Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio - 58840TX0110012 Health Insurance Plan

Aetna Health Inc. (a TX corp.) health insurance plan with the Plan ID 58840TX0110012. The plan is called Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 79.74% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 20.26% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 58840TX0110012
Health Insurance Plan Year 2022
State Texas
Health Insurance Issuer Aetna Health Inc. (a TX corp.)
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 58840TX0110012-00
Provider Network(s) ['TXN002']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Wed, 27 Mar 2024 12:10 GMT).

Providers Texas All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
Available Variants of the Health Plan

Standard Off Exchange Plan - 58840TX0110012-00

Standard On Exchange Plan - 58840TX0110012-01

Open to Indians below 300% FPL - 58840TX0110012-02

Open to Indians above 300% FPL - 58840TX0110012-03

Last Plan Update Date Wed, 29 Sep 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio Health Insurance Plan Variant 58840TX0110012-00 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 2022
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Gold Off Exchange Plan
Dental Only Plan No
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 1
First Tier Utilization 100%
Formulary ID TXF012
Formulary URL URL
HIOS Product ID 58840TX011
Import Date 9/29/2021 1:01
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? Yes
Issuer Actuarial Value 79.74%
Issuer ID 58840
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 Gold
Multiple In Network Tiers No
National Network No
Network ID TXN002
Out of Country Coverage No
Out of Service Area Coverage No
Out of Service Area Coverage Description Except for Emergencies
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan ID (Standard Component ID with Variant) 58840TX0110012-00
Plan Marketing Name Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio
Plan Type HMO
Plan Variant Marketing Name Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $2,000
SBC Scenario, Having a Baby, Copayment $10
SBC Scenario, Having a Baby, Deductible $1,450
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $900
SBC Scenario, Having Diabetes, Deductible $1,450
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $200
SBC Scenario, Treatment of a Simple Fracture, Copayment $80
SBC Scenario, Treatment of a Simple Fracture, Deductible $1,450
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID TXS002
Source Name HIOS
Specialist Requiring a Referral Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.
Plan ID 58840TX0110012
State Code TX
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 20.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $2900 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $1450 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $1,450
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group per group not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person per person not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Individual Not Applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $17400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8700 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,700
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person per person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual Not Applicable
Unique Plan Design Yes
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered Yes

Copay & Coinsurance of Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio Health Insurance Plan, 58840TX0110012

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio, 58840TX0110012 Health Insurance Plan, 58840TX0110012

  • Does Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio Health Insurance Plan, 58840TX0110012 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (58840TX0110012) Health Insurance Plan, Variant (58840TX0110012-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

    Does (58840TX0110012) Health Insurance Plan, Variant (58840TX0110012-00) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).

    Does (58840TX0110012) Health Insurance Plan, Variant (58840TX0110012-00) have Out of Service Area Coverage?

    No, unfortunately there is no Out of Service Area Coverage for this Health Insurance Plan (variant of plan). Details: Except for Emergencies

    Does (58840TX0110012) Health Insurance Plan, Variant (58840TX0110012-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

    Does Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio Health Insurance Plan, Variant (58840TX0110012-00) offer Disease Management Programs for Asthma?

    Yes, the Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio Health Insurance Plan Variant 58840TX0110012-00 offers Disease Management Program for Asthma.

    Does Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio Health Insurance Plan, Variant (58840TX0110012-00) offer Disease Management Programs for Heart disease?

    Yes, the Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio Health Insurance Plan Variant 58840TX0110012-00 offers Disease Management Program for Heart disease.

    Does Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio Health Insurance Plan, Variant (58840TX0110012-00) offer Disease Management Programs for Depression?

    Yes, the Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio Health Insurance Plan Variant 58840TX0110012-00 offers Disease Management Program for Depression.

    Does Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio Health Insurance Plan, Variant (58840TX0110012-00) offer Disease Management Programs for Diabetes?

    Yes, the Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio Health Insurance Plan Variant 58840TX0110012-00 offers Disease Management Program for Diabetes.

    Does Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio Health Insurance Plan, Variant (58840TX0110012-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio Health Insurance Plan Variant 58840TX0110012-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio Health Insurance Plan, Variant (58840TX0110012-00) offer Disease Management Programs for Low back pain?

    Yes, the Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio Health Insurance Plan Variant 58840TX0110012-00 offers Disease Management Program for Low back pain.

    Does Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio Health Insurance Plan, Variant (58840TX0110012-00) offer Disease Management Programs for Pregnancy?

    Yes, the Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Store Discounts, San Antonio Health Insurance Plan Variant 58840TX0110012-00 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Wed, 27 Mar 2024 12:10 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