Questions and answers about the Coverage Examples:
•
•
•
•
•
•
•
Costs don’t include
premiums
.
For each treatment situation, the Coverage Example
helps you see how
deductibles
,
co-payments
, and
co-insurance
can add up. It also helps you see what
expenses might be left up to you to pay because the
service or treatment isn’t covered or payment is
limited.
Yes.
When you look at the Summary of Benefits and
Coverage for other plans, you’ll find the same
Coverage Examples. When you compare plans, check
the “Patient Pays” box in each example. The smaller
that number, the more coverage the plan provides.
Sample care costs are based on national averages
supplied by the U.S. Department of Health and
Human Services (HHS), and aren’t specific to a
particular geographic area or health plan.
The patient’s condition was not an excluded or
preexisting condition.
Does the Coverage Example predict
my own care needs?
Are there other costs I should
consider when comparing plans?
All services and treatments started and ended in the
same coverage period.
No.
Treatments shown are just examples. The care
you would receive for this condition could be
different, based on your doctor’s advice, your age,
how serious your condition is, and many other
factors.
Yes.
An important cost is the
premium
you pay.
Generally, the lower your premium, the more you’ll
pay in
out-of-pocket
costs, such as co-payments,
deductibles
, and
co-insurance
. You also should
consider contributions to accounts such as health
savings accounts (HSAs), flexible spending
arrangements (FSAs) or health reimbursement
accounts (HRAs) that help you pay
out-of-pocket
expenses.
There are no other medical expenses for any member
covered under this plan.
Out-of-pocket
expenses are based only on treating
the condition in the example.
The patient received all care from
in-network
providers
. If the patient had received care from
out-
of-network providers
, costs would have been higher.
Does the Coverage Example predict
my future expenses?
No
.
Coverage Examples are not cost estimators.
You can’t use the examples to estimate costs for an
actual condition. They are for comparative purposes
only. Your own costs will be different depending on
the care you receive, the prices your
providers
charge, and the reimbursement your health plan
allows.
Open Access Aetna Select HSA 80
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
: HMO/High Deductible
What are some of the assumptions
behind the Coverage Examples?
What does a Coverage Example
show?
Can I use Coverage Examples to
compare plans?
Questions
: Call 1-800-558-0860 or visit
If you aren't clear about any of the underlined terms used in this form, see the Glossary. You can view the
Glossary a
or call 1-800-AETNA-HR (1-800-238-6247) to request a copy.
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