Consolidated Insurance Services

Aetna

2009 Plan summaries

Benefit	Open Value	Open Value w/Rx	Open Premier	Open Premier w/Rx
Mo Premium	$0	$0	$70	$132
Dr visit	$15 copay	$15 copay	$0 copay	$0 copay
Maxium Out-of-Pocket	$2,500	$2,500	$1,000	$1,000
Rx Copays	N/A	$275 ded 4/34.50/80	N/A	$0 ded 4/40/70
Specialist visit	$15 copay	$15 copay	$0 copay	$0 copay
Inpatient Hospital	Days 1-7, copay $150 per day $0 for additional days	Days 1-7, copay $185 per day $0 for additional days	$0 copay	$0 copay
Outpatient Hospital	$150 copay	$185 copay	$0 copay	$0 copay
Emergency Care	$50 copay	$50 copay	$0 copay	$0 copay
Ambulance Services	$100 copay	$100 copay	$50 copay	$50 copay
Vision	$0 copay 1 routine exam every year. $125 limit for eyewear every two yrs