Health Investor HMO Option Plan
Aetna SelectSM (Open Access)
Summary Plan Description
Summary of Benefits and Coverage
More information about the OA Plan:
English PDF | Spanish PDF

Is This the Plan for You?
  • Control how you spend, or save, your health care dollars with the Health Investor HMO plan and a Health Savings Account
  • See your Primary Care Physician or any other doctor in the network
  • Aetna’s National network allows you to seek care within the State or outside of Florida within our network of providers
  • NO REFERRALS needed
  • You pay the first $1,250 ($2,500 for family) out-of-pocket for all services and prescriptions except for preventive care – this is your deductible*
  • After the deductible is met, your insurance “kicks in” and you pay a percentage of the cost - this is your coinsurance**
  • Preventive Care covered 100%
  • If you or your covered dependents do not have other health coverage, you may open a Health Savings Account (HSA) and make pretax contributions to it. You can use the HSA to pay qualified out-of-pocket expenses, such as your deductible and coinsurance
  • Unused money rolls over and can grow over time, tax free
  • You own your HSA, so it’s yours to keep
  • Aetna Health Connections, Disease Management, Informed Health Line, and Beginning Right Maternity programs included at no extra cost
  • *Annual Deductible: this is the yearly amount you are required to pay before anything except preventive care is covered.
  • **Coinsurance: a percentage of the medical and pharmacy costs you are required to pay after your annual deductible is met.

Plan Highlights
Annual Deductible: Individual $1,250 / Family $2,500
What you pay for care received after meeting your deductible
  • Doctor office visits: 20%
  • Hospital Stay: 20%
  • Emergency Room: 20%
  • Urgent Care: 20%
Prescription Drugs (administered by Medco)
Retail 30 day supply / Mail order 30-90 day supply

  • Generic: 30%
  • Prefered Brand: 30%
  • Non-Preferred Brand: 50%
Annual out-of-pocket max – after deductible (includes prescription costs)
  • Individual: $3,000
  • Family: $6,000
Preventive care: Covered 100% (for specific services, frequency limitations may apply)
After you meet your deductible and your out-of-pocket maximum, the play pays 100% for covered care for the rest of the year

Find a PCP or doctor in the network
Under "AETNA OPEN ACCESS PLANS" select "Aetna SelectSM (Open Access)

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