Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 - 82824GA0110019 Health Insurance Plan

Aetna Health Inc. (a GA corp.) health insurance plan with the Plan ID 82824GA0110019. The plan is called Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 78.00% (we converted the output of AV Calculator to percentage to compare with data provided by Issuer, it shows the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 22.00% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.

Health Insurance Plan ID 82824GA0110019
Health Insurance Plan Year 2023
State Georgia
Health Insurance Issuer Aetna Health Inc. (a GA corp.)
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 82824GA0110019-00
Provider Network(s) ['GAN001']
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 Georgia 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 - 82824GA0110019-00

Standard On Exchange Plan - 82824GA0110019-01

Open to Indians below 300% FPL - 82824GA0110019-02

Open to Indians above 300% FPL - 82824GA0110019-03

Last Plan Update Date Sat, 07 Jan 2023 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Benefits of Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 Health Insurance Plan, 82824GA0110019-00

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited
NO
Accidental Dental

Exclusions: Member cost share based on place and type of service.

YES

$60.00

100.00%
Acupuncture

Limit: 10.0 Visit(s) per Year

Exclusions: Coverage is limited to 10 visits per calendar year.

YES

$30.00

100.00%
Allergy Testing

Exclusions: Member cost share based on place and type of service.

YES

$60.00

100.00%
Applied Behavior Analysis Based Therapies
YES

25.00% Coinsurance after deductible

100.00%
Bariatric Surgery
NO
Basic Dental Care - Adult
NO
Basic Dental Care - Child
NO
Bone Marrow Transplant

Exclusions: Member cost share based on place and type of service. Network benefits must be received within the transplant network.

YES

25.00% Coinsurance after deductible

100.00%
Chemotherapy

Exclusions: Member cost share based on place and type of service.

YES

25.00% Coinsurance after deductible

100.00%
Chiropractic Care

Limit: 20.0 Visit(s) per Year

Exclusions: Coverage is limited to 20 visits per calendar year.

YES

$30.00

100.00%
Clinical Trials

Exclusions: Member cost share based on place and type of service.

YES

$60.00

100.00%
Cosmetic Surgery
NO
Delivery and All Inpatient Services for Maternity Care
YES

25.00% Coinsurance after deductible

100.00%
Dental Anesthesia
YES

25.00% Coinsurance after deductible

100.00%
Dental Check-Up for Children
NO
Diabetes Care Management

Exclusions: Member cost share based on place and type of service.?

YES

$60.00

100.00%
Diabetes Education

Exclusions: Member cost share based on place and type of service.

YES

$60.00

100.00%
Dialysis

Exclusions: Member cost share based on place and type of service.?

YES

25.00% Coinsurance after deductible

100.00%
Durable Medical Equipment
YES

45.00% Coinsurance after deductible

100.00%
Emergency Room Services

Exclusions: No coverage for non-emergency use of the emergency room.

YES

25.00% Coinsurance after deductible

25.00% Coinsurance after deductible
Emergency Transportation/Ambulance
YES

25.00% Coinsurance after deductible

25.00% Coinsurance after deductible
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 every 12 months. Includes contact lens fitting. Coverage is limited to covered person through the end of the month in which the person turns 19.

YES

50.00% Coinsurance after deductible

100.00%
Gender Affirming Care
NO
Generic Drugs

Exclusions: Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.

YES

$15.00

100.00%
Habilitation Services
YES

25.00% Coinsurance after deductible

100.00%
Hearing Aids

Exclusions: Coverage is limited to $3000 maximum per 48 months per ear for hearing aid. Paid as billed

YES

50.00% Coinsurance after deductible

100.00%
Heart Transplant

Exclusions: Member cost share based on place and type of service. Network benefits must be received within the transplant network.

YES

25.00% Coinsurance after deductible

100.00%
Home Health Care Services

Limit: 120.0 Visit(s) per Year

Exclusions: Coverage is limited to 120 visits per calendar year.

YES

25.00% Coinsurance after deductible

100.00%
Hospice Services

Exclusions: Member cost share based on place and type of service.

YES

25.00% Coinsurance after deductible

100.00%
Imaging (CT/PET Scans, MRIs)
YES

25.00% Coinsurance after deductible

100.00%
Infertility Treatment

Exclusions: Coverage limited to diagnosis and treatment of the underlying medical condition. Member cost share based on place and type of service.

NO
Infusion Therapy

Exclusions: Member cost share based on place and type of service.

YES

25.00% Coinsurance after deductible

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)
YES

25.00% Coinsurance after deductible

100.00%
Inpatient Physician and Surgical Services
YES

25.00% Coinsurance after deductible

100.00%
Laboratory Outpatient and Professional Services
YES

25.00% Coinsurance after deductible

100.00%
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult
NO
Major Dental Care - Child
NO
Mental/Behavioral Health Inpatient Services
YES

25.00% Coinsurance after deductible

100.00%
Mental/Behavioral Health Outpatient Services
YES

$30.00

100.00%
Mental Health Other

Exclusions: Member cost share based on place and type of service.

YES

$30.00

100.00%
Morbid Obesity Treatment
NO
Non-Preferred Brand Drugs

Exclusions: Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.

YES

$60.00

100.00%
Nutritional Counseling
YES

No Charge

100.00%
Off Label Prescription Drugs

Exclusions: Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.

YES

$60.00

100.00%
Orthodontia - Adult
NO
Orthodontia - Child
NO
Other Practitioner Office Visit (Nurse, Physician Assistant)
YES

$30.00

100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
YES

25.00% Coinsurance after deductible

100.00%
Outpatient Rehabilitation Services

Limit: 40.0 Visit(s) per Year

Exclusions: Coverage is limited to 40 visits per calendar year for PT/OT combined and 40 visits per year for ST. Benefit limits for rehabilitation and habilitation services are separate.

YES

$30.00

100.00%
Outpatient Surgery Physician/Surgical Services
YES

25.00% Coinsurance after deductible

100.00%
Preferred Brand Drugs

Exclusions: Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.

YES

$30.00

100.00%
Prenatal and Postnatal Care

Exclusions: Member cost sharing applies to postnatal care

YES

25.00% Coinsurance after deductible

100.00%
Prescription Drugs Other

Exclusions: Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.

YES

$60.00

100.00%
Preventive Care/Screening/Immunization

Exclusions: Age and frequency schedules may apply. Deductible waiver out of network does not apply to all preventive benefits, only those required by state mandate.

YES

0.00%

100.00%
Primary Care Visit to Treat an Injury or Illness
YES

$30.00

100.00%
Private-Duty Nursing
NO
Prosthetic Devices
YES

50.00% Coinsurance after deductible

100.00%
Radiation

Exclusions: Member cost share based on place and type of service.

YES

25.00% Coinsurance after deductible

100.00%
Reconstructive Surgery

Exclusions: Member cost share based on place and type of service.?

YES

25.00% Coinsurance after deductible

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 40.0 Visit(s) per Year

Exclusions: Coverage is limited to 40 visits per calendar year, PT/OT combined. Benefit limits for rehabilitation and habilitation services are separate.

YES

$30.00

100.00%
Rehabilitative Speech Therapy

Limit: 40.0 Visit(s) per Year

Exclusions: Coverage is limited to 40 visits per calendar year. Benefit limits for rehabilitation and habilitation services are separate.

YES

$30.00

100.00%
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.

YES

50.00% Coinsurance after deductible

100.00%
Routine Foot Care
NO
Skilled Nursing Facility

Limit: 60.0 Days per Year

Exclusions: Coverage is limited to 60 days per calendar year.

YES

25.00% Coinsurance after deductible

100.00%
Specialist Visit
YES

$60.00

100.00%
Specialty Drugs

Exclusions: Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.

YES

$250.00

100.00%
Substance Abuse Disorder Inpatient Services
YES

25.00% Coinsurance after deductible

100.00%
Substance Abuse Disorder Outpatient Services
YES

$30.00

100.00%
Transplant

Exclusions: Member cost share based on place and type of service. Network benefits must be received within the transplant network.

YES

25.00% Coinsurance after deductible

100.00%
Treatment for Temporomandibular Joint Disorders

Exclusions: Member cost share based on place and type of service.

YES

$60.00

100.00%
Urgent Care Centers or Facilities

Exclusions: No coverage for non-urgent care.

YES

$45.00

100.00%
Weight Loss Programs

Exclusions: Online weight loss programs are available.

NO
Well Baby Visits and Care

Exclusions: Coverage is limited 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

100.00%
Well Child Care

Exclusions: Coverage is limited 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

100.00%
X-rays and Diagnostic Imaging
YES

25.00% Coinsurance after deductible

100.00%

Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 Health Insurance Plan Variant 82824GA0110019-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.78
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2023
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Gold Off Exchange Plan
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 1
First Tier Utilization 100%
Formulary ID GAF019
Formulary URL URL
HIOS Product ID 82824GA011
Import Date 1/7/2023 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? No
Issuer ID 82824
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 GAN001
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 1/1/2023
Plan ID (Standard Component ID with Variant) 82824GA0110019-00
Plan Marketing Name Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7
Plan Type HMO
Plan Variant Marketing Name Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $2,400
SBC Scenario, Having a Baby, Copayment $10
SBC Scenario, Having a Baby, Deductible $2,000
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $1,200
SBC Scenario, Having Diabetes, Deductible $100
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $200
SBC Scenario, Treatment of a Simple Fracture, Deductible $1,900
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID GAS001
Source Name HIOS
Plan ID 82824GA0110019
State Code GA
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 25.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $4000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $2000 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $2,000
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 No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered Yes

Copay & Coinsurance of Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 Health Insurance Plan, 82824GA0110019

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

Frequently Asked Questions(FAQ) about Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7, 82824GA0110019 Health Insurance Plan, 82824GA0110019

  • Does Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 Health Insurance Plan, 82824GA0110019 support Mail Ordering?

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

  • Does (82824GA0110019) Health Insurance Plan, Variant (82824GA0110019-00) 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 (82824GA0110019) Health Insurance Plan, Variant (82824GA0110019-00) have Out Of Country Coverage?

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

    Does (82824GA0110019) Health Insurance Plan, Variant (82824GA0110019-00) 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 (82824GA0110019) Health Insurance Plan, Variant (82824GA0110019-00) 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 Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 Health Insurance Plan, Variant (82824GA0110019-00) offer Disease Management Programs for Asthma?

    Yes, the Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 Health Insurance Plan Variant 82824GA0110019-00 offers Disease Management Program for Asthma.

    Does Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 Health Insurance Plan, Variant (82824GA0110019-00) offer Disease Management Programs for Heart disease?

    Yes, the Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 Health Insurance Plan Variant 82824GA0110019-00 offers Disease Management Program for Heart disease.

    Does Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 Health Insurance Plan, Variant (82824GA0110019-00) offer Disease Management Programs for Depression?

    Yes, the Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 Health Insurance Plan Variant 82824GA0110019-00 offers Disease Management Program for Depression.

    Does Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 Health Insurance Plan, Variant (82824GA0110019-00) offer Disease Management Programs for Diabetes?

    Yes, the Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 Health Insurance Plan Variant 82824GA0110019-00 offers Disease Management Program for Diabetes.

    Does Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 Health Insurance Plan, Variant (82824GA0110019-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 Health Insurance Plan Variant 82824GA0110019-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 Health Insurance Plan, Variant (82824GA0110019-00) offer Disease Management Programs for Low back pain?

    Yes, the Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 Health Insurance Plan Variant 82824GA0110019-00 offers Disease Management Program for Low back pain.

    Does Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 Health Insurance Plan, Variant (82824GA0110019-00) offer Disease Management Programs for Pregnancy?

    Yes, the Gold S: Aetna network of doctors & hospitals + $0 Walk-in clinic + $0 Telehealth 24/7 Health Insurance Plan Variant 82824GA0110019-00 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