CHICAGO ASSOCIATION OF REALTORS MEDICAL BENEFITS SUMMARY 2018
		www.Aetna.com/asa
NETWORK                  Aetna Signature Administrators ®PPO
Indivdual Deductible	$3,500 In-Network/$7,000 Out-of-Network	$2,000 In-Network/$4,000 Out-of-Network
Family Deductible	$7,000 In-Network/$14,000 Out-of-Network	$4,000 In-Network/$8,000 Out-of-Network
Family Deductible Accumulation Method	Individual/Family Deductible	Individual/Family Deductible
Plan Coinsurance Percentage(plan pays)	80% In-network/60% Out-of-Network	80% In-network/60% Out-of-Network
Individual Coinsurance Out of Pocket Maximum (family coinsurance out-of-pocket maximum is 2x coinsurance out-of-pocket maximum)	$2,950 In-network/$5,900 Out-of-Network	$4,600 In-network/$9,200 Out-of-Network
Total Individual out-of-pocket maximum	$6,450 In-Network/$12,900 Out-of-Network	$6,600 In-Network/$13,200 Out-of-Network
Total Family out-of-pocket maximum	Family total out-of-pocket maximum is 2x the indivdual out of pocket maximum	Family total out-of-pocket maximum is 2x the indivdual out of pocket maximum
Lifetime Maximum	No Maximum	No Maximum
Office Visit Copay* (does not require referral)	Deductible and coinsurance	$40 primary care provider, $60 specialist
Prescription Drugs             PBM Cigna
Generic	Deductible - 80%	Copay $20
Brand	Deductible - 80%	Copay $50
Non-preferred Brand	Deductible - 80%	Copay $75
Preventive Medical Services:                                                                                                                                                                  Services recommended by the U.S. Preventive Services Task Force (USPTF) including routine physical exams, associated imaging and laboratory services such as mammograms and PSA tests, well-child exams and immunizations. *	Paid at 100% - no deductible, coinsurance	Paid at 100% - no deductible, coinsurance
Urgent Care Visit*	Deductible and coinsurance	$75 copay, then covered at 100%
Diagnostic X-Ray and Laboratory Services*	Deductible and coinsurance	Deductible and coinsurance
MRI, CT Scan, PET scan Ultrasound, EKG, chemotheraphy, dialysis and BRCA	Deductible and coinsurance	Deductible and coinsurance
Emergency Room Treatment      Subject to a 30% penalty for non-emergency use*	Deductible and coinsurance	$250 copay
Maternity	Deductible and coinsurance	Deductible and coinsurance
Outpatient Physical Medicine  Includes: Physical, speech and occupational therapies, cardiac and pulmonary rehabilatation, treatment for development delay and Chiropractic care.	Deductible and coinsurance limited to 30 visits	Deductible and coinsurance limited to 30 visits
Home Health Care	Limited to 30 visits	Limited to 30 visits
Subacute Rehabilitation and Nursing Facility Services	Limited to 31 days combined	Limited to 31 days combined
Inpatient Rehabilitation Services	Limited to 31 days	Limited to 31 days
Transplants                                                                                                                             Covered the same as any other service when performed by a designated provider	Deductible and coinsurance	Deductible and coinsurance
Behavioral Health and Substance Abuse for groups with 50 emplyees and less.	Inpatient: limited to 30 days Inpatient and Outpatient: subject to deductible and 50% coinsurance. Outpatient: limited to 40 visits	Inpatient: limited to 30 days Inpatient and Outpatient: subject to deductible and 50% coinsurance. Outpatient: limited to 40 visits
Inpatient and Outpatient Hospital*, Physician Services, Maternity Care, Ambulance, Durable Medical Equipment, and most other covered services	Deductible and coinsurance	Deductible and coinsurance
* Services performed by an out-of-network provider are subject to the out-of-network deductible and coinsurance