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EPO Plan - Florida

Contact

Aetna Select EPO
P.O. Box 14079
Lexington, KY 40512-4079
Group #: 805400

Member Services - (877) 402-8742
Behavioral Health - (800) 424-5679
Pharmacy Management - (800) 238-6279
www.aetna.com

Information

An Exclusive Provider Organization (EPO) medical plan is available to employees, Research Associates, External Graduate Students and their dependents in Florida. TSRI Graduate Students are not eligible for this plan. The network of providers is Aetna Select EPO. To search for a primary care physician (PCP), click on Aetna Network of Providers or call Aetna member services at (877) 402-8742.

An EPO plan requires the employee to designate a primary care physician (PCP) who will coordinate all care received including providing referrals to specialists. Prescriptions and Mental Health services are also provided through the EPO plan. Vision services are provided separately through Vision Service Provider (VSP).

The chart below outlines the main provisions of the EPO medical plan

Medical
Coverage
Outpatient Services
Annual Deductible: waived for preventive care and office visits

$100 per person
$200 per family

 

Annual Out-of-Pocket Max
$2500 per person
$5000 per family
PCP Office Visits/Specialist Office Visit
$30 co-pay/$40 co-pay
Outpatient Surgery
90% after deductible
Diagnostic Lab/Diagnostic X-ray
100% covered/$40 co-pay X-Ray/$150 co-pay Complex X-Ray
Inpatient Services
Urgent Care
$50 per visit
Emergency Room
$100 co-pay deductible waived
Inpatient Hospital Charges
90% after deductible
Other Services
Well Baby Care 100% covered
Adult Periodic Exams
100% covered
Well Woman Exams 100% covered
Immunizations
100% covered
Chiropractic Care
$15 co-pay; 20 visits/year
Acupuncture
None


Prescriptions Retail
(30 day supply)
Mail Order
(90 day supply)
Rx Annual Deductible $100/person, $200/family (applies to brand formulary and non-formulary drugs only)
Generic
$10
$20
Brand Name
$35
$70
Non-Formulary
$60
$120

Mental Health
Coverage
Inpatient Care 90% after deductible
Outpatient Care
$40 co-pay
Alcohol & Substance Abuse
Inpatient Hospitalization/ Detoxification
90% after deductible
Outpatient Services
$40 co-pay