Aetna Classic 3500 PD NCM: OAMC

Individual Health Insurance (Obamacare)

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Benefits & Coverage

Plan Name
Aetna Classic 3500 PD NCM: OAMC
Plan ID
33906PA0110003
Plan Year
2014
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Silver
Plan Type
PPO
Deductible
$3,500
Out-of-Pocket Maximum
$6,350
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

/
VANGORE, SURYA
431 W ROOSEVELT BLVD
PHILADELPHIA, PA 19120
TORCATO, BRIAN
5900 RISING SUN AVE
PHILADELPHIA, PA 19120
JAFFE, RICHARD
101 E OLNEY AVE
PHILADELPHIA, PA 19120
BLENDER, BURTON
335 E WYOMING AVE
PHILADELPHIA, PA 19120
TADLEY, GERALD
335 E WYOMING AVE
PHILADELPHIA, PA 19120
BELL, GEORGE
101 E OLNEY AVE
PHILADELPHIA, PA 19120
GARCIA, LAUREANO
328 W GODFREY AVE
PHILADELPHIA, PA 19120
ANG, DEXTER
100 BOWMAN DR
VOORHEES, NJ 08043
SRIDHARA, CHANNARAYAPATNA
101 E OLNEY AVE
PHILADELPHIA, PA 19120
AHMAD, MUSHTAQ
500 E GODFREY AVE
PHILADELPHIA, PA 19120
YOO, STANLEY
101 E OLNEY AVE
PHILADELPHIA, PA 19120
ROSS, HARRIS
328 W GODFREY AVENUE
PHILADELPHIA, PA 19120
NGUYEN, TRUONG
5746 RISING SUN AVE
PHILADELPHIA, PA 19120
SANANMAN, PETER
51 N 39TH ST
PHILADELPHIA, PA 19104
KIM, HI
5438 N LAWRENCE STREET
PHILADELPHIA, PA 19120
TJOA, PING-AN
111 FERGUSON LN
NEWARK, DE 19702
BIRNBAUM, MICHAEL
8380 OLD YORK RD
ELKINS PARK, PA 19027
KRON, KENNETH
7401 OLD YORK RD
MELROSE PARK, PA 19027
SCHWARTZ, MELISSA
375 TOWNSHIP LINE RD
ELKINS PARK, PA 19027
RAPHAEL, CHARI
8080 OLD YORK RD
ELKINS PARK, PA 19027
HOLL, WILLIAM
1413 W MOYAMENSING AVE
PHILADELPHIA, PA 19145
DEMARIA, RICHARD
8080 OLD YORK RD
ELKINS PARK, PA 19027
MANIN, BRADLEY
8302 OLD YORK RD
ELKINS PARK, PA 19027
SILVERSTEIN, DANIEL
8302 OLD YORK RD
ELKINS PARK, PA 19027
NEWBERG, AARON
1939 W CHELTENHAM AVE
ELKINS PARK, PA 19027
Details
SURYA VANGORE, M.D.
Phone Number
(215) 455-3444
Office Locations
431 W ROOSEVELT BLVD
PHILADELPHIA, PA 19120
431 W ROOSEVELT BLVD PHILADELPHIA PA, 19120

Community Q&A

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