Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care

61671NC0100006
Expanded Bronze
HMO

Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care is an Expanded Bronze HMO plan by Aetna CVS Health.

Locations

Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care is offered in the following counties.

Plan Overview

This is a plan overview for 2025 version of Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care 61671NC0100006.
Insurer: Aetna CVS Health
Network Type: HMO
Metal Type: Expanded Bronze
HSA Eligible?: No
Plan ID: 61671NC0100006

Cost-Sharing Overview

Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care 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 S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care?

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 S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care 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 Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care 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 S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care 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 Not ApplicableNot Applicable 100.00%
Specialist Visit
Covered
$100.00 Not ApplicableNot Applicable 100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
$50.00 Not ApplicableNot Applicable 100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Hospice Services
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00% Excludes homemaker services, such as cooking, housekeeping, and food or meal preparation.
Routine Dental Services (Adult)
Not Covered
Infertility Treatment
Covered
$100.00 Not ApplicableNot Applicable 100.00% Infertility Services- Benefits are provided for certain services related to the diagnosis, treatment and correction of any underlying causes of infertility for all members. Benefits are limited to three medical ovulation induction cycles per lifetime per member.
Long-Term/Custodial Nursing Home Care
Not Covered
Private-Duty Nursing
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Routine Eye Exam (Adult)
Not Covered
Urgent Care Centers or Facilities
Covered
$75.00 Not ApplicableNot Applicable 100.00% No coverage for non-urgent care.
Home Health Care Services
Covered
$50.00 Not ApplicableNot Applicable 100.00%
Emergency Room Services
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible No coverage for non-emergency use of the emergency room.
Emergency Transportation/Ambulance
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Inpatient Physician and Surgical Services
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Bariatric Surgery
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Cosmetic Surgery
Not Covered
Skilled Nursing Facility
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%90.0 Days per Year
Prenatal and Postnatal Care
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00% Member cost sharing applies to postnatal care
Delivery and All Inpatient Services for Maternity Care
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Mental/Behavioral Health Outpatient Services
Covered
$50.00 Not ApplicableNot Applicable 100.00% The cost sharing that displays applies to outpatient office visits only. All other outpatient services may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.
Mental/Behavioral Health Inpatient Services
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Substance Abuse Disorder Outpatient Services
Covered
$50.00 Not ApplicableNot Applicable 100.00%
Substance Abuse Disorder Inpatient Services
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Generic Drugs
Covered
$25.00 Not ApplicableNot Applicable 100.00% Cost share could vary based on drug and pharmacy selected. Please see the Summary of Benefits & Coverage (SBC) or policy document for plan details.
Preferred Brand Drugs
Covered
$50.00 Copay after deductible Not ApplicableNot Applicable 100.00% Cost share could vary based on drug and pharmacy selected. Please see the Summary of Benefits & Coverage (SBC) or policy document for plan details.
Non-Preferred Brand Drugs
Covered
$100.00 Copay after deductible Not ApplicableNot Applicable 100.00% Cost share could vary based on drug and pharmacy selected. Please see the Summary of Benefits & Coverage (SBC) or policy document for plan details.
Specialty Drugs
Covered
$500.00 Copay after deductible Not ApplicableNot Applicable 100.00% Cost share could vary based on drug and pharmacy selected. Please see the Summary of Benefits & Coverage (SBC) or policy document for plan details.
Outpatient Rehabilitation Services
Covered
$50.00 Not ApplicableNot Applicable 100.00%30.0 Visit(s) per Year Coverage is limited to 30 visits per year for Physical Therapy, Occupational Therapy, and Chiropractic Care combined.
Habilitation Services
Covered
$50.00 Not ApplicableNot Applicable 100.00% Health care services that are needed to keep, learn, or improve your skills and functioning for daily living which may include physical therapy, occupational therapy, and speech therapy. Please refer to the plan policy documents for detailed information.
Chiropractic Care
Covered
$50.00 Not ApplicableNot Applicable 100.00%30.0 Visit(s) per Year Coverage is limited to 30 visits per year for Physical Therapy, Occupational Therapy, and Chiropractic Care combined.
Durable Medical Equipment
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00% Appliances and accessories that serve no medical purpose or that are primarily for comfort or convenience; repair or replacement of equipment due to abuse or desire for new equipment. Orthotic devices for correction of Positional Plagiocephaly are limited to 1 device per lifetime.
Hearing Aids
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%1.0 Item(s) per 3 Years Coverage is limited to 1 item per hearing impaired ear every 36 months.
Imaging (CT/PET Scans, MRIs)
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Preventive Care/Screening/Immunization
Covered
Not Applicable 0.00%Not Applicable 100.00% Age and frequency schedules may apply.
Routine Foot Care
Not Covered
Coverage is limited to the treatment of corns, calluses and care of the toenails for patients with diabetes or vascular disease and treatment of bunions (capsular or bone surgery). Member cost share based on place and type of service.
Acupuncture
Not Covered
Weight Loss Programs
Not Covered
Routine Eye Exam for Children
Covered
$10.00 Not ApplicableNot Applicable 100.00%1.0 Exam(s) per Year Coverage through the end of the month in which the member turns 19.
Eye Glasses for Children
Covered
$10.00 Not ApplicableNot Applicable 100.00%1.0 Item(s) per Year Coverage is limited to 1 set of frames and 1 set of contact lenses or eyeglass lenses per year, through the end of the month in which the member turns 19.
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
$50.00 Not ApplicableNot Applicable 100.00%30.0 Visit(s) per Year
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
$50.00 Not ApplicableNot Applicable 100.00%30.0 Visit(s) per Year Coverage is limited to 30 visits per year for Physical Therapy, Occupational Therapy, and Chiropractic Care combined.
Well Baby Visits and Care
Covered
Not Applicable No ChargeNot Applicable 100.00% Age and frequency schedules may apply.
Laboratory Outpatient and Professional Services
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
X-rays and Diagnostic Imaging
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 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
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00% Member cost share based on place and type of service. Network benefits must be received within the Institutes of Excellence (IOE) transplant network.
Accidental Dental
Covered
$100.00 Not ApplicableNot Applicable 100.00% Member cost share based on place and type of service.
Dialysis
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00% Member cost share based on place and type of service.
Allergy Testing
Covered
$100.00 Not ApplicableNot Applicable 100.00% Member cost share based on place and type of service.
Chemotherapy
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00% Member cost share based on place and type of service.
Radiation
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00% Member cost share based on place and type of service.
Diabetes Education
Covered
$100.00 Not ApplicableNot Applicable 100.00% Member cost share based on place and type of service.
Prosthetic Devices
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Infusion Therapy
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00% Member cost share based on place and type of service.
Treatment for Temporomandibular Joint Disorders
Covered
$100.00 Not ApplicableNot Applicable 100.00% Member cost share based on place and type of service.
Nutritional Counseling
Covered
Not Applicable No ChargeNot Applicable 100.00% Nutritional counseling visits are separate from the obesity-related office visits.
Reconstructive Surgery
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00% Member cost share based on place and type of service.
Gender Affirming Care

Free Preventive Services

There is no copayment or coinsurance for any of the following Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care 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 S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care 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 S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care?

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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