Health Plan Medical Scenarios

Emily is having a baby.  The estimates below include an uncomplicated vaginal delivery without sterilization, and a hospital stay of three nights for Emily and her baby. Emily and her newborn are the only people covered by her health plan option.

These estimates include the deductible and coinsurance limits for Emily and baby. With the inclusion of the baby's estimated costs and associated deductible and coinsurance limits, the estimate you see here may appear higher than the deductible and coinsurance limits listed in the medical plan details. Check your plan benefits for specific details.

Here are Emily's possible deductible, coinsurance, maximum out-of-pocket cost, and annual premiums, depending on health plan option. Included also is the HSA employee contribution for Basic Health participants.

Here are cost estimates for Emily's delivery.

• These estimates below presume no prior deductible was met
• The estimates are for in-network providers only
• The estimates are for inpatient hospital service
• Your real costs will depend on the services you receive and how Aetna is billed by the doctor or health care facility
• We cannot guarantee the accuracy of any cost or estimate, as they can change without notification
• This information is solely for use in evaluating and estimating the out-of-pocket costs for services by a doctor or facility
• Basic Health members are responsible for the balance of their deductible and out of pocket expenses if/when the HSA funds have exhausted. 

Emily's Costs:

Newborn's Costs:

** No deductible for newborn; Emily has already met the family deductible.

Total Costs and Annual Premiums: Factoring in annual premiums, Emily's projected costs for the year she delivers a new baby would be:

*** Emily was Employee Only prior to her baby being born; her HSA employer contribution would be for Employee Only as of the beginning of the year, and her premiums would change to Employee + Child level with her Qualifying Life Event.

These scenarios are pulled from Aetna's database. If you would like to create your own scenarios, visit Aetna’s website and click on “Log in/Register” to access these resources:​​​​​  

• Payment Estimator: Compares costs to give you real-time, personalized estimates
• Cost of Care Estimator: Provides average in-network and out-of-network costs

Bella lives by herself, and recently injured her foot and needs help figuring out what to do about it. The estimates below include a complete foot x-ray, with a minimum of three views. Some facilities may charge an additional fee for the radiologist to read the x-ray. Check your plan benefits for more details.

Here are Bella's possible deductible, coinsurance, maximum out-of-pocket cost, and annual premiums, depending on health plan option. Included also is the HSA employee contribution for Basic Health participants.

Here are cost estimates for Bella's foot x-rays.

• These estimates below presume no prior deductible was met
• The estimates are for in-network providers only
• The estimates are for non-preventive x-ray procedure
• Your real costs will depend on the services you receive and how Aetna is billed by the doctor or health care facility
• We cannot guarantee the accuracy of any cost or estimate, as they can change without notification
• This information is solely for use in evaluating and estimating the out-of-pocket costs for services by a doctor or facility
• Basic Health members are responsible for the balance of their deductible and out of pocket expenses if/when the HSA funds have exhausted. 

Bella's Costs:

Total Costs and Annual Premiums: Factoring in annual premiums, Bella's projected costs for the year she injures her foot would be:

These scenarios are pulled from Aetna's database. If you would like to create your own scenarios, visit Aetna’s website and click on “Log in/Register” to access these resources:​​​​​  

• Payment Estimator: Compares costs to give you real-time, personalized estimates
• Cost of Care Estimator:Provides average in-network and out-of-network costs

Mark's family is very concerned for him, as he just found out he has Type 1 diabetes. His doctor has prescribed a continuous glucose monitor for him. The estimates below include a continuous glucose monitor, receive, transmitter, and sensor, purchased through an in-network Durable Medical Equipment supplier. Check your plan benefits for more details.

Here are Mark's possible deductible, coinsurance, maximum out-of-pocket cost, and annual premiums, depending on health plan option. Included also is the HSA employee contribution for Basic Health participants.

Here are cost estimates for Mark's continuous glucose monitor, receive, transmitter, and sensor.

• These estimates below presume no prior deductible was met
• The estimates are for in-network providers only
• The estimates are for Durable Medical Equipment service
• Your real costs will depend on the services you receive and how Aetna is billed by the doctor or health care facility
• We cannot guarantee the accuracy of any cost or estimate, as they can change without notification
• This information is solely for use in evaluating and estimating the out-of-pocket costs for services by a doctor or facility
• Basic Health members are responsible for the balance of their deductible and out of pocket expenses if/when the HSA funds have exhausted. 

Mark's Costs:

Total Costs and Annual Premiums: Factoring in annual premiums, Mark's projected costs for the year he is diagnosed with Type 1 diabetes would be:

These scenarios are pulled from Aetna's database. If you would like to create your own scenarios, visit Aetna’s website and click on “Log in/Register” to access these resources:​​​​​  

• Payment Estimator: Compares costs to give you real-time, personalized estimates
• Cost of Care Estimator: Provides average in-network and out-of-network costs

Robert and his wife Claire are on the UVA Health Plan, and Claire encouraged Robert to seek medical advice for a nagging back pain he hasn't been able to heal. His primary care physician recommends that Robert start physical therapy on his back immediately.

The estimates below are for physical therapy, therapeutic procedure, one or more areas. Check your plan benefits for more details.

Here are Robert's possible deductible, coinsurance, maximum out-of-pocket cost, and annual premiums, depending on health plan option. Included also is the HSA employee contribution for Basic Health participants.

Here are cost estimates for Robert's physical therapy on his back; this is a per visit estimate.

• These estimates below presume no prior deductible was met
• The estimates are for in-network providers only
• The estimates are for physical therapy, therapeutic procedure, one or more areas
• Your real costs will depend on the services you receive and how Aetna is billed by the doctor or health care facility
• We cannot guarantee the accuracy of any cost or estimate, as they can change without notification
• This information is solely for use in evaluating and estimating the out-of-pocket costs for services by a doctor or facility
• Basic Health members are responsible for the balance of their deductible and out of pocket expenses if/when the HSA funds have exhausted. 

Robert's Costs:

Total Costs and Annual Premiums: Factoring in annual premiums, Robert's projected costs for the year he has back pain and seeks physical therapy would be:

These scenarios are pulled from Aetna's database. If you would like to create your own scenarios, visit Aetna’s website and click on “Log in/Register” to access these resources:​​​​​  

• Payment Estimator: Compares costs to give you real-time, personalized estimates
• Cost of Care Estimator: Provides average in-network and out-of-network costs

Ken hasn't been feeling well lately, and decides to visit his primary care physician to discover what is troubling his body.

The estimates below are for a typical primary care established patient office visit. A typical office visit at your primary care physician's office would entail just the cost of the visit itself for low to moderate severity problems. Check your plan benefits for more details.

Here are Ken's possible deductible, coinsurance, maximum out-of-pocket cost, and annual premiums, depending on health plan option. Included also is the HSA employee contribution for Basic Health participants.

*Mental Health outpatient treatment office visit offer the same member cost-share as Primary Care provider office visits.  

Here are cost estimates for Ken's primary care physician office visit.

• These estimates below presume no prior deductible was met
• The estimates are for in-network providers only
• The estimates are for a typical primary care established patient office visit
• Your real costs will depend on the services you receive and how Aetna is billed by the doctor or health care facility
• We cannot guarantee the accuracy of any cost or estimate, as they can change without notification
• This information is solely for use in evaluating and estimating the out-of-pocket costs for services by a doctor or facility
• Basic Health members are responsible for the balance of their deductible and out of pocket expenses if/when the HSA funds have exhausted. 

Ken's Costs:

Total Costs and Annual Premiums: Factoring in annual premiums, Ken's projected costs for the year he visits his primary care physician would be:

These scenarios are pulled from Aetna's database. If you would like to create your own scenarios, visit Aetna’s website and click on “Log in/Register” to access these resources:​​​​​  

• Payment Estimator: Compares costs to give you real-time, personalized estimates
• Cost of Care Estimator: Provides average in-network and out-of-network costs

Tim's right knee had been bothering him for a long time, and he finally decided to have it replaced. His total knee replacement includes most typical services, from admission to discharge, but does not include physical therapy after his knee replacement. Charges may vary greatly depending on the type of implant Tim receives.

Here are Tim's possible deductible, coinsurance, maximum out-of-pocket cost, and annual premiums, depending on health plan option. Included also is the HSA employee contribution for Basic Health participants.

Here are cost estimates for Tim's total knee replacement.

• These estimates below presume no prior deductible was met
• The estimates are for in-network providers only
• The estimates are for in-patient hospital services
• The estimates are for a typical primary care established patient office visit
• Your real costs will depend on the services you receive and how Aetna is billed by the doctor or health care facility
• We cannot guarantee the accuracy of any cost or estimate, as they can change without notification
• This information is solely for use in evaluating and estimating the out-of-pocket costs for services by a doctor or facility
• Basic Health members are responsible for the balance of their deductible and out of pocket expenses if/when the HSA funds have exhausted. 

Tim's Costs:

Total Costs and Annual Premiums: Factoring in annual premiums, Tim's projected costs for the year he has a total knee replacement would be:

These scenarios are pulled from Aetna's database. If you would like to create your own scenarios, visit Aetna’s website and click on “Log in/Register” to access these resources:​​​​​

• Payment Estimator: Compares costs to give you real-time, personalized estimates
• Cost of Care Estimator: Provides average in-network and out-of-network costs