Benefits & Coverage

Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Aetna
Metal Level
Silver
Plan Type
PPO
Deductible
$3500
Out-of-Pocket Maximum
$6350
Plan Highlights

Cost & Coverage

Estimated Monthly Base Rate
Estimated monthly premium starts at $563.00
Deductible
Individual: $3500
Family: $7000
In-Network Out-of-Pocket Limit
Individual: $6350
Family: $12700
What is included in the in-network out-of-pocket limit?
Deductible + Coinsurance + Co-pay
Is this plan Health Savings Account (HSA) eligible?
No
How can I find a doctor in this plan's network?
Plan Type
PPO

Health Services Options

Service
In Network
Out of Network
Primary care physician office visit
$30 Copay
50% Coinsurance after deductible
Specialist
$60 Copay
50% Coinsurance after deductible
Diagnostic Test (X-ray, blood work)
$60 Copay
50% Coinsurance after deductible
Outpatient Facility Fee
30% Coinsurance after deductible
50% Coinsurance after deductible
Outpatient Physician/Surgeon Fee
30% Coinsurance after deductible
50% Coinsurance after deductible
Hospital facility fee
30% Coinsurance after deductible
50% Coinsurance after deductible
Hospital physician/surgeon fee
30% Coinsurance after deductible
50% Coinsurance after deductible
Emergency Room
$400 Copay
$400 Copay

Drug Services

Generic Drugs
Coverage: $4 Copay
Preferred Brand Drugs
Coverage: $55 Copay after deductible
Specialty Drugs
Coverage: $500 Copay after deductible
What drugs are covered in the formulary?

Mental Health or Substance Abuse Services

Service
In Network
Out of Network
Mental/behavioral health outpatient services
$60 Copay
50% Coinsurance after deductible
Mental/behavioral health inpatient services
30% Coinsurance after deductible
50% Coinsurance after deductible
Substance use disorder inpatient services
30% Coinsurance after deductible
50% Coinsurance after deductible
Substance use disorder outpatient services
$60 Copay
50% Coinsurance after deductible

Maternity Services

Service
In Network
Out of Network
Prenatal/postnatal care
30% Coinsurance after deductible
50% Coinsurance after deductible
Delivery and all inpatient services for maternity care
30% Coinsurance after deductible
50% Coinsurance after deductible

Coverage Options Summary

Included Benefits
  • Dental check up children
  • Durable medical equipment
  • Emergency Transportation
  • Eye glasses children
  • Habilitation
  • Home health care
  • Hospice
  • Imaging (CT/PET scans, MRIs)
  • Inpatient rehabilitation
  • Non-preferred brand drugs
  • Skilled nursing care
  • Other practitioner office visit
  • Outpatient rehabilitation
  • Preventive care, screening, immunization
  • Routine eye exam children
  • Urgent Care
Excluded Benefits
  • Acupuncture
  • Bariatric surgery
  • Cosmetic surgery
  • Dental care adult
  • Hearing Aid
  • Infertility treatment
  • Long Term Care
  • Non-emergency care outside U.S.
  • Private duty nursing
  • Routine foot care
  • Routine hearing tests
  • Weight loss program
Limited Benefits
  • Chiropractic
  • Eye exam adult

What To Know

  • This is an ACA (Obamacare) compliant health plan.

Physician Directory

List of doctors that accepts Aetna Classic 3500 PD NCM: OAMC Obamacare Plan in Pennsylvania

/
STEERMAN, PAUL
101 E OLNEY AVE
PHILADELPHIA, PA 19120
NGUYEN, KENNETH
448 E WYOMING AVE
PHILADELPHIA, PA 19120
WIMMER, ROBERT
101 E OLNEY AVE
PHILADELPHIA, PA 19120
SCHINDLER, ALAN
101 E OLNEY AVE
PHILADELPHIA, PA 19120
ESQUENAZI, ALBERTO
101 E OLNEY AVE
PHILADELPHIA, PA 19120
MEHROTRA, DEEPAK
101 E OLNEY AVE
PHILADELPHIA, PA 19120
MASSEY, JULIE
101 E OLNEY AVE
PHILADELPHIA, PA 19120
ROTH, JONATHAN
101 E OLNEY AVE
PHILADELPHIA, PA 19120
TADLEY, GERALD
335 E WYOMING AVE
PHILADELPHIA, PA 19120
BLENDER, BURTON
335 E WYOMING AVE
PHILADELPHIA, PA 19120
HOELLEIN, KENNETH
101 E OLNEY AVE
PHILADELPHIA, PA 19120
SELBST, ALISON
101 E OLNEY AVE
PHILADELPHIA, PA 19120
LEVIN, BRUCE
410 E ROOSEVELT BLVD
PHILADELPHIA, PA 19120
VANGORE, SURYA
431 W ROOSEVELT BLVD
PHILADELPHIA, PA 19120
CLARKE, CLAUDINE
101 E OLNEY AVE
PHILADELPHIA, PA 19120
SRIDHARA, CHANNARAYAPATNA
101 E OLNEY AVE
PHILADELPHIA, PA 19120
TORCATO, BRIAN
5900 RISING SUN AVE
PHILADELPHIA, PA 19120
VACHRANUKUNKIET, THEERA
101 E OLNEY AVE
PHILADELPHIA, PA 19120
SANANMAN, PETER
51 N 39TH ST
PHILADELPHIA, PA 19104
AHMAD, MUSHTAQ
500 E GODFREY AVE
PHILADELPHIA, PA 19120
BELL, GEORGE
101 E OLNEY AVE
PHILADELPHIA, PA 19120
KIM, KOOK
5438 N LAWRENCE ST
PHILADELPHIA, PA 19120
AMJAD, MUHAMMAD
500 E GODFREY AVE
PHILADELPHIA, PA 19120
JAFFE, RICHARD
101 E OLNEY AVE
PHILADELPHIA, PA 19120
TJOA, PING-AN
111 FERGUSON LN
NEWARK, DE 19702
Details
PAUL STEERMAN, MD
Phone Number
(215) 456-7000
Office Locations
101 E OLNEY AVE
PHILADELPHIA, PA 19120
101 E OLNEY AVE PHILADELPHIA PA, 19120

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