2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 46
AETNA POS PROVIDERS
MEDICAL BENEFITS
Outpatient Diagnostic
Testing, X-ray and
Laboratory Services
Outpatient
QuestSelect
Services
Plan Pays
90%
Covered Person
Pays
10% after
Deductible
100%
N/A
NON POS PROVIDERS
(Subject to Usual &
Customary Charges)
Plan Pays
Covered Person
Pays
70%
30% 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)
90%
10% after
Deductible
90%
Physician Office Visits
100%
$20 Copay;
Deductible waived
70%
100%
$0
70%
30%
after Deductible
100%
$20 Copay;
Deductible Waived
70%
30% after
Deductible
100%
N/A
No Coverage
N/A
100%
$20 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
100%
$20 Copay;
Deductible waived
N/A
No Coverage
N/A
X-ray and Lab Services
Performed in a Physician’s
Office
Physician’s Services
10% after
Deductible; subject
to POS Out-ofPocket Limits
30% after
Deductible
Office Visits/Telemedicine,
including medical and Mental
Disorders:
Routine Cancer Screening
(see Eligible Medical
Expenses for additional limits)
Routine Care (age 19 and
over)
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