Common Medical Event
Services You May
Need
Your cost if you use
an APN and/or
Aexcel Network
Provider
Your cost if you use an
In-Network Provider
Your cost if
you use an
Out-of-
Network
Provider
Limitations & Exceptions
If you have a hospital stay
Facility fee (e.g.,
hospital room)
20%
coinsurance
20% coinsurance if you are
not in an Aexcel or APN
network;
40% coinsurance if you are in
an Aexcel/APN network
Not covered
Bariatric/transplant services received at
any facility that is not an Institutes of
Quality/Excellence facility are not
covered; APN/Aexcel does not apply.
Services must be precertified or benefits
are reduced by 50%, up to a $1,000
maximum. No out-of-network coverage.
Physician/surgeon fee
20%
coinsurance
Not covered
If you have outpatient surgery
Physician/surgeon fees
20%
coinsurance
20% coinsurance if you are
not in an Aexcel or APN
network;
40% co-insurance if you are
in an Aexcel/APN network
Not covered
Bariatric/transplant services received at
any facility that is not an Institutes of
Quality/Excellence facility are not
covered; APN/Aexcel does not apply.
Services must be precertified or benefits
are reduced by 50%, up to a $1,000
maximum. No out-of-network coverage.
If you need immediate
medical attention
Emergency room
services
APN/Aexcel network not
applicable
20%
coinsurance
20%
coinsurance
Non emergency use not covered.
Emergency medical
transportation
APN/Aexcel network not
applicable
20%
coinsurance
20%
coinsurance
Non emergency use not covered.
Urgent care
APN/Aexcel network not
applicable
20%
coinsurance
Not covered No out-of-network coverage.
If you have mental health,
behavioral health or
substance abuse needs
Mental/Behavioral
health outpatient
services
APN/Aexcel network not
applicable
20%
coinsurance
Not covered No out-of-network coverage.
Mental/Behavioral
health inpatient
services
APN/Aexcel network not
applicable
20%
coinsurance
Not covered No out-of-network coverage.
Substance use disorder
outpatient services
APN/Aexcel network not
applicable
20%
coinsurance
Not covered No out-of-network coverage.
Substance use disorder
inpatient services
APN/Aexcel network not
applicable
20%
coinsurance
Not covered No out-of-network coverage.
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