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2017 EXPAT BENEFITS
GUIDE
3
AETNA INTERNATIONAL 2017 EXPAT MEDICAL PLAN SUMMARY
AETNA INTERNATIONAL — Medical Benefits
Outside the U.S.
In-Network**
(Inside the U.S.)
Out-of-Network
(Inside the U.S.)
Maximum lifetime benefit
Unlimited
Unlimited
Unlimited
Deductible
$0 — Individual
$0 — Family
$0 — Individual
$0 — Family
$200 — Individual
$400 — Family
Annual out-of-pocket maximum
$1,500 — Individual
$4,500 — Family
(Does not apply to employees
in the Middle East Plan)
$1,500 — Individual
$4,500 — Family
$3,000 — Individual
$9,000 — Family
Inpatient per confinement deductible
(Maximum of three per calendar year)
None
None
$250
Hospital Services
Inpatient
90%*
80%
60% after $250 per
confinement deductible
Outpatient
90%*
80%
60% after deductible
Pre-certification penalty
None
None
$400
Non-emergency use of the
emergency room
90%*
80%
60% after deductible
Emergency room
90%*
80%
80%
Urgent care
90%*
80%
60% after deductible
Physician Services and Wellness Benefits
PCP or specialist doctor’s office visits
90%*
80%
60% after deductible
Routine child physical exams
(Includes immunizations)
90%*
100%
60% after deductible
Routine adult physical exams
(Includes immunizations)
90%*
100%
60% after deductible
Routine gynecological exams
(One exam and pap smear per
calendar year)
90%*
100%
60% after deductible
Mammograms
(One exam per calendar year)
90%*
100%
60% after deductible
PSA tests
(One per calendar year for males
age 40+)
90%*
100%
60% after deductible
Digital rectal exam
(One per calendar year for males
age 40+)
90%*
100%
60% after deductible
Cancer screenings
(One flex sigmoid and one double
barium contrast every 5 years; at
age 50+ one colonoscopy every
5 years)
90%*
100%
60% after deductible
Routine hearing exam
(One per calendar year)
90%*
100%
60% after deductible
Mental Health and Alcohol/Substance Abuse Services
Inpatient treatment
90%*
80%
60% after $250 per
confinement deductible
Outpatient treatment
90%*
80%
60% after deductible
(continued)