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PPO/HDHP/POS/EPO/ACO Summary of Benefits and Coverage (SBCs)

National Plans

High deductible health plans

Aetna HDHP 6350 (PDF)
Aetna HDHP 2000 (PDF)
Aetna HDHP 2000 Out-of-Area (PDF)
Aetna HDHP 4000 (PDF)
Aetna HDHP 4000 Out-of-Area (PDF)

EPO Plans

Aetna EPO 20 (PDF)
Aetna EPO 1000 (PDF)
Aetna EPO 2000 (PDF)

Indemnity Plan

Aetna Indemnity Plan (PDF)

PPO Plans

Aetna PPO 300 (PDF)
Aetna PPO 500 Out-of-Area (PDF)
Aetna PPO 750 (PDF)
Aetna PPO 1000 (PDF)
Aetna PPO 1000 Out-of-Area (PDF)
Aetna PPO 2000 (PDF)
Aetna PPO 3000 (PDF)
Aetna PPO 5000 (PDF)
Aetna PPO 7150 (PDF)
Aetna PPO 7150 Out-of-Area (PDF)

JV Plans

JV Banner PPO 1000 (PDF)
JV Banner PPO 2500 (PDF)
JV Banner PPO 6500 (PDF)

ACO UT Plans

ACO UT PPO 300
ACO UT PPO 1000
ACO UT PPO 2000
ACO UT HDHP 5000

California Plans

HMO Plans

Aetna HMO 0-100 (PDF)
Aetna HMO 2000 (PDF)
Aetna Value Network (PDF)

NY Tri-State Plans

High deductible health plans

Aetna HDHP 2000 (PDF)
Aetna HDHP 4000 (PDF)
Aetna HDHP 6150 (PDF)

EPO Plans

Aetna EPO 20 (PDF)
Aetna EPO 45 (PDF)
Aetna EPO 2000 (PDF)
Aetna EPO 4000 (PDF)

POS Plans

Aetna POS 15 (PDF)
Aetna POS 30 (PDF)

PPO Plans

Aetna PPO 750 (PDF)
Aetna PPO 1000 (PDF)
Aetna PPO 2000 (PDF)

Texas Plans

High deductible health plans

Aetna HDHP 2000 (PDF)
Aetna HDHP 2000 Out-of-Area (PDF)
Aetna HDHP 4000 (PDF)
Aetna HDHP 4000 Out-of-Area (PDF)
Aetna HDHP 6350 (PDF)

Indemnity Plan

Aetna Indemnity Plan (PDF)

PPO Plans

Aetna PPO 300 (PDF)
Aetna PPO 500 Out-of-Area (PDF)
Aetna PPO 750 (PDF)
Aetna PPO 1000 (PDF)
Aetna PPO 1000 Out-of-Area (PDF)
Aetna PPO 2000 (PDF)
Aetna PPO 3000 (PDF)
Aetna PPO 5000 (PDF)
Aetna PPO 7150 (PDF)
Aetna PPO 7150 Out-of-Area (PDF)

ACO UT Plans

ACO UT PPO 300
ACO UT PPO 1000
ACO UT PPO 2000
ACO UT HDHP 5000

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