Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay - 72547IL0170005 Health Insurance Plan

Aetna Life Insurance Company health insurance plan with the Plan ID 72547IL0170005. The plan is called Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 78.06% (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 21.94% 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 72547IL0170005
Health Insurance Plan Year 2025
State Illinois
Health Insurance Issuer Aetna Life Insurance Company
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 72547IL0170005-00
Provider Network(s) NON-PREFERRED PREFERRED
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 13 May 2025 06:05 GMT).

Providers Illinois All US States
All 46170 92184
PCP 7005 8044
Allergy 30 36
OB/GYN 297 336
Dentists 46 50
Available Variants of the Health Plan

Standard Off Exchange Plan - 72547IL0170005-00

Standard On Exchange Plan - 72547IL0170005-01

Open to Indians below 300% FPL - 72547IL0170005-02

Open to Indians above 300% FPL - 72547IL0170005-03

Last Plan Update Date Tue, 24 Sep 2024 00:00 GMT
Last Import Date Tue, 13 May 2025 06:05 GMT

Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay Health Insurance Plan Variant 72547IL0170005-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.7806
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 Gold Off Exchange Plan
Dental Only Plan No
Design Type Design 1
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 0.9998
First Tier Utilization 100%
Formulary ID ILF010
Formulary URL URL
HIOS Product ID 72547IL017
Import Date 2024-09-24 20:01:47
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 ID 72547
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 ILN001
Out of Country Coverage No
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Covered with Limitations
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan ID (Standard Component ID with Variant) 72547IL0170005-00
Plan Marketing Name Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay
Plan Type PPO
Plan Variant Marketing Name Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $2,500
SBC Scenario, Having a Baby, Copayment $10
SBC Scenario, Having a Baby, Deductible $1,500
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 $100
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $100
SBC Scenario, Treatment of a Simple Fracture, Copayment $200
SBC Scenario, Treatment of a Simple Fracture, Deductible $1,500
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID ILS001
Source Name SERFF
Plan ID 72547IL0170005
State Code IL
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 $31000 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person $15500 per person
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual $15,500
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 $3000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $1500 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $1,500
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group $28000 per group
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person $14000 per person
Combined Medical and Drug EHB Deductible, Out of Network, Individual $14,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $15600 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $7800 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $7,800
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 + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay Health Insurance Plan, 72547IL0170005

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

Frequently Asked Questions(FAQ) about Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay, 72547IL0170005 Health Insurance Plan, 72547IL0170005

  • Does Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay Health Insurance Plan, 72547IL0170005 support Mail Ordering?

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

  • Does (72547IL0170005) Health Insurance Plan, Variant (72547IL0170005-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

    Does (72547IL0170005) Health Insurance Plan, Variant (72547IL0170005-00) have Out Of Country Coverage?

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

    Does (72547IL0170005) Health Insurance Plan, Variant (72547IL0170005-00) have Out of Service Area Coverage?

    Yes. Details: Covered with Limitations

    Does (72547IL0170005) Health Insurance Plan, Variant (72547IL0170005-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

    Does Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay Health Insurance Plan, Variant (72547IL0170005-00) offer Disease Management Programs for Asthma?

    Yes, the Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay Health Insurance Plan Variant 72547IL0170005-00 offers Disease Management Program for Asthma.

    Does Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay Health Insurance Plan, Variant (72547IL0170005-00) offer Disease Management Programs for Heart disease?

    Yes, the Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay Health Insurance Plan Variant 72547IL0170005-00 offers Disease Management Program for Heart disease.

    Does Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay Health Insurance Plan, Variant (72547IL0170005-00) offer Disease Management Programs for Depression?

    Yes, the Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay Health Insurance Plan Variant 72547IL0170005-00 offers Disease Management Program for Depression.

    Does Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay Health Insurance Plan, Variant (72547IL0170005-00) offer Disease Management Programs for Diabetes?

    Yes, the Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay Health Insurance Plan Variant 72547IL0170005-00 offers Disease Management Program for Diabetes.

    Does Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay Health Insurance Plan, Variant (72547IL0170005-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay Health Insurance Plan Variant 72547IL0170005-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay Health Insurance Plan, Variant (72547IL0170005-00) offer Disease Management Programs for Low back pain?

    Yes, the Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay Health Insurance Plan Variant 72547IL0170005-00 offers Disease Management Program for Low back pain.

    Does Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay Health Insurance Plan, Variant (72547IL0170005-00) offer Disease Management Programs for Pregnancy?

    Yes, the Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay Health Insurance Plan Variant 72547IL0170005-00 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Tue, 13 May 2025 06:05 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