2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 42
AETNA POS PROVIDERS
MEDICAL BENEFITS
Outpatient Diagnostic
Testing, X-ray and Laboratory
Outpatient QuestSelect
Services
Plan Pays
80%
100%
Covered Person
Pays
20% after
Deductible
N/A
NON POS PROVIDERS
(Subject to Usual &
Customary Charges)
Plan Pays
Covered Person
Pays
60%
40% after
Deductible
N/A
N/A
The use of Quest Diagnostics or LabCorp is strictly voluntary. If utilizing these labs for services offered under their
programs, the Medical Plan will pay 100% of the eligible charges a Covered Person incurs for outpatient laboratory
services and will waive any of this Medical Plan's Copays, Deductibles and/or Coinsurance requirements.
If a Covered Person and/or a Physician elect to use another lab – including the lab in the Physician’s office, normal
Medical Plan benefits will apply. See the Diagnostic Testing, X-ray and Laboratory Services benefit under Eligible
Medical Expenses for further details of this program.
Outpatient Therapies
(i.e. physical, speech,
occupational)
80%
20% after
Deductible
80%
Physician Office Visits
100%
$25 Copay;
Deductible waived
60%
100%
$0
60%
100%
$25 Copay;
Deductible Waived
60%
Routine Cancer Screening
(see Eligible Medical
Expenses for additional limits)
100%
N/A
No Coverage
N/A
Routine Care (age 19 and over)
100%
$25 Copay;
Deductible waived
No Coverage
N/A
X-ray and Lab Services
Performed in a Physician’s
Office
Routine Eye Exam
100%
$0
100%
No Coverage
N/A
Routine Mammograms
Routine Newborn Care
(whether or not the newborn
is enrolled as a dependent)
100%
Paid under
the mother’s
maternity
benefit
100%
after
Copay
$25 Copay;
Deductible waived
N/A
Paid under the
mother’s maternity
benefit
No Coverage
Paid under the
mother’s
maternity
benefit
No Coverage
N/A
Paid under the
mother’s maternity
benefit
X-ray and Lab Services
Performed in a Physician’s
Office
Physician’s Services
20% after
Deductible; subject
to POS Out-ofPocket Limits
40% after
Deductible
40% after
Deductible
40% after
Deductible
Office Visits/Telemedicine,
including medical and Mental
Disorders:
Smoking Cessation
Calendar Year Maximum
Benefit
$25 Copay;
Deductible waived
1 program
38
N/A