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Aetna - Aetna Leap Basic MIPPA
Nebraska, 2017
Plan Type
POS
Metal Tier
Bronze
Out of Pocket Maximum
$7,050
Deductible
$7,050
Emergency Room Care: No charge after deductible
Cost Sharing Benefits (In Network)
Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.
| Deductible (Individual) | $7,050 |
|---|---|
| Deductible (Family) | $14,100 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $7,050 |
| Out of Pocket Maximum (Family) | $14,100 |
Doctor Visits
| Primary Care Visit | No charge after deductible |
|---|---|
| Specialist Visit | No charge after deductible |
| Inpatient Facility | No charge after deductible |
| Inpatient Physician | No charge after deductible |
| Emergency Room Services | No charge after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | No charge after deductible |
|---|---|
| Laboratory Outpatient and Professional Services | No charge after deductible |
| X-Ray and Diagnostic Imaging | No charge after deductible |
Health Management Programs
| Asthma | Not available |
|---|---|
| Depression | Not available |
| Diabetes | Available |
| Heart Disease | Available |
| High Blood Pressure / High Cholesterol | Not available |
| Lower Back Pain | Not available |
| Pain Management | Not available |
| Pregnancy | Not available |
| Weight Loss | Not available |
Other
| Mental / Behavioral Health Inpatient | No charge after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | No charge after deductible |
| Rehabilitative Speech Therapy | No charge after deductible |
| Rehabilitative Occupational & Physical Therapy | No charge after deductible |
| Outpatient Facility | No charge after deductible |
| Outpatient Surgery | No charge after deductible |
Prescription Drugs
| Generic Rx | Data Not Available |
|---|---|
| Preferred Brand Rx | No charge after deductible |
| Non Preferred Brand Rx | No charge after deductible |
| Specialty Drugs | No charge after deductible |
Other Plans in Nebraska
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Aetna Leap Everyday MIPPA | Deductible $6,075 | Coinsurance Not applicable | Out of Pocket $6,075 |
| Plan Aetna Leap Diabetes CHI Health Omaha | Deductible $6,300 | Coinsurance Not applicable | Out of Pocket $6,300 |
| Plan Aetna Leap Catastrophic CHI Health Omaha | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Aetna Leap Diabetes Gold MIPPA | Deductible $3,950 | Coinsurance Not applicable | Out of Pocket $3,950 |
| Plan Aetna Leap Healthy Minds POS | Deductible $5,600 | Coinsurance Not applicable | Out of Pocket $5,600 |
| Plan Aetna Leap Catastrophic POS | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Aetna Leap Everyday Plus Nebraska Health Network | Deductible $5,050 | Coinsurance Not applicable | Out of Pocket $5,050 |
| Plan Aetna Leap Basic Nebraska Health Network | Deductible $7,050 | Coinsurance Not applicable | Out of Pocket $7,050 |
| Plan Aetna Leap Everyday POS | Deductible $6,075 | Coinsurance Not applicable | Out of Pocket $6,075 |
| Plan Aetna Leap Catastrophic Nebraska Health Network | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Aetna Leap Everyday Plus POS | Deductible $5,050 | Coinsurance Not applicable | Out of Pocket $5,050 |
| Plan Aetna Leap Basic POS | Deductible $7,050 | Coinsurance Not applicable | Out of Pocket $7,050 |
| Plan Aetna Leap Everyday Nebraska Health Network | Deductible $6,075 | Coinsurance Not applicable | Out of Pocket $6,075 |
| Plan Aetna Leap Healthy Minds Nebraska Health Network | Deductible $5,600 | Coinsurance Not applicable | Out of Pocket $5,600 |
| Plan Aetna Leap Catastrophic MIPPA | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Aetna Leap Everyday CHI Health Omaha | Deductible $6,075 | Coinsurance Not applicable | Out of Pocket $6,075 |
| Plan Aetna Leap Diabetes MIPPA | Deductible $6,300 | Coinsurance Not applicable | Out of Pocket $6,300 |
| Plan Aetna Leap Healthy Minds CHI Health Omaha | Deductible $5,600 | Coinsurance Not applicable | Out of Pocket $5,600 |
| Plan Aetna Leap Everyday Plus MIPPA | Deductible $5,050 | Coinsurance Not applicable | Out of Pocket $5,050 |
| Plan Aetna Leap Basic CHI Health Omaha | Deductible $7,050 | Coinsurance Not applicable | Out of Pocket $7,050 |
| Plan Aetna Leap Diabetes POS | Deductible $6,300 | Coinsurance Not applicable | Out of Pocket $6,300 |
| Plan Aetna Leap Diabetes Nebraska Health Network | Deductible $6,300 | Coinsurance Not applicable | Out of Pocket $6,300 |
| Plan Aetna Leap Healthy Minds MIPPA | Deductible $5,600 | Coinsurance Not applicable | Out of Pocket $5,600 |
| Plan Aetna Leap Everyday Plus CHI Health Omaha | Deductible $5,050 | Coinsurance Not applicable | Out of Pocket $5,050 |