Your HMO Benefits

2009 Summary of Benefits [PDF]

Aetna Open Access^® HMO plan.

For the 2009 plan year, out-of-pocket cost sharing is changing as follows:

• You pay nothing for preventive care.
• Office-visit copays are $20.
• A modest deductible has been added. A deductible is a fixed dollar amount you pay for your covered medical services before the plan pays benefits.
• Deductibles are $200 for single coverage or $400 for family coverage — except as otherwise noted.
• The out-of-pocket maximum is now $1,500 for single coverage and $3,000 for family coverage. This is the maximum you will have to pay out of pocket for medical care covered by your plan.

Using the 2009 Aetna Open Access^® HMO Plan
is as easy as 1 – 2 – 3!

Here’s all you need to do:

1 - Go directly to an Aetna network health care professional or facility.

You can go directly to a network health care professional or facility for covered services — you do not need a referral.

2 - Pay the applicable amount.

Preventive care is covered 100%
Recommended immunizations, certain tests and cancer screenings are covered 100%. That means no copays, no deductibles.*

Pay a deductible and then a copay
You pay a modest deductible and once your deductible is complete, you pay a flat fee, called a copay, for covered services. Refer to the Summary of Benefits to see how much.

Reach your out-of-pocket max and Aetna pays the rest
When your share of covered expenses reaches the out-of-pocket maximum, the plan pays 100% of your covered expenses for the rest of the plan year.

3 - Take advantage of the plan's resources.

Know before you go! Aetna tools and resources can help you be your healthiest and make smarter decisions about the care you receive.

Aetna Navigator
Women's Health Initiatives
Wellness Programs
Discount Programs