Aetna PPO- Bronze Plan Options

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BRONZE PPO Options

Every ACA plan is assigned a metal tier: Platinum, Gold, Silver, or Bronze. All plans offer the same quality of care. The metal tier is based on how you and your plan split the costs. BRONZE plans will have the lowest premiums, but the highest out-of-pocket costs as well as the highest deductibles. Below you will find a comparison of Aetna’s Bronze options.

Aetna BRONZE PPO Plans

Plan Info	Bronze 1	Bronze 4	Bronze S
	Benefits Summary	Benefits Summary	Benefits Summary
Deductible – Individual/Family	$8,995 / $17,990	$0	$7,500 / $15,000
Out of Pocket Max – Individual/Family	$9,395 / $18,790	$9,400 / $18,800	$9,400 / $18,800
Coinsurance	50%	50%	50%
Primary Care/Specialist	$55 / $125	$15 / $100	$55 / $100
Emergency Room Care	50% coinsurance	$2,200 copay/visit	50% coinsurance
Urgent Care	$60 copay	$50 copay/visit	$75 copay
Inpatient hospital stay	50% coinsurance	$2,500 copay/day, days 1-3	50% coinsurance
Lab services / Xray	50% coinsurance	Lab: $50 copay / visit X-ray: $75 copay / visit	50% coinsurance
Prescription Drugs
Preferred generic	Tier 1A: $5 copay/ $12.50 copay Tier 1: $40 copay/ $100 copay deductible does not apply	Tier 1A: $5 copay/ $12.50 copay/ Tier 1: $40 copay/ $100 copay	$25 copay/ $62.50 copay deductible does not apply (preferred and non preferred)
Preferred Brand Drugs	$70 copay/$175 copay deductible does not apply	40% coinsurance for up to a 90 day supply	$50 copay / $125 copay
Non-preferred generic/brand drugs	$95 copay / $237.50 copay deductible does not apply	45% coinsurance for up to a 90 day supply	$100 copay/ $250 copay
Preferred/non-preferred specialty drugs	$500 copay deductible does not apply	50% coinsurance for up to a 30 day supply	$500 copay

Every ACA plan covers 10 essential benefits:

Prescription drugs
Pregnancy, maternity and newborn care
Pediatric services, including oral and vision care
Mental health and substance use disorder services
Preventive and wellness services, and chronic disease management
Laboratory services
Emergency services
Hospitalization
Ambulatory services
Rehabilitative and habilitative services and devices

All Aetna individual plans in Illinois allow you to go directly to any recognized health care provider, including specialists, for covered expenses. The following are standard benefits included in all Aetna individual plans:

Unlimited office visits to your primary care physician and specialists
No referrals required
No waiting periods to access preventive health and routine physicals
Lab work and x-rays included in routine physicals
100% annual routine GYN exam coverage – no waiting period, copay, or deductible
100% coverage on in-network childhood immunizations
Prescription drug coverage

Aetna CVS Health Plans – 2024 Illinois PPO Hospital Network

Hospital Network Highlights – hospitals include, but are not limited to:

Chicago:

Northshore Hospital
Northwestern Hospital
Lurie’s Children’s HospitalJackson Park Hospital Foundation
Holy Cross Hospital
Humbolt Park Health
John H. Stroger Hospital of Cook County
La Rabida Children’s Hospital
Loretto Hospital
Louis Weiss Memorial Hospital
Mercy Harvard Hospital
Insight Chicago
Methodist Hospital of Chicago
Mount Sinai Hospital and Medical Center
Rush University Hospital
University of Chicago Hospital

Northshore University Health System:

Northshore University Health System – Chicago
Northshore University Health System – Glenbrook
Northshore University Health System – Highland Park
Northshore University Health System – Evanston
Northshore University Health System – Skokie
Edward Hospital
Elmhurst Memorial Hospital
Northwest Community Hospital
Swedish Covenant Hospital
- OSF Little Company of Mary Hospital
- Provident Hospital of Cook County
- Roseland Community Hospital
- Schwab Rehabilitation Hospital
- South Shore Hospital
- St. Anthony Hospital
- St. Bernard Hospital
- Swedish Covenant Hospital
- Thorek Hospital and Medical Center
- Vista Medical Center East
- Vista Medical Center West
University of Illinois at Chicago Medical Center