year Benefits will be provided for manipulation or adjustment of osseous or articular structures, commonly referred to as chiropractic and osteopathic manipulation, when performed by a person licensed to perform such procedures.
Durable Medical Equipment
Covered
50.00% Coinsurance after deductible 100.00%
Hearing Aids
Covered
50.00% Coinsurance after deductible 100.00%2 Item(s) per 2 Years Hearing aids limited to 1 hearing aid per ear every 24 months. Bone anchored hearing aids and cochlear implants are covered.
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
Covered
50.00% Coinsurance after deductible 100.00% Only covered for persons diagnosed with diabetes.
Acupuncture
Covered
50.00% Coinsurance after deductible 100.00%10 Visit(s) per Year Coverage is limited to 10 visits per calendar year.
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 Exam(s) per Year Coverage is limited to 1 exam every 12 months 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 year. Age 0-19.
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
50.00% Coinsurance after deductible 100.00% Provided when rendered by a licensed Speech Therapist or Speech Therapist certified by the American Speech and Hearing Association.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
50.00% Coinsurance after deductible 100.00% Provided when rendered by a registered Occupational Therapist or registered professional Physical Therapist under the supervision of a Physician.
Well Baby Visits and Care
Covered
No Charge No Charge 100.00% Children immunizations covered at 100% deductible waived for children up to 72 months of age. Coverage is limited to 7 exams in the first 12 months of life; 3 exams in the second 12 months of life; 3 exams in the third 12 months of life; 1 exam every 12 months thereafter to age 22.
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
Covered
50.00% Coinsurance after deductible 100.00% Abortions are only covered when the life of the mother would be endangered if the fetus were carried to term, or when the pregnancy is the result of an act of rape or incest
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
50.00% Coinsurance after deductible 100.00%
Dialysis
Covered
50.00% Coinsurance after deductible 100.00%
Allergy Testing
Covered
50.00% Coinsurance after deductible 100.00%
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%
Diabetes Education
Covered
50.00% Coinsurance after deductible 100.00% Services must be rendered by a physician, or duly certified, registered or licensed health care professional with expertise in diabetes management.
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
50.00% Coinsurance after deductible 100.00% Member cost share based on place and type of service.
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
Autism Spectrum Disorders
Covered
50.00% Coinsurance after deductible 100.00% Member cost share based on place and type of service.
Bones/Joints
Covered
50.00% Coinsurance after deductible 100.00% Member cost share based on place and type of service.
Breast Implant Removal
Covered
50.00% Coinsurance after deductible 100.00% Member cost share based on place and type of service.
Clinical Trials
Covered
50.00% Coinsurance after deductible 100.00% Member cost share based on place and type of service.
Dental Anesthesia
Covered
50.00% Coinsurance after deductible 100.00%
Diabetes Care Management
Covered
50.00% Coinsurance after deductible 100.00% Member cost share based on place and type of service.
Inherited Metabolic Disorder – PKU
Covered
50.00% Coinsurance after deductible 100.00%
Multiple Sclerosis
Covered
50.00% Coinsurance after deductible 100.00% Member cost share based on place and type of service.
Organ Transplants
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.
Prescription Drugs Other
Covered
50.00% 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 Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7 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 Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7 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 Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7?

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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