AGING ICON

PLAN

Empire MEP HCPPO

Out of Network

Emoire MEP HCPPO

In Network

HOW DOCTORS & PATIENTS LIKE

 THIS PLAN

A+ BEST for Adults

Preventive Exams for children not covered

Your Aetna Doctors should be sure they are in the Empire HCPPO

Deductibles and co-pays

$250/$625

Out Of Pocket max. increased to $700

same as in network

co-pays are not counted to deductibles

Well Child Care

80% after deductible

100% immunizations & office visits

PRESCRIPTION PLAN CHANGES

no assignment of benefits

reimbursement only

% raised for co-pays

 out of pocket raised

CAN I USE MY

 OUT OF NETWORK DOCTOR & HOSPITAL

All doctors are covered

for 80% of office fee after deductible

$15 co-pay

$5 co-pay with Medicare

ADVANTAGE OF USING IN NETWORK DOCTORS

Most doctors know this plan and accept  it.

Co-pays instead of %

PHYSICAL THERAPY/

CHIROPRACTIC

Same as Medical Coverage Out-of-Network

In-Network agrees to managed care limits

80 % of contracted rate

OUT PATIENT MENTAL HEALTH

80% after deductible

80% after deductible

814.Empire BCBS NY

HMO

21.Aetna

 HCN NY

847.Aetna HMO

822.HIP NY

838.HealthNet NY/CT

Only doctors at participating hospitals will accept.

Bare Bones Coverage

Comprehensive Primary Care at a low cost.

Only doctors at participating hospitals will accept.

Bare Bones Coverage

VERY GOOD for Preventive Services for children and women’s care.

Doctors compare this coverage to Medicare HMO’s. Small Network

  $150 Hospital  co-pay

per admission added  

NONE

  $150 Hospital  co-pay

per admission added

$50 emergency room

 $100 Hospital  co-pay

per admission added

 $150 Hospital  co-pay

per admission added

no change

no change

no change

no change

no change

no change

no change

NONE

NONE

NONE

NO

70% covered after $250 deductible with limits on fees and procedures including hospital care

NO

NO

NO

Requires PCP Selection

Limits out of pocket cost

No out of Pocket for In Network doctors visits $15 co-pay for specialists

Requires PCP Selection

Pay only a $10 co-pay

 for office visits

Pay only a $10 co-pay

for office visits.

Pay only a $10 co-pay

for office visits.

$10 co-pay

Limited number of visits both in and out of network b Preauthorization and

 $1500 Annual Max.

Only limited in-network coverage with

 managed care  limits

Limited number of visits

in-network $10 co-pay

Limited number of visits

in-network $10 co-pay

Approved Services

in-network $10 co-pay

Authorization Required

$15 in network 50% out

Approved Services

in-network $10 co-pay

60 visits limit

in-network $10 co-pay

Approved Services

in-network $10 co-pay