Introduction to the U.S. health care delivery system

Healthcare System

My current healthcare plan is through Aetna via my husband's work. It is through a company, so the cost is drastically less than a private plan.

Husband's employer

Out of Pocket Costs:

In Network Co-Pay: $

In Network Deductible: $500

Out of Network Deductible: $1,000

Percentage of Coverage: 100% after deductible is met, some percentages do apply for out of network providers, but Aetna does not give a specific amount.

Aetna does have many limitations placed on members. For instance, out-of-network providers can be used, but the patient must handle all of the billing information themselves. Additionally, the deductible is twice as high for out-of-network coverage. Any out-of-network emergencies are still handled as in-network.

Another limitation is enrollment. Enrollment can only happen once a year. The only exception for this rule is with either a court order, adoption, or birth. In these circumstances, the person must be enrolled within 31 days.

The plan does not have any restrictions for pre-existing conditions.

Exclusions:

My current plan does not cover home births, elective surgeries, weight loss surgeries and treatments, as well as any alternative care treatments including: Acupressure, acupuncture, acupuncture therepy, non-standard allergy services, non-emergency charges outside of the United States, applied behavior tests, over the counter contraceptive supplies including but not limited to condoms, contraceptive foams, jellies and ointments Cosmetic services and plastic surgery: any treatment, surgery (cosmetic or plastic), service or supply to alter, improve or enhance the shape or appearance of the body whether or not for psychological or emotional reasons, counseling, and court ordered services. (Benefit Plan 38)