Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - 61671NC0100006 Health Insurance Plan

Aetna Health Inc. (a PA corp.) health insurance plan with the Plan ID 61671NC0100006. The plan is called Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 63.81% (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 36.19% 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 61671NC0100006
Health Insurance Plan Year 2025
State North Carolina
Health Insurance Issuer Aetna Health Inc. (a PA corp.)
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 61671NC0100006-00
Provider Network(s) PREFERRED NON-PREFERRED
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 10 Dec 2024 06:32 GMT).

Providers North Carolina All US States
All 34197 40886
PCP 4702 5251
Allergy 11 12
OB/GYN 179 216
Dentists 1809 2019
Available Variants of the Health Plan

Standard Off Exchange Plan - 61671NC0100006-00

Standard On Exchange Plan - 61671NC0100006-01

Open to Indians below 300% FPL - 61671NC0100006-02

Open to Indians above 300% FPL - 61671NC0100006-03

Last Plan Update Date Thu, 26 Sep 2024 00:00 GMT
Last Import Date Tue, 10 Dec 2024 06:32 GMT

Benefits of Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care Health Insurance Plan, 61671NC0100006-00

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

Member cost share based on place and type of service.

YES

$100.00

100.00%
Acupuncture
NO
Allergy Testing

Member cost share based on place and type of service.

YES

$100.00

100.00%
Bariatric Surgery
YES

50.00% Coinsurance after deductible

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% Coinsurance after deductible

100.00%
Chiropractic Care

Limit: 30.0 Visit(s) per Year

Coverage is limited to 30 visits per year for Physical Therapy, Occupational Therapy, and Chiropractic Care combined.

YES

$50.00

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

50.00% Coinsurance after deductible

100.00%
Dental Check-Up for Children
NO
Diabetes Education

Member cost share based on place and type of service.

YES

$100.00

100.00%
Dialysis

Member cost share based on place and type of service.

YES

50.00% Coinsurance after deductible

100.00%
Durable Medical Equipment

Exclusions: Appliances and accessories that serve no medical purpose or that are primarily for comfort or convenience; repair or replacement of equipment due to abuse or desire for new equipment.

Orthotic devices for correction of Positional Plagiocephaly are limited to 1 device per lifetime.

YES

50.00% Coinsurance after deductible

100.00%
Emergency Room Services

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

YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Emergency Transportation/Ambulance
YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
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

$25.00

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 3 Years

Coverage is limited to 1 item per hearing impaired ear every 36 months.

YES

50.00% Coinsurance after deductible

100.00%
Home Health Care Services
YES

$50.00

100.00%
Hospice Services

Exclusions: Excludes homemaker services, such as cooking, housekeeping, and food or meal preparation.

YES

50.00% Coinsurance after deductible

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

50.00% Coinsurance after deductible

100.00%
Infertility Treatment

Infertility Services- Benefits are provided for certain services related to the diagnosis, treatment and correction of any underlying causes of infertility for all members. Benefits are limited to three medical ovulation induction cycles per lifetime per member.

YES

$100.00

100.00%
Infusion Therapy

Member cost share based on place and type of service.

YES

50.00% Coinsurance after deductible

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

50.00% Coinsurance after deductible

100.00%
Inpatient Physician and Surgical Services
YES

50.00% Coinsurance after deductible

100.00%
Laboratory Outpatient and Professional Services
YES

50.00% 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

50.00% Coinsurance after deductible

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

$50.00

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

$100.00 Copay after deductible

100.00%
Nutritional Counseling

Nutritional counseling visits are separate from the obesity-related office visits.

YES

No Charge

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

$50.00

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

50.00% Coinsurance after deductible

100.00%
Outpatient Rehabilitation Services

Limit: 30.0 Visit(s) per Year

Coverage is limited to 30 visits per year for Physical Therapy, Occupational Therapy, and Chiropractic Care combined.

YES

$50.00

100.00%
Outpatient Surgery Physician/Surgical Services
YES

50.00% Coinsurance after deductible

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

$50.00 Copay after deductible

100.00%
Prenatal and Postnatal Care

Member cost sharing applies to postnatal care

YES

50.00% Coinsurance after deductible

100.00%
Preventive Care/Screening/Immunization

Age and frequency schedules may apply.

YES

0.00%

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

$50.00

100.00%
Private-Duty Nursing
YES

50.00% Coinsurance after deductible

100.00%
Prosthetic Devices
YES

50.00% Coinsurance after deductible

100.00%
Radiation

Member cost share based on place and type of service.

YES

50.00% Coinsurance after deductible

100.00%
Reconstructive Surgery

Member cost share based on place and type of service.

YES

50.00% Coinsurance after deductible

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 30.0 Visit(s) per Year

Coverage is limited to 30 visits per year for Physical Therapy, Occupational Therapy, and Chiropractic Care combined.

YES

$50.00

100.00%
Rehabilitative Speech Therapy

Limit: 30.0 Visit(s) per Year

YES

$50.00

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

Limit: 1.0 Exam(s) per Year

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

YES

$10.00

100.00%
Routine Foot Care

Coverage is limited to the treatment of corns, calluses and care of the toenails for patients with diabetes or vascular disease and treatment of bunions (capsular or bone surgery). Member cost share based on place and type of service.

NO
Skilled Nursing Facility

Limit: 90.0 Days per Year

YES

50.00% Coinsurance after deductible

100.00%
Specialist Visit
YES

$100.00

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

$500.00 Copay after deductible

100.00%
Substance Abuse Disorder Inpatient Services
YES

50.00% Coinsurance after deductible

100.00%
Substance Abuse Disorder Outpatient Services
YES

$50.00

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% Coinsurance after deductible

100.00%
Treatment for Temporomandibular Joint Disorders

Member cost share based on place and type of service.

YES

$100.00

100.00%
Urgent Care Centers or Facilities

Exclusions: No coverage for non-urgent care.

YES

$75.00

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

50.00% Coinsurance after deductible

100.00%

Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care Health Insurance Plan Variant 61671NC0100006-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.6381
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 Bronze 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 1.0
First Tier Utilization 100%
Formulary ID NCF011
Formulary URL URL
HIOS Product ID 61671NC010
Import Date 2024-09-26 03:01:39
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 ID 61671
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 Expanded Bronze
Multiple In Network Tiers No
National Network No
Network ID NCN001
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) 61671NC0100006-00
Plan Marketing Name Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care
Plan Type HMO
Plan Variant Marketing Name Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $1,700
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $7,500
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 $3,200
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $400
SBC Scenario, Treatment of a Simple Fracture, Deductible $1,900
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID NCS001
Source Name HIOS
Plan ID 61671NC0100006
State Code NC
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group $18400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person $9200 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $9,200
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group $15000 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person $7500 per person
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual $7,500
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 50.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $15000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $7500 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $7,500
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 $18400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $9200 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,200
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 Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care Health Insurance Plan, 61671NC0100006

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

Frequently Asked Questions(FAQ) about Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care, 61671NC0100006 Health Insurance Plan, 61671NC0100006

  • Does Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care Health Insurance Plan, 61671NC0100006 support Mail Ordering?

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

  • Does (61671NC0100006) Health Insurance Plan, Variant (61671NC0100006-00) 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 (61671NC0100006) Health Insurance Plan, Variant (61671NC0100006-00) have Out Of Country Coverage?

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

    Does (61671NC0100006) Health Insurance Plan, Variant (61671NC0100006-00) 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 (61671NC0100006) Health Insurance Plan, Variant (61671NC0100006-00) 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 Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care Health Insurance Plan, Variant (61671NC0100006-00) offer Disease Management Programs for Asthma?

    Yes, the Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care Health Insurance Plan Variant 61671NC0100006-00 offers Disease Management Program for Asthma.

    Does Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care Health Insurance Plan, Variant (61671NC0100006-00) offer Disease Management Programs for Heart disease?

    Yes, the Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care Health Insurance Plan Variant 61671NC0100006-00 offers Disease Management Program for Heart disease.

    Does Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care Health Insurance Plan, Variant (61671NC0100006-00) offer Disease Management Programs for Depression?

    Yes, the Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care Health Insurance Plan Variant 61671NC0100006-00 offers Disease Management Program for Depression.

    Does Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care Health Insurance Plan, Variant (61671NC0100006-00) offer Disease Management Programs for Diabetes?

    Yes, the Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care Health Insurance Plan Variant 61671NC0100006-00 offers Disease Management Program for Diabetes.

    Does Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care Health Insurance Plan, Variant (61671NC0100006-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care Health Insurance Plan Variant 61671NC0100006-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care Health Insurance Plan, Variant (61671NC0100006-00) offer Disease Management Programs for Low back pain?

    Yes, the Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care Health Insurance Plan Variant 61671NC0100006-00 offers Disease Management Program for Low back pain.

    Does Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care Health Insurance Plan, Variant (61671NC0100006-00) offer Disease Management Programs for Pregnancy?

    Yes, the Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care Health Insurance Plan Variant 61671NC0100006-00 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Tue, 10 Dec 2024 06:32 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