Silver S PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care - 72547IL0170009 Health Insurance Plan
Aetna Life Insurance Company health insurance plan with the Plan ID 72547IL0170009. The plan is called Silver S PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 100.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 0.00% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 72547IL0170009 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Illinois | ||||||||||||||||||
| Health Insurance Issuer | Aetna Life Insurance Company | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 72547IL0170009-02 | ||||||||||||||||||
| Provider Network(s) | NON-PREFERRED PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 03 Dec 2024 06:24 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 72547IL0170009-00 Standard On Exchange Plan - 72547IL0170009-01 Open to Indians below 300% FPL - 72547IL0170009-02 Open to Indians above 300% FPL - 72547IL0170009-03 73% AV Silver Plan - 72547IL0170009-04 |
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| Last Plan Update Date | Tue, 12 Sep 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 03 Dec 2024 06:24 GMT |
Benefits of Silver S PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care Health Insurance Plan, 72547IL0170009-02
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
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 |
YES | No Charge |
No Charge |
| Accidental Dental
|
YES | No Charge |
No Charge |
| Acupuncture
|
NO | ||
| Allergy Testing
|
YES | No Charge |
No Charge |
| Autism Spectrum Disorders
Member cost share based on place and type of service. |
YES | No Charge |
No Charge |
| Bariatric Surgery
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. |
YES | No Charge |
No Charge |
| Basic Dental Care - Adult
|
NO | ||
| Basic Dental Care - Child
|
NO | ||
| Bones/Joints
Member cost share based on place and type of service. |
YES | No Charge |
No Charge |
| Breast Implant Removal
Member cost share based on place and type of service. |
YES | No Charge |
No Charge |
| Chemotherapy
Member cost share based on place and type of service. |
YES | No Charge |
No Charge |
| Chiropractic Care
Limit: 25.0 Visit(s) per Year Exclusions: 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. |
YES | No Charge |
No Charge |
| Clinical Trials
Member cost share based on place and type of service. |
YES | No Charge |
No Charge |
| Cosmetic Surgery
Cosmetic surgery for the correction of the congenital deformities or for conditions resulting from accidental injuries, scars, tumors or disease is covered. |
YES | No Charge |
No Charge |
| Delivery and All Inpatient Services for Maternity Care
|
YES | No Charge |
No Charge |
| Dental Anesthesia
|
YES | No Charge |
No Charge |
| Dental Check-Up for Children
|
NO | ||
| Diabetes Care Management
Member cost share based on place and type of service. |
YES | No Charge |
No Charge |
| Diabetes Education
Services must be rendered by a physician, or duly certified, registered or licensed health care professional with expertise in diabetes management. |
YES | No Charge |
No Charge |
| Dialysis
|
YES | No Charge |
No Charge |
| Durable Medical Equipment
|
YES | No Charge |
No Charge |
| Emergency Room Services
|
YES | No Charge |
No Charge |
| Emergency Transportation/Ambulance
|
YES | No Charge |
No Charge |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Year Exclusions: Coverage is limited to 1 set of frames and 1 set of contact lenses or eyeglass lenses per year. Age 0-19. |
YES | No Charge |
No Charge |
| Gender Affirming Care
|
NO | ||
| Generic Drugs
Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details. |
YES | No Charge |
No Charge |
| Habilitation Services
Treatment must be medically necessary and therapeutic and not investigational. |
YES | No Charge |
No Charge |
| Hearing Aids
Limit: 1.0 Item(s) per 2 Years Exclusions: Hearing aids limited to 1 hearing aid per ear every 24 months. Bone anchored hearing aids and cochlear implants are covered. |
YES | No Charge |
No Charge |
| Home Health Care Services
|
YES | No Charge |
No Charge |
| Hospice Services
|
YES | No Charge |
No Charge |
| Imaging (CT/PET Scans, MRIs)
|
YES | No Charge |
No Charge |
| Infertility Treatment
Exclusions: Limited to 4 attempts; if live birth, 2 additional attempts covered. |
YES | No Charge |
No Charge |
| Infusion Therapy
Member cost share based on place and type of service. |
YES | No Charge |
No Charge |
| Inherited Metabolic Disorder - PKU
|
YES | No Charge |
No Charge |
| Inpatient Hospital Services (e.g., Hospital Stay)
|
YES | No Charge |
No Charge |
| Inpatient Physician and Surgical Services
|
YES | No Charge |
No Charge |
| Laboratory Outpatient and Professional Services
|
YES | No Charge |
No Charge |
| Long-Term/Custodial Nursing Home Care
|
NO | ||
| Major Dental Care - Adult
|
NO | ||
| Major Dental Care - Child
|
NO | ||
| Mental/Behavioral Health Inpatient Services
|
YES | No Charge |
No Charge |
| Mental/Behavioral Health Outpatient Services
|
YES | No Charge |
No Charge |
| Multiple Sclerosis
Member cost share based on place and type of service. |
YES | No Charge |
No Charge |
| Non-Preferred Brand Drugs
Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details. |
YES | No Charge |
No Charge |
| Nutritional Counseling
|
YES | No Charge |
No Charge |
| Organ Transplants
Member cost share based on place and type of service. Network benefits must be received within the transplant network. |
YES | No Charge |
No Charge |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
|
NO | ||
| Other Practitioner Office Visit (Nurse, Physician Assistant)
|
YES | No Charge |
No Charge |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
|
YES | No Charge |
No Charge |
| Outpatient Rehabilitation Services
|
YES | No Charge |
No Charge |
| Outpatient Surgery Physician/Surgical Services
|
YES | No Charge |
No Charge |
| Preferred Brand Drugs
Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details. |
YES | No Charge |
No Charge |
| Prenatal and Postnatal Care
Member cost sharing applies to postnatal care |
YES | No Charge |
No Charge |
| Prescription Drugs Other
Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details. |
YES | No Charge |
No Charge |
| Preventive Care/Screening/Immunization
Exclusions: Age and frequency schedules may apply. |
YES | No Charge |
No Charge |
| Primary Care Visit to Treat an Injury or Illness
|
YES | No Charge |
No Charge |
| Private-Duty Nursing
Exclusions: Inpatient Private Duty Nursing Services are not covered. |
YES | No Charge |
No Charge |
| Prosthetic Devices
|
YES | No Charge |
No Charge |
| Radiation
|
YES | No Charge |
No Charge |
| Reconstructive Surgery
Member cost share based on place and type of service. |
YES | No Charge |
No Charge |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Provided when rendered by a registered Occupational Therapist or registered professional Physical Therapist under the supervision of a Physician. |
YES | No Charge |
No Charge |
| Rehabilitative Speech Therapy
Provided when rendered by a licensed Speech Therapist or Speech Therapist certified by the American Speech and Hearing Association. |
YES | No Charge |
No Charge |
| Routine Dental Services (Adult)
|
NO | ||
| Routine Eye Exam (Adult)
|
NO | ||
| Routine Eye Exam for Children
Limit: 1.0 Exam(s) per Year Exclusions: Coverage is limited to 1 exam every 12 months age 0-19. |
YES | No Charge |
No Charge |
| Routine Foot Care
Only covered for persons diagnosed with diabetes. |
YES | No Charge |
No Charge |
| Skilled Nursing Facility
|
YES | No Charge |
No Charge |
| Specialist Visit
|
YES | No Charge |
No Charge |
| Specialty Drugs
Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details. |
YES | No Charge |
No Charge |
| Substance Abuse Disorder Inpatient Services
|
YES | No Charge |
No Charge |
| Substance Abuse Disorder Outpatient Services
|
YES | No Charge |
No Charge |
| Transplant
Member cost share based on place and type of service. Network benefits must be received within the transplant network. |
YES | No Charge |
No Charge |
| Treatment for Temporomandibular Joint Disorders
Member cost share based on place and type of service. |
YES | No Charge |
No Charge |
| Urgent Care Centers or Facilities
|
YES | No Charge |
No Charge |
| Weight Loss Programs
Online weight loss programs are available. |
NO | ||
| Well Baby Visits and Care
Exclusions: 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. |
YES | No Charge |
No Charge |
| X-rays and Diagnostic Imaging
|
YES | No Charge |
No Charge |
Silver S PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care Health Insurance Plan Variant 72547IL0170009-02 Attributes
| Plan Attribute | Value |
|---|---|
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Zero Cost Sharing Plan Variation |
| Dental Only Plan | No |
| Design Type | Design 1 |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy |
| EHB Percent of Total Premium | 0.9991 |
| First Tier Utilization | 100% |
| Formulary ID | ILF015 |
| Formulary URL | URL |
| HIOS Product ID | 72547IL017 |
| Import Date | 2023-09-12 20:01:55 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | 0 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 100.00% |
| Issuer ID | 72547 |
| Issuer Marketplace Marketing Name | Aetna CVS Health |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Silver |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | ILN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Covered with Limitations |
| Plan Brochure | URL |
| Plan Effective Date | 2024-01-01 |
| Plan ID (Standard Component ID with Variant) | 72547IL0170009-02 |
| Plan Marketing Name | Silver S PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care |
| Plan Type | PPO |
| Plan Variant Marketing Name | Silver S PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | ILS001 |
| Source Name | SERFF |
| Plan ID | 72547IL0170009 |
| State Code | IL |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $0 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | $0 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | $0 per person |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $0 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $0 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $0 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $0 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | $0 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | $0 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $0 |
| Unique Plan Design | Yes |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | Yes |
Copay & Coinsurance of Silver S PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care Health Insurance Plan, 72547IL0170009
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Silver S PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care, 72547IL0170009 Health Insurance Plan, 72547IL0170009
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Does Silver S PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care Health Insurance Plan, 72547IL0170009 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (72547IL0170009) Health Insurance Plan, Variant (72547IL0170009-02) offer Disease Management Programs?
Does (72547IL0170009) Health Insurance Plan, Variant (72547IL0170009-02) have Out Of Country Coverage?
Does (72547IL0170009) Health Insurance Plan, Variant (72547IL0170009-02) have Out of Service Area Coverage?
Does (72547IL0170009) Health Insurance Plan, Variant (72547IL0170009-02) offer Disease Management Programs?
Does Silver S PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care Health Insurance Plan, Variant (72547IL0170009-02) offer Disease Management Programs for Asthma?
Does Silver S PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care Health Insurance Plan, Variant (72547IL0170009-02) offer Disease Management Programs for Heart disease?
Does Silver S PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care Health Insurance Plan, Variant (72547IL0170009-02) offer Disease Management Programs for Depression?
Does Silver S PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care Health Insurance Plan, Variant (72547IL0170009-02) offer Disease Management Programs for Diabetes?
Does Silver S PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care Health Insurance Plan, Variant (72547IL0170009-02) offer Disease Management Programs for High blood pressure & high cholesterol?
Does Silver S PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care Health Insurance Plan, Variant (72547IL0170009-02) offer Disease Management Programs for Low back pain?
Does Silver S PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care Health Insurance Plan, Variant (72547IL0170009-02) offer Disease Management Programs for Pregnancy?
Disclaimer: This is based on the import(Date: Tue, 03 Dec 2024 06:24 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API