Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay

72547IL0170010
Silver
PPO

Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay is a Silver PPO plan by Aetna CVS Health.

IMPORTANT: You are viewing the 2024 version of Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay 72547IL0170010. You can enroll in this plan during open enrollment 2024, which starts November 1st and ends January 15th, 2023, in most states.

Locations

Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay is offered in the following counties.

Plan Overview

This is a plan overview for 2024 version of Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay 72547IL0170010.
Insurer: Aetna CVS Health
Network Type: PPO
Metal Type: Silver
HSA Eligible?: No
Plan ID: 72547IL0170010

Cost-Sharing Overview

Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay 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 Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay?

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

Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay 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 Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay 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: Yes
Out of Service Area Coverage Description: Covered with Limitations
National Network: No

Additional Benefits and Cost-Sharing

Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay 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
$35.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible
Specialist Visit
Covered
$80.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
$35.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Hospice Services
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Routine Dental Services (Adult)
Not Covered
Infertility Treatment
Covered
$80.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible Limited to 4 attempts; if live birth, 2 additional attempts covered.
Long-Term/Custodial Nursing Home Care
Not Covered
Private-Duty Nursing
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible Inpatient Private Duty Nursing Services are not covered.
Routine Eye Exam (Adult)
Not Covered
Urgent Care Centers or Facilities
Covered
$50.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible
Home Health Care Services
Covered
$60.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible
Emergency Room Services
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
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 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Inpatient Physician and Surgical Services
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Bariatric Surgery
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible 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
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible 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
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Prenatal and Postnatal Care
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible Member cost sharing applies to postnatal care
Delivery and All Inpatient Services for Maternity Care
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services
Covered
$35.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services
Covered
$35.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Generic Drugs
Covered
$25.00 Not ApplicableNot Applicable 50.00% Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.
Preferred Brand Drugs
Covered
$60.00 Not ApplicableNot Applicable 50.00% Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.
Non-Preferred Brand Drugs
Covered
$125.00 Not ApplicableNot Applicable 50.00% Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.
Specialty Drugs
Covered
$400.00 Not ApplicableNot Applicable 50.00% Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.
Outpatient Rehabilitation Services
Covered
$60.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible
Habilitation Services
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible Treatment must be medically necessary and therapeutic and not investigational.
Chiropractic Care
Covered
$60.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible25.0 Visit(s) per Year New Style Accumulation and Cost Share- Coverage is limited to 25 visits per manipulation per calendar year, separate from habilitation and includes all outpatient places of service for Chiro. 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
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Hearing Aids
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible1.0 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
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Preventive Care/Screening/Immunization
Covered
Not Applicable No ChargeNot Applicable 50.00% Coinsurance after deductible Age and frequency schedules may apply.
Routine Foot Care
Covered
$80.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible Only covered for persons diagnosed with diabetes.
Acupuncture
Not Covered
Weight Loss Programs
Not Covered
Online weight loss programs are available.
Routine Eye Exam for Children
Covered
$10.00 Not ApplicableNot Applicable 50.00%1.0 Exam(s) per Year Coverage is limited to 1 exam every 12 months age 0-19.
Eye Glasses for Children
Covered
$10.00 Not ApplicableNot Applicable 50.00%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. Age 0-19.
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
$60.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible 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
$60.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible 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
Not Applicable No ChargeNot Applicable 50.00% Coinsurance after deductible 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
$40.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible
X-rays and Diagnostic Imaging
Covered
$45.00 Copay after deductible Not ApplicableNot Applicable 50.00% Coinsurance after deductible
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
$80.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible 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
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible Member cost share based on place and type of service. Network benefits must be received within the transplant network.
Accidental Dental
Covered
$80.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible
Dialysis
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Allergy Testing
Covered
$80.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible
Chemotherapy
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible Member cost share based on place and type of service.
Radiation
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Diabetes Education
Covered
$80.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible Services must be rendered by a physician, or duly certified, registered or licensed health care professional with expertise in diabetes management.
Prosthetic Devices
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Infusion Therapy
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible Member cost share based on place and type of service.
Treatment for Temporomandibular Joint Disorders
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible Member cost share based on place and type of service.
Nutritional Counseling
Covered
Not Applicable No ChargeNot Applicable 50.00% Coinsurance after deductible
Reconstructive Surgery
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible Member cost share based on place and type of service.
Gender Affirming Care
Autism Spectrum Disorders
Covered
$35.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible Member cost share based on place and type of service.
Bones/Joints
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible Member cost share based on place and type of service.
Breast Implant Removal
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible Member cost share based on place and type of service.
Clinical Trials
Covered
$80.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible Member cost share based on place and type of service.
Dental Anesthesia
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Diabetes Care Management
Covered
$80.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible Member cost share based on place and type of service.
Inherited Metabolic Disorder – PKU
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Multiple Sclerosis
Covered
$60.00 Not ApplicableNot Applicable 50.00% Coinsurance after deductible Member cost share based on place and type of service.
Organ Transplants
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible Member cost share based on place and type of service. Network benefits must be received within the transplant network.
Prescription Drugs Other
Covered
$125.00 Not ApplicableNot Applicable 50.00% 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 Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay 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 Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay 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 Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay?

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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