Aetna CA Preventative and Hospital Care 3000 (HSA Compatible) California Health Insurance Plan Details

Insurance Plan Summary
Company
Aetna
Plan Name
CA Preventative and Hospital Care 3000 (HSA Compatible)
Plan Type
PPO
Primary Care Physician Required
No 
Specialist Referrals Required
No 
HSA Eligible
Yes 
Out-of-Network Coverage
Yes
In-Network Coverage
Coinsurance
20% after deductible 
Office Visit
 
Primary Doctor
Not Covered 
Specialist
Not Covered 
Periodic Health Exam
$35 Copay 
Periodic OB-GYN Exam
No Charge 
Well Baby Care
$35 copay; Age and frequency schedule apply 
Chiropractic
Not Covered 
Mental Health
Not covered except for severe biologically based mental and nervous disorders with associated treatment of drug and alcohol dependencies 
Prescription Drugs
 
Generic
Discount Card Available 
Brand
Discount Card Available 
Non-Formulary
Discount Card Available 
Separate Rx Deductible
None 
Mail Order
Not Available
Outpatient Lab/X-Ray
Not Covered 
Emergency Room
$100 Copay (waived if admitted) plus 20% Coinsurance after deductible 
Outpatient Surgery
20% Coinsurance after deductible 
Hospitalization
20% Coinsurance after deductible 
Maternity
 
Pre & Postnatal Office Visit
Not Covered 
Labor & Delivery Hospital Stay
Not Covered 
Additional Information
Will insurance company obtain and pay for medical records?
Yes
eSign
(electronic signature)
Yes
A.M. Best Rating
A
as of 06/11/2007
More Insurance Plan Details
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Exclusions and Limitations
Exclusions and Limitations
Actions
Company
Aetna
Plan Name
CA Preventative and Hospital Care 3000 (HSA Compatible)
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