Aetna CVS Health

Gold 1 Advanced: Aetna Whole Health network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Links

Plan Overview

Medical Deductible	Individual: $1,500 Family: $3,000 Per Person: $1,500
Prescription Drug Deductible	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical
Medical Out-of-Pocket Maximum	Individual: $7,250 Family: $14,500 Per Person: $7,250
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Office Visit

Primary Doctor	Standard: $10 Copay
Specialist	Standard: $50 Copay

Prescription Drug Information

Preferred Brand Drugs	Standard: $50 Copay
Non Preferred Brand Drugs	Standard: 40% Coinsurance after deductible
Generic Drugs	Standard: $10 Copay
Specialty Drugs	Standard: 40% Coinsurance after deductible

Inpatient Coverage

Hospital Services	Standard: 20% Coinsurance after deductible
Inpatient Services	Standard: 20% Coinsurance after deductible

Emergency and Urgent Care

Emergency Room

Standard: $100 Copay after deductible<br>20% Coinsurance after deductible

This site is not the Health Insurance Marketplace website, and the link to the FFM website is