In a point-of-service (POS) plan, you do not have to select a primary care physician or obtain a referral to see a specialist, although there are advantages to doing so. You also have the choice of seeking care from in-network or out-of-network providers, although cost of services will vary. All in-network preventive services will be covered at 100% with no cost sharing.
The following table shows the Aetna Choice POS II Plan details.
| Plan Features | In-Network Services | Out-of-Network Services |
| Annual Deductible (individual/family) | $600/$1,200 | $1,200/$2,400 |
| Annual Medical Out-of-Pocket Maximum (individual/family) | $4,000/$8,000 | $8,000/$16,000 |
| Lifetime Maximum | Unlimited | |
| MEDICAL SERVICES | ||
| Coinsurance | 80% | 60% after deductible (all services) |
| Primary Care Copay | $35 copay | 60% after deductible |
| Specialty Care Copay/Urgent Care |
$50 copay | 60% after deductible |
| Preventive Office Visit – Adult (per calendar year) | 100% | 60% after deductible |
| Preventive Office Visit – Child (per calendar year) | 100% | 60% after deductible |
| Immunizations | 100% | 60% after deductible |
| Lab Work/X-Ray/Mammography (related to preventive exams) | 100% | 60% after deductible |
| Lab Work/X-Ray (when not related to preventive exams) | 80% after deductible | 60% after deductible |
| Routine OB/GYN Exam | 100% | 60% after deductible |
| Routine Prenatal OB | 100% | 60% after deductible The key attributes of this plan are: |
| Delivery and Postpartum | 80% after deductible | 60% after deductible |
| Female Sterilization | 100% | 60% after deductible |
| Routine Mammography Exam | 100% | 60% after deductible |
| HOSPITAL SERVICES | ||
| Inpatient Coverage (semi-private room) | 80% after deductible | 60% after deductible |
| Outpatient Coverage | 80% after deductible | 60% after deductible |
| Emergency Room – True Emergency (in- and out-of-network) | 80% after $300 copay | |
| Emergency Room – Non-True Emergency (in- and out-of-network) | 80% after $300 copay | |
| Hearing Exams (one exam every two calendar years unless otherwise noted) | $50 copay | 60% after deductible |
| Hearing Aids (up to $5,000 every three calendar years) | 80% after deductible | 60% after deductible |
| MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES | ||
| Inpatient Coverage | 80% after deductible | 60% after deductible |
| Outpatient Coverage | $35 copay | 60% after deductible |