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 73.56% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 26.44% 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 | 23435AZ0040014-04 | ||||||||||||||||||
| Provider Network(s) | PREFERRED NON-PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 16 Sep 2025 15:17 GMT). |
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| 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 |
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| Last Plan Update Date | Fri, 15 Nov 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 16 Sep 2025 15:17 GMT |
Benefits of BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan, 23435AZ0040014-04
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
Exclusions: nan nan |
NO | ||
| Accidental Dental
Exclusions: nan 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
Exclusions: nan nan |
NO | ||
| Allergy Testing
Exclusions: nan Member cost share based on place and type of service. |
YES | $125.00 |
100.00% |
| Bariatric Surgery
Exclusions: nan 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
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Child
Exclusions: nan nan |
NO | ||
| Chemotherapy
Exclusions: nan Member cost share based on place and type of service. |
YES | 50.00% |
100.00% |
| Chiropractic Care
Limit: 20.0 Visit(s) per Year Exclusions: nan nan |
YES | $100.00 |
100.00% |
| Cosmetic Surgery
Exclusions: nan Cosmetic surgery or procedures excluded, other than to treat congenital defects and birth abnormalities |
NO | ||
| Delivery and All Inpatient Services for Maternity Care
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Dental Check-Up for Children
Exclusions: nan nan |
NO | ||
| Diabetes Education
Exclusions: nan Member cost share based on place and type of service. |
YES | $125.00 |
100.00% |
| Dialysis
Exclusions: nan Member cost share based on place and type of service. |
YES | 50.00% |
100.00% |
| Durable Medical Equipment
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Emergency Room Services
Exclusions: No coverage for non-emergency use of the emergency room. nan |
YES | 50.00% |
50.00% |
| Emergency Transportation/Ambulance
Exclusions: nan nan |
YES | 50.00% |
50.00% |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Year Exclusions: nan 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
Exclusions: nan nan |
NO | ||
| Generic Drugs
Exclusions: nan 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
Exclusions: nan 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 Exclusions: nan 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 Exclusions: nan nan |
YES | $100.00 |
100.00% |
| Hospice Services
Exclusions: nan Member cost share based on place and type of service. |
YES | 50.00% |
100.00% |
| Imaging (CT/PET Scans, MRIs)
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Infertility Treatment
Exclusions: nan 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: nan Member cost share based on place and type of service. |
YES | 50.00% |
100.00% |
| Inpatient Hospital Services (e.g., Hospital Stay)
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Inpatient Physician and Surgical Services
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Laboratory Outpatient and Professional Services
Exclusions: nan nan |
YES | $75.00 |
100.00% |
| Long-Term/Custodial Nursing Home Care
Exclusions: nan nan |
NO | ||
| Major Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Major Dental Care - Child
Exclusions: nan nan |
NO | ||
| Mental/Behavioral Health Inpatient Services
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Mental/Behavioral Health Outpatient Services
Exclusions: nan 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
Exclusions: nan 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
Exclusions: nan nan |
YES | No Charge |
100.00% |
| Orthodontia - Adult
Exclusions: nan nan |
NO | ||
| Orthodontia - Child
Exclusions: nan nan |
NO | ||
| Other Practitioner Office Visit (Nurse, Physician Assistant)
Exclusions: nan 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)
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Outpatient Rehabilitation Services
Limit: 60.0 Visit(s) per Year Exclusions: nan 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
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Preferred Brand Drugs
Exclusions: nan 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
Exclusions: nan Member cost sharing applies to postnatal care. |
YES | 50.00% |
100.00% |
| Preventive Care/Screening/Immunization
Exclusions: nan Age and frequency schedules may apply. |
YES | No Charge |
100.00% |
| Primary Care Visit to Treat an Injury or Illness
Exclusions: nan 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
Exclusions: nan 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
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Radiation
Exclusions: nan Member cost share based on place and type of service. |
YES | 50.00% |
100.00% |
| Reconstructive Surgery
Exclusions: nan 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 Exclusions: nan 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 Exclusions: nan 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)
Exclusions: nan nan |
NO | ||
| Routine Eye Exam (Adult)
Exclusions: nan nan |
NO | ||
| Routine Eye Exam for Children
Limit: 1.0 Visit(s) per Year Exclusions: nan Coverage through the end of the month in which the member turns 19. |
YES | $10.00 |
100.00% |
| Routine Foot Care
Exclusions: nan nan |
NO | ||
| Skilled Nursing Facility
Limit: 90.0 Days per Year Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Specialist Visit
Exclusions: nan nan |
YES | $125.00 |
100.00% |
| Specialty Drugs
Exclusions: nan 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
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Substance Abuse Disorder Outpatient Services
Exclusions: nan nan |
YES | $40.00 |
100.00% |
| Transplant
Exclusions: nan 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
Exclusions: nan 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. nan |
YES | $45.00 |
100.00% |
| Weight Loss Programs
Exclusions: nan nan |
NO | ||
| Well Baby Visits and Care
Exclusions: nan Age and frequency schedules may apply. |
YES | No Charge |
100.00% |
| X-rays and Diagnostic Imaging
Exclusions: nan nan |
YES | $100.00 |
100.00% |
BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan Variant 23435AZ0040014-04 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 | 73% AV Level Silver 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, Depression, Diabetes, Heart Disease, 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 | 2024-11-15 00:01:36 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| 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 | 73.56% |
| 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) | 23435AZ0040014-04 |
| 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 | $14690 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | $7345 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | $7,345 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $14690 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $7345 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,345 |
| 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
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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 (23435AZ0040014-04) offer Disease Management Programs?
Does (23435AZ0040014) Health Insurance Plan, Variant (23435AZ0040014-04) have Out Of Country Coverage?
Does (23435AZ0040014) Health Insurance Plan, Variant (23435AZ0040014-04) have Out of Service Area Coverage?
Does (23435AZ0040014) Health Insurance Plan, Variant (23435AZ0040014-04) offer Disease Management Programs?
Does BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan, Variant (23435AZ0040014-04) offer Disease Management Programs for Asthma?
Does BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan, Variant (23435AZ0040014-04) offer Disease Management Programs for Heart disease?
Does BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan, Variant (23435AZ0040014-04) offer Disease Management Programs for Depression?
Does BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan, Variant (23435AZ0040014-04) offer Disease Management Programs for Diabetes?
Does BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan, Variant (23435AZ0040014-04) offer Disease Management Programs for High blood pressure & high cholesterol?
Does BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan, Variant (23435AZ0040014-04) offer Disease Management Programs for Low back pain?
Does BannerAetna Silver 4: No PCP required + free 98point6 virtual care 24/7 Health Insurance Plan, Variant (23435AZ0040014-04) offer Disease Management Programs for Pregnancy?
Disclaimer: This is based on the import(Date: Tue, 16 Sep 2025 15:17 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