BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 - 23435AZ0040014 Health Insurance Plan

Banner Health and Aetna Health Plan Inc. health insurance plan with the Plan ID 23435AZ0040014. The plan is called BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 71.49% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 28.51% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 23435AZ0040014
Health Insurance Plan Year 2025
State Arizona
Health Insurance Issuer Banner Health and Aetna Health Plan Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 23435AZ0040014-00
Provider Network(s) PREFERRED NON-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).

Providers Arizona All US States
All 15100 26836
PCP 1613 1783
Allergy 4 5
OB/GYN 70 83
Dentists 2289 2565
Available Variants of the Health Plan

Standard Off Exchange Plan - 23435AZ0040014-00

Standard On Exchange Plan - 23435AZ0040014-01

Open to Indians below 300% FPL - 23435AZ0040014-02

Open to Indians above 300% FPL - 23435AZ0040014-03

73% AV Silver Plan - 23435AZ0040014-04

87% AV Silver Plan - 23435AZ0040014-05

94% AV Silver Plan - 23435AZ0040014-06

Last Plan Update Date Thu, 03 Oct 2024 00:00 GMT
Last Import Date Tue, 03 Dec 2024 06:24 GMT

Benefits of BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan, 23435AZ0040014-00

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

Benefits are payable for the services of a Physician, dentist, or dental surgeon, provided the services are rendered for treatment of an accidental injury to sound natural teeth where the continuous course of treatment is started within six (6) months of the accident. Member cost share based on place and type of service.

YES

$125.00

100.00%
Acupuncture
NO
Allergy Testing

Member cost share based on place and type of service.

YES

$125.00

100.00%
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

50.00%

100.00%
Basic Dental Care - Adult
NO
Basic Dental Care - Child
NO
Chemotherapy

Member cost share based on place and type of service.

YES

50.00%

100.00%
Chiropractic Care

Limit: 20.0 Visit(s) per Year

YES

$100.00

100.00%
Cosmetic Surgery

Cosmetic surgery or procedures excluded, other than to treat congenital defects and birth abnormalities

NO
Delivery and All Inpatient Services for Maternity Care
YES

50.00%

100.00%
Dental Check-Up for Children
NO
Diabetes Education

Member cost share based on place and type of service.

YES

$125.00

100.00%
Dialysis

Member cost share based on place and type of service.

YES

50.00%

100.00%
Durable Medical Equipment
YES

50.00%

100.00%
Emergency Room Services

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

YES

50.00%

50.00%
Emergency Transportation/Ambulance
YES

50.00%

50.00%
Eye Glasses for Children

Limit: 1.0 Item(s) per Year

Coverage is limited to 1 set of frames and 1 set of contact lenses or eyeglass lenses per year through the end of the month in which the member turns 19.

YES

$10.00

100.00%
Gender Affirming Care
NO
Generic Drugs

Cost share could vary based on drug and pharmacy selected. Please see the Summary of Benefits & Coverage (SBC) or policy document for plan details.

YES

$3.00

100.00%
Habilitation Services

Health care services that are needed to keep, learn, or improve your skills and functioning for daily living which may include physical therapy, occupational therapy, and speech therapy. Please refer to the plan policy documents for detailed information.

YES

50.00%

100.00%
Hearing Aids

Limit: 1.0 Item(s) per Year

Coverage is limited to one hearing aid per ear per year.

YES

50.00%

100.00%
Home Health Care Services

Limit: 42.0 Visit(s) per Year

YES

$100.00

100.00%
Hospice Services

Member cost share based on place and type of service.

YES

50.00%

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

50.00%

100.00%
Infertility Treatment

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

NO
Infusion Therapy

Member cost share based on place and type of service.

YES

50.00%

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

50.00%

100.00%
Inpatient Physician and Surgical Services
YES

50.00%

100.00%
Laboratory Outpatient and Professional Services
YES

$75.00

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

50.00%

100.00%
Mental/Behavioral Health Outpatient Services

The cost sharing that displays applies to outpatient office visits only. All other outpatient services may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

YES

$40.00

100.00%
Non-Preferred Brand Drugs

Cost share could vary based on drug and pharmacy selected. Please see the Summary of Benefits & Coverage (SBC) or policy document for plan details.

YES

40.00%

100.00%
Nutritional Counseling
YES

No Charge

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

Cost share applies to both in-person and virtual services from in-network providers. Cost share does not apply to virtual services from designated telemedicine providers. If this is an HSA plan, deductible applies.

YES

$40.00

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

50.00%

100.00%
Outpatient Rehabilitation Services

Limit: 60.0 Visit(s) per Year

Coverage is limited to 60 visits per year for Physical Therapy, Occupational Therapy, and Speech Therapy combined.

YES

$100.00

100.00%
Outpatient Surgery Physician/Surgical Services
YES

50.00%

100.00%
Preferred Brand Drugs

Cost share could vary based on drug and pharmacy selected. Please see the Summary of Benefits & Coverage (SBC) or policy document for plan details.

YES

$150.00

100.00%
Prenatal and Postnatal Care

Member cost sharing applies to postnatal care.

YES

50.00%

100.00%
Preventive Care/Screening/Immunization

Age and frequency schedules may apply.

YES

No Charge

100.00%
Primary Care Visit to Treat an Injury or Illness

Cost share applies to both in-person and virtual services from in-network providers. Cost share does not apply to virtual services from designated telemedicine providers. If this is an HSA plan, deductible applies.

YES

$40.00

100.00%
Private-Duty Nursing

Private hospital rooms and/or private duty nursing are only available during inpatient stays and determined to be medically appropriate. Private duty nursing is available only in an inpatient setting when skilled nursing is not available from the facility. Custodial Nursing is not covered.

NO
Prosthetic Devices
YES

50.00%

100.00%
Radiation

Member cost share based on place and type of service.

YES

50.00%

100.00%
Reconstructive Surgery

Member cost share based on place and type of service.

YES

50.00%

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 60.0 Visit(s) per Year

Coverage is limited to 60 visits per year for Physical Therapy, Occupational Therapy, and Speech Therapy combined.

YES

$100.00

100.00%
Rehabilitative Speech Therapy

Limit: 60.0 Visit(s) per Year

Coverage is limited to 60 visits per year for Physical Therapy, Occupational Therapy, and Speech Therapy combined.

YES

$100.00

100.00%
Routine Dental Services (Adult)
NO
Routine Eye Exam (Adult)
NO
Routine Eye Exam for Children

Limit: 1.0 Visit(s) per Year

Coverage through the end of the month in which the member turns 19.

YES

$10.00

100.00%
Routine Foot Care
NO
Skilled Nursing Facility

Limit: 90.0 Days per Year

YES

50.00%

100.00%
Specialist Visit
YES

$125.00

100.00%
Specialty Drugs

Cost share could vary based on drug and pharmacy selected. Please see the Summary of Benefits & Coverage (SBC) or policy document for plan details.

YES

50.00%

100.00%
Substance Abuse Disorder Inpatient Services
YES

50.00%

100.00%
Substance Abuse Disorder Outpatient Services
YES

$40.00

100.00%
Transplant

Member cost share based on place and type of service. Network benefits must be received within the Institutes of Excellence (IOE) transplant network.

YES

50.00%

100.00%
Treatment for Temporomandibular Joint Disorders

Coverage is limited to accident, trauma, congenital/developmental defects or pathology. Member cost share based on place and type of service.

YES

$125.00

100.00%
Urgent Care Centers or Facilities

Exclusions: No coverage for non-urgent care.

YES

$50.00

100.00%
Weight Loss Programs
NO
Well Baby Visits and Care

Age and frequency schedules may apply.

YES

No Charge

100.00%
X-rays and Diagnostic Imaging
YES

$100.00

100.00%

BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan Variant 23435AZ0040014-00 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 2025
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Silver Off Exchange Plan
Drug EHB Deductible, Combined In/Out of Network, Family Per Group per group not applicable
Drug EHB Deductible, Combined In/Out of Network, Family Per Person per person not applicable
Drug EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 0.00%
Drug EHB Deductible, In Network (Tier 1), Family Per Group per group not applicable
Drug EHB Deductible, In Network (Tier 1), Family Per Person per person not applicable
Drug EHB Deductible, In Network (Tier 1), Individual Not Applicable
Drug EHB Deductible, Out of Network, Family Per Group per group not applicable
Drug EHB Deductible, Out of Network, Family Per Person per person not applicable
Drug EHB Deductible, Out of Network, Individual Not Applicable
Dental Only Plan No
Design Type Not Applicable
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 1.0
First Tier Utilization 100%
Formulary ID AZF014
Formulary URL URL
HIOS Product ID 23435AZ004
Import Date 2024-10-03 01:01:22
Limited Cost Sharing Plan Variation - Estimated Advanced Payment 0
Inpatient Copayment Maximum Days 0
HSA Eligible No
New/Existing Plan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer Actuarial Value 71.49%
Issuer ID 23435
Issuer Marketplace Marketing Name BannerAetna
Market Coverage Individual
Medical Drug Deductibles Integrated No
Medical Drug Maximum Out of Pocket Integrated Yes
Medical EHB Deductible, Combined In/Out of Network, Family Per Group $0 per group
Medical EHB Deductible, Combined In/Out of Network, Family Per Person $0 per person
Medical EHB Deductible, Combined In/Out of Network, Individual $0
Medical EHB Deductible, In Network (Tier 1), Default Coinsurance 50.00%
Medical EHB Deductible, In Network (Tier 1), Family Per Group $0 per group
Medical EHB Deductible, In Network (Tier 1), Family Per Person $0 per person
Medical EHB Deductible, In Network (Tier 1), Individual $0
Medical EHB Deductible, Out of Network, Family Per Group per group not applicable
Medical EHB Deductible, Out of Network, Family Per Person per person not applicable
Medical EHB Deductible, Out of Network, Individual Not Applicable
Metal Level Silver
Multiple In Network Tiers No
National Network No
Network ID AZN003
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 2025-01-01
Plan ID (Standard Component ID with Variant) 23435AZ0040014-00
Plan Marketing Name BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7
Plan Type HMO
Plan Variant Marketing Name BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $5,000
SBC Scenario, Having a Baby, Copayment $500
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 $2,800
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $1,000
SBC Scenario, Treatment of a Simple Fracture, Copayment $500
SBC Scenario, Treatment of a Simple Fracture, Deductible $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID AZS003
Source Name HIOS
Plan ID 23435AZ0040014
State Code AZ
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group $18390 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person $9195 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $9,195
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $18390 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $9195 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,195
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 BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan, 23435AZ0040014

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

Frequently Asked Questions(FAQ) about BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7, 23435AZ0040014 Health Insurance Plan, 23435AZ0040014

  • Does BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan, 23435AZ0040014 support Mail Ordering?

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

  • Does (23435AZ0040014) Health Insurance Plan, Variant (23435AZ0040014-00) 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 (23435AZ0040014) Health Insurance Plan, Variant (23435AZ0040014-00) have Out Of Country Coverage?

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

    Does (23435AZ0040014) Health Insurance Plan, Variant (23435AZ0040014-00) 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 (23435AZ0040014) Health Insurance Plan, Variant (23435AZ0040014-00) 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 BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan, Variant (23435AZ0040014-00) offer Disease Management Programs for Asthma?

    Yes, the BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan Variant 23435AZ0040014-00 offers Disease Management Program for Asthma.

    Does BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan, Variant (23435AZ0040014-00) offer Disease Management Programs for Heart disease?

    Yes, the BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan Variant 23435AZ0040014-00 offers Disease Management Program for Heart disease.

    Does BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan, Variant (23435AZ0040014-00) offer Disease Management Programs for Depression?

    Yes, the BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan Variant 23435AZ0040014-00 offers Disease Management Program for Depression.

    Does BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan, Variant (23435AZ0040014-00) offer Disease Management Programs for Diabetes?

    Yes, the BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan Variant 23435AZ0040014-00 offers Disease Management Program for Diabetes.

    Does BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan, Variant (23435AZ0040014-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan Variant 23435AZ0040014-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan, Variant (23435AZ0040014-00) offer Disease Management Programs for Low back pain?

    Yes, the BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan Variant 23435AZ0040014-00 offers Disease Management Program for Low back pain.

    Does BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan, Variant (23435AZ0040014-00) offer Disease Management Programs for Pregnancy?

    Yes, the BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan Variant 23435AZ0040014-00 offers Disease Management Program 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