Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay - 72547IL0170010 Health Insurance Plan

Aetna Life Insurance Company health insurance plan with the Plan ID 72547IL0170010. The plan is called Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 100.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 0.00% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 72547IL0170010
Health Insurance Plan Year 2024
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 72547IL0170010-02
Provider Network(s) PREFERRED
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 14 May 2024 06:16 GMT).

Providers Illinois All US States
All 36439 41846
PCP 6406 7157
Allergy 30 33
OB/GYN 269 301
Dentists 41 43
Available Variants of the Health Plan

Standard Off Exchange Plan - 72547IL0170010-00

Standard On Exchange Plan - 72547IL0170010-01

Open to Indians below 300% FPL - 72547IL0170010-02

Open to Indians above 300% FPL - 72547IL0170010-03

73% AV Silver Plan - 72547IL0170010-04

87% AV Silver Plan - 72547IL0170010-05

94% AV Silver Plan - 72547IL0170010-06

Last Plan Update Date Tue, 12 Sep 2023 00:00 GMT
Last Import Date Tue, 14 May 2024 06:16 GMT

Benefits of Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay Health Insurance Plan, 72547IL0170010-02

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited

Abortions are only covered when the life of the mother would be endangered if the fetus were carried to term, or when the pregnancy is the result of an act of rape or incest

YES

No Charge

No Charge
Accidental Dental
YES

No Charge

No Charge
Acupuncture
NO
Allergy Testing
YES

No Charge

No Charge
Autism Spectrum Disorders

Member cost share based on place and type of service.

YES

No Charge

No Charge
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

No Charge

No Charge
Basic Dental Care - Adult
NO
Basic Dental Care - Child
NO
Bones/Joints

Member cost share based on place and type of service.

YES

No Charge

No Charge
Breast Implant Removal

Member cost share based on place and type of service.

YES

No Charge

No Charge
Chemotherapy

Member cost share based on place and type of service.

YES

No Charge

No Charge
Chiropractic Care

Limit: 25.0 Visit(s) per Year

Exclusions: New Style Accumulation and Cost Share- Coverage is limited to 25 visits per manipulation per calendar year, separate from habilitation and includes all outpatient places of service for Chiro.

Benefits will be provided for manipulation or adjustment of osseous or articular structures, commonly referred to as chiropractic and osteopathic manipulation, when performed by a person licensed to perform such procedures.

YES

No Charge

No Charge
Clinical Trials

Member cost share based on place and type of service.

YES

No Charge

No Charge
Cosmetic Surgery

Cosmetic surgery for the correction of the congenital deformities or for conditions resulting from accidental injuries, scars, tumors or disease is covered.

YES

No Charge

No Charge
Delivery and All Inpatient Services for Maternity Care
YES

No Charge

No Charge
Dental Anesthesia
YES

No Charge

No Charge
Dental Check-Up for Children
NO
Diabetes Care Management

Member cost share based on place and type of service.

YES

No Charge

No Charge
Diabetes Education

Services must be rendered by a physician, or duly certified, registered or licensed health care professional with expertise in diabetes management.

YES

No Charge

No Charge
Dialysis
YES

No Charge

No Charge
Durable Medical Equipment
YES

No Charge

No Charge
Emergency Room Services
YES

No Charge

No Charge
Emergency Transportation/Ambulance
YES

No Charge

No Charge
Eye Glasses for Children

Limit: 1.0 Item(s) per Year

Exclusions: Coverage is limited to 1 set of frames and 1 set of contact lenses or eyeglass lenses per year. Age 0-19.

YES

No Charge

No Charge
Gender Affirming Care
NO
Generic Drugs

Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.

YES

No Charge

No Charge
Habilitation Services

Treatment must be medically necessary and therapeutic and not investigational.

YES

No Charge

No Charge
Hearing Aids

Limit: 1.0 Item(s) per 2 Years

Exclusions: Hearing aids limited to 1 hearing aid per ear every 24 months. Bone anchored hearing aids and cochlear implants are covered.

YES

No Charge

No Charge
Home Health Care Services
YES

No Charge

No Charge
Hospice Services
YES

No Charge

No Charge
Imaging (CT/PET Scans, MRIs)
YES

No Charge

No Charge
Infertility Treatment

Exclusions: Limited to 4 attempts; if live birth, 2 additional attempts covered.

YES

No Charge

No Charge
Infusion Therapy

Member cost share based on place and type of service.

YES

No Charge

No Charge
Inherited Metabolic Disorder - PKU
YES

No Charge

No Charge
Inpatient Hospital Services (e.g., Hospital Stay)
YES

No Charge

No Charge
Inpatient Physician and Surgical Services
YES

No Charge

No Charge
Laboratory Outpatient and Professional Services
YES

No Charge

No Charge
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult
NO
Major Dental Care - Child
NO
Mental/Behavioral Health Inpatient Services
YES

No Charge

No Charge
Mental/Behavioral Health Outpatient Services
YES

No Charge

No Charge
Multiple Sclerosis

Member cost share based on place and type of service.

YES

No Charge

No Charge
Non-Preferred Brand Drugs

Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.

YES

No Charge

No Charge
Nutritional Counseling
YES

No Charge

No Charge
Organ Transplants

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

YES

No Charge

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

No Charge

No Charge
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
YES

No Charge

No Charge
Outpatient Rehabilitation Services
YES

No Charge

No Charge
Outpatient Surgery Physician/Surgical Services
YES

No Charge

No Charge
Preferred Brand Drugs

Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.

YES

No Charge

No Charge
Prenatal and Postnatal Care

Member cost sharing applies to postnatal care

YES

No Charge

No Charge
Prescription Drugs Other

Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.

YES

No Charge

No Charge
Preventive Care/Screening/Immunization

Exclusions: Age and frequency schedules may apply.

YES

No Charge

No Charge
Primary Care Visit to Treat an Injury or Illness
YES

No Charge

No Charge
Private-Duty Nursing

Exclusions: Inpatient Private Duty Nursing Services are not covered.

YES

No Charge

No Charge
Prosthetic Devices
YES

No Charge

No Charge
Radiation
YES

No Charge

No Charge
Reconstructive Surgery

Member cost share based on place and type of service.

YES

No Charge

No Charge
Rehabilitative Occupational and Rehabilitative Physical Therapy

Provided when rendered by a registered Occupational Therapist or registered professional Physical Therapist under the supervision of a Physician.

YES

No Charge

No Charge
Rehabilitative Speech Therapy

Provided when rendered by a licensed Speech Therapist or Speech Therapist certified by the American Speech and Hearing Association.

YES

No Charge

No Charge
Routine Dental Services (Adult)
NO
Routine Eye Exam (Adult)
NO
Routine Eye Exam for Children

Limit: 1.0 Exam(s) per Year

Exclusions: Coverage is limited to 1 exam every 12 months age 0-19.

YES

No Charge

No Charge
Routine Foot Care

Only covered for persons diagnosed with diabetes.

YES

No Charge

No Charge
Skilled Nursing Facility
YES

No Charge

No Charge
Specialist Visit
YES

No Charge

No Charge
Specialty Drugs

Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.

YES

No Charge

No Charge
Substance Abuse Disorder Inpatient Services
YES

No Charge

No Charge
Substance Abuse Disorder Outpatient Services
YES

No Charge

No Charge
Transplant

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

YES

No Charge

No Charge
Treatment for Temporomandibular Joint Disorders

Member cost share based on place and type of service.

YES

No Charge

No Charge
Urgent Care Centers or Facilities
YES

No Charge

No Charge
Weight Loss Programs

Online weight loss programs are available.

NO
Well Baby Visits and Care

Exclusions: Children immunizations covered at 100% deductible waived for children up to 72 months of age. Coverage is limited to 7 exams in the first 12 months of life; 3 exams in the second 12 months of life; 3 exams in the third 12 months of life; 1 exam every 12 months thereafter to age 22.

YES

No Charge

No Charge
X-rays and Diagnostic Imaging
YES

No Charge

No Charge

Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay Health Insurance Plan Variant 72547IL0170010-02 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 2024
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Zero Cost Sharing Plan Variation
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 0.9991
First Tier Utilization 100%
Formulary ID ILF019
Formulary URL URL
HIOS Product ID 72547IL017
Import Date 2023-09-12 20:01:55
Limited Cost Sharing Plan Variation - Estimated Advanced Payment 0
Inpatient Copayment Maximum Days 0
HSA Eligible No
New/Existing Plan New
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer Actuarial Value 100.00%
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 Silver
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 2024-01-01
Plan ID (Standard Component ID with Variant) 72547IL0170010-02
Plan Marketing Name Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay
Plan Type PPO
Plan Variant Marketing Name Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $0
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 $0
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $0
SBC Scenario, Treatment of a Simple Fracture, Deductible $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID ILS001
Source Name SERFF
Plan ID 72547IL0170010
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 per group not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person per person not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 0.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $0 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $0 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $0
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group $0 per group
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person $0 per person
Combined Medical and Drug EHB Deductible, Out of Network, Individual $0
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $0 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $0 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $0
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group $0 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person $0 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $0
Unique Plan Design Yes
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered Yes

Copay & Coinsurance of Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay Health Insurance Plan, 72547IL0170010

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

Frequently Asked Questions(FAQ) about Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay, 72547IL0170010 Health Insurance Plan, 72547IL0170010

  • Does Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay Health Insurance Plan, 72547IL0170010 support Mail Ordering?

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

  • Does (72547IL0170010) Health Insurance Plan, Variant (72547IL0170010-02) 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 (72547IL0170010) Health Insurance Plan, Variant (72547IL0170010-02) have Out Of Country Coverage?

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

    Does (72547IL0170010) Health Insurance Plan, Variant (72547IL0170010-02) have Out of Service Area Coverage?

    Yes. Details: Covered with Limitations

    Does (72547IL0170010) Health Insurance Plan, Variant (72547IL0170010-02) 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 Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay Health Insurance Plan, Variant (72547IL0170010-02) offer Disease Management Programs for Asthma?

    Yes, the Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay Health Insurance Plan Variant 72547IL0170010-02 offers Disease Management Program for Asthma.

    Does Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay Health Insurance Plan, Variant (72547IL0170010-02) offer Disease Management Programs for Heart disease?

    Yes, the Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay Health Insurance Plan Variant 72547IL0170010-02 offers Disease Management Program for Heart disease.

    Does Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay Health Insurance Plan, Variant (72547IL0170010-02) offer Disease Management Programs for Depression?

    Yes, the Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay Health Insurance Plan Variant 72547IL0170010-02 offers Disease Management Program for Depression.

    Does Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay Health Insurance Plan, Variant (72547IL0170010-02) offer Disease Management Programs for Diabetes?

    Yes, the Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay Health Insurance Plan Variant 72547IL0170010-02 offers Disease Management Program for Diabetes.

    Does Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay Health Insurance Plan, Variant (72547IL0170010-02) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay Health Insurance Plan Variant 72547IL0170010-02 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay Health Insurance Plan, Variant (72547IL0170010-02) offer Disease Management Programs for Low back pain?

    Yes, the Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay Health Insurance Plan Variant 72547IL0170010-02 offers Disease Management Program for Low back pain.

    Does Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay Health Insurance Plan, Variant (72547IL0170010-02) offer Disease Management Programs for Pregnancy?

    Yes, the Silver 6 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay Health Insurance Plan Variant 72547IL0170010-02 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Tue, 14 May 2024 06:16 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