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Sample care costs:
Total
Total
Patient pays:
Patient pays:
Total
Total
These examples show how this plan might cover
medical care in given situations. Use these examples
to see, in general, how much financial protection a
sample patient might get if they are covered under
different plans.
Amount owed to providers:
$ 7,540
Amount owed to providers:
$ 5,400
Plan pays:
$ 5,060
Plan pays:
$ 3,110
Patient pays:
$ 2,480
Patient pays:
$ 2,290
Sample care costs:
Aetna HealthFund HRA80
Summary of Benefits and Coverage
: What this Plan Covers & What it Costs
Coverage Period
: 01/01/2014 - 12/31/2014
Coverage for
: Employee + Family |
Plan Type
: PPO/High Deductible
About these Coverage
Examples:
Having a baby
(normal delivery)
Managing type 2 diabetes
(routine maintenance of a
well-controlled condition)
Anesthesia
900
Education
300
Laboratory tests
500
Laboratory tests
100
Prescriptions
200
Vaccines, other preventive
100
Hospital charges (mother)
$ 2,700
Prescriptions
$ 2,900
Routine obstetric care
2,100 Medical Equipment and Supplies
1,300
Hospital charges (baby)
900 Office Visits and Procedures
700
Deductibles
$ 1,600
Co-insurance
$ 280
Co-pays
$ 20
Limits or exclusions
$ 80
Co-insurance
$ 710
$ 2,290
Radiology
200
$ 5,400
Vaccines, other preventive
40
$ 7,540
Deductibles
$ 1,600
Co-pays
$ 330
Limits or exclusions
$ 150
$ 2,480
This is not
a cost
estimator.
Don’t use these examples to
estimate your actual costs
under this plan. The actual
care you receive will be
different from these examples,
and the cost of that care will
also be different.
See the next page for
important information about
these examples.
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