Hide Notes 

Slide 1: Take charge of your health. We’re here to help. AetnA AdvAntAge plAns for individuAls, fAmilies And the self-employed in texAs AA.02.311.1-TX (4/10) G
Slide 2: Aetna Advantage plan choices Our health insurance plans are designed to offer you quality coverage at an excellent value. Coverage can include prescription drugs, doctor visits, hospitalization and preventive care services. Generally speaking, the lower your “premiums,” or monthly payments, the higher your “deductible,” which is the amount you pay out of pocket before the plan begins paying for expenses. You’ll pay less by using “in-network” doctors, hospitals, pharmacies and other health care providers who participate in Aetna’s nationwide network than by using “out-of-network” doctors. Visit www.planforyourhealth.com for an in-depth list of terms in this brochure and what they mean. it’s easy to establish a health savings Account… Simply enroll in an Aetna HSA Compatible High Deductible Health Plan and you will automatically have an HSA opened through Bank of America. You will also receive a debit card and a welcome package with additional information to get you started. If you do not wish to set up an HSA, you can opt out by calling Bank of America – or the account will be automatically canceled after 90 days if the debit card is not activated or if you do not enroll online. Why choose an Aetna HealthFund HSA? No set-up fees No monthly administration fee n No withdrawal forms required n Convenient access to HSA funds via debit card or online n Track HSA activity online n n Is your doctor in the Aetna network? Which local physicians, hospitals, pharmacies and eyewear providers participate in the nationwide Aetna Advantage Plan network? Visit www.aetna.com/docfind/custom/ advplans. Or call 1-800-694-3258 and ask for a directory of providers. About HSAs Many of our high-deductible plans are Health Savings Account (HSA) Compatible, offering you lower premiums and tax advantaged savings. An HSA is a personal account that lets you pay for qualified medical expenses with tax advantaged funds. You or an eligible family member make contributions to your HSA tax-free, and those dollars earn interest tax-free. Then, when you make withdrawals from your account to pay for qualified health care expenses, they’re tax-free, too. Get more from your Aetna plan Cover just your children Aetna Advantage Plans are also available for children only, which means you can enroll your child even if no other family member enrolls. Coverage includes immunizations, well-child visits, emergency room and dental preventive services (if a dental plan is selected). Note: when an HSA Compatible plan is selected for child only enrollment, an HSA account is not available for the child. Add dental pdn max With the Aetna Advantage Dental PDN Max insurance plan, you can obtain services from either a participating or non-participating dentist. Participating dentists have agreed to provide services at a negotiated rate for both covered services, as well as non-covered services such as cosmetic tooth whitening and orthodontic care, so you generally pay less out-of-pocket. You also have the flexibility to visit a dentist who does not participate in Aetna’s network, though you will not have access to negotiated fees. Dental coverage is offered only if medical coverage is obtained. 1 Aetna Advantage Plans for Individuals, Families and the Self-Employed are underwritten by Aetna Life Insurance Company (Aetna) directly and/or through an out-of-state blanket trust. In some states, individuals may qualify as a business group of one and may be eligible for guaranteed issue, small group health plans. These plans are medically underwritten and you may be declined coverage in accordance with your health condition.
Slide 3: Plan Details 1) First Dollar Managed Choice Open Access and Preferred Provider Benefits Plans (PPO) plan options robust coverage and lower out-of-pocket expenses with no deductibles when you choose a network provider featuring: n n 4) Managed Choice Open Access and Preferred Provider Benefits Plans (PPO) Value plan options Affordability — a balance of lower monthly premiums and quality coverage…where you want to cap the amount you’ll spend on total medical expenses each year featuring: n n Lower monthly premiums (that’s the “Value” part) No deductible for generic prescription drugs Lower copay for in-network provider visits No deductible for generic prescription drugs 5) n Preventive and Hospital Care plan options 2) Managed Choice Open Access and Preferred Provider Benefits Plans (PPO) plan options Affordability is one of your top priorities and you use only basic health care services…and want to keep your monthly premiums lower featuring: Health insurance coverage with lower monthly premiums and varying deductible levels robust coverage and lower monthly payments balanced with a deductible…where you don’t want to pay a lot for frequent doctor visits featuring: n Health insurance coverage with lower monthly premiums and varying deductible levels 6) Managed Choice Open Access and Preferred Provider Benefits Plans (PPO) with Limited Rx 3) Managed Choice Open Access and Preferred Provider Benefits Plans (PPO) High Deductible plan options robust medical coverage with limited pharmacy benefits…with lower costs for smart consumers featuring: n lower premium costs…and an hsA-compatible plan that offers tax advantaged savings featuring: n 0% coinsurance in network after your deductible is met Lower monthly premiums, higher annual deductibles (at least $3,000 for individuals and $6,000 for families) n Can be paired with a tax-advantaged Health Savings Account (HSA) n Health insurance coverage with lower monthly premiums 2 3
Slide 4: plus ... these benefits Are inCluded with most of our plAns. n Ae t nA’ s t e x As r At i ngs Ar e As * your rates will depend on the area in which your county is located. for more information or a quote on what your rate would be, call your broker. Area 1 Counties+ Blanco Bosque Brazos Brooks Brown Burleson Coleman Comanche De Witt Dimmit Edwards Frio Gillespie Goliad Gonzales Hamilton Jim Hogg Jones Karnes Kenedy Kerr Kimble Kinney La Salle Lavaca Llano (except Horseshoe Bay) Madison Mason Maverick McMullen Milam Mills Real Refugio Robertson San Saba Taylor Uvalde Washington Webb Zapata Zavala Coverage for office visits to your primary care physician and specialists No claim forms to fill out when you visit a network provider No referrals required to see a specialist* No waiting period for routine physical exams 100% annual routine GYN exam coverage — no waiting period, no dollar maximum and no copay or deductible when you visit a network provider Coverage for prescription drugs* Coverage for routine physicals including lab work and X-rays 100% coverage for in-network childhood immunizations n n n n Area 2 Counties+ Ector Jasper (Brookeland) Lubbock McLennan Midland Tom Green Wichita n n Area 3 Counties+ Aransas Armstrong Bee Briscoe Calhoun Cameron Carson Castro Childress Collingsworth Dallam Deaf Smith Donley Duval Gray Hall Hansford Hartley Hemphill Hidalgo Hutchinson Jackson Jim Wells Kleberg Lipscomb Live Oak Moore Nueces Ochiltree Oldham Parmer Potter Randall Roberts San Patricio Sherman Starr Swisher Victoria Wheeler Willacy n Area 4 Counties+ Anderson Andrews Angelina Archer Bailey Baylor Borden Bowie Brewster Callahan Cass Clay Cochran Coke Concho Cottle Crane Crockett Crosby Culberson Dawson Dickens Eastland Falls Fisher Floyd Foard Gaines Garza Glasscock Hale Hardeman Haskell Henderson (except Mabank) Hockley Houston Howard Hudspeth Irion Jack Jeff Davis Kent King Knox Lamb Leon Limestone Loving Lynn Martin McCulloch Menard Mitchell Motley Nacogdoches Nolan Panola Pecos Polk Presidio Reagan Reeves Runnels Rusk Sabine San Augustine Schleicher Scurry Shackelford Shelby Stephens Sterling Stonewall Sutton Terrell Terry Throckmorton Trinity Upton Val Verde Ward Wilbarger Winkler Yoakum Young * These benefits are not applicable to Preventive and Hospital Care plans Area 5 Counties+ Aexcel specialist network** Camp Cherokee Collin Cooke Dallas Delta Denton Ellis Erath Fannin Franklin Freestone Grayson Gregg Harrison Henderson (Mabank) Hill Hood Hopkins Hunt Johnson Kaufman Lamar Marion Montague Morris Navarro Palo Pinto Parker Rains Red River Rockwall Smith Somervell Tarrant Titus Upshur Van Zandt Wise Wood Area 6 Counties++ Aexcel specialist network** Austin Brazoria Chambers Colorado Fort Bend Galveston Grimes Hardin Harris Jasper (except Brookeland) Jefferson Liberty Matagorda Montgomery Newton Orange San Jacinto Tyler Walker Waller Wharton Area 7 Counties+ Aexcel specialist network** Atascosa Bandera Bexar Comal Guadalupe Kendall Medina Wilson Area 8 Counties++ Aexcel specialist network** Bastrop Bell Burnet Caldwell Coryell Fayette Hays Lampasas Lee Llano (Horseshoe Bay) Travis Williamson Area 9 Counties++ El Paso * ** All products not available in all counties. Please refer to the county in which you reside for the available product. The Aetna Performance Network® features Aexcel-designated specialists who have demonstrated cost-effectiveness in the delivery of care and met certain clinical performance measures. The Aexcel designation applies to select specialists in 12 specialty areas: Cardiology, Cardiothoracic Surgery, Gastroenterology, General Surgery, Obstetrics and Gynecology, Orthopedics, Otolaryngology/ENT, Neurology, Neurosurgery, Plastic Surgery, Urology, and Vascular Surgery. Aetna members in the designated counties must choose Aexcel designated specialists or they will incur out-ofnetwork charges. There is no additional cost when members use Aexcel specialists. You’ll find them by looking for the star next to the doctors’ names at www.aetna.com/docfind/custom/ advplans or in your printed directory. Areas 1-5, and Area 7 are Preferred Provider Benefits Plans. Area 6, and Area 8-9 are Managed Choice Open Access Plans. 4 + ++ 5
Slide 5: 1) member benefits Deductible Individual Family Coinsurance (Member’s responsibility) first dollar managed Choice open Access and preferred provider benefits plans (ppo) 30 in-network $0 $0 30% up to out-of-pocket max. out-of-network+ $5,000 $10,000 50% after deductible up to out-of-pocket max. 2) member benefits Deductible Individual Family Coinsurance (Member’s responsibility) managed Choice open Access and preferred provider benefits plans (ppo) 2500 in-network $2,500 $5,000 out-of-network+ $5,000 $10,000 $0 once out-of-pocket max. is satisfied Coinsurance Maximum Individual Family Out-of-Pocket Maximum Individual Family Lifetime Maximum* per insured Non-Specialist Office Visit Unlimited visits General Physician, Family Practitioner, Pediatrician or Internist Specialist Visit Unlimited visits Hospital Admission Outpatient Surgery Urgent Care Facility Emergency Room Annual Routine Gyn Exam No waiting period, no calendar year max. Annual Pap/Mammogram Maternity Preventive Health — Routine Physical Aetna will pay up to $200 per exam* No waiting period Lab/X-Ray Skilled Nursing — in lieu of hospital 30 days per calendar year* Physical/Occupational Therapy and Chiropractic Care 24 visits per calendar year* Home Health Care — in lieu of hospital 30 visits per calendar year* Durable Medical Equipment Aetna will pay up to $2000 per calendar year* phArmACy Pharmacy Deductible per individual Generic Oral Contraceptives Included Preferred Brand Oral Contraceptives Included Non-Preferred Brand Oral Contraceptives Included Self-Injectible Drugs Calendar Year Maximum per individual* $500 $15 copay deductible waived $40 copay after deductible $60 copay after deductible 20% after deductible Unlimited $500 Does not apply to generic $15 copay plus 30% deductible waived $40 copay plus 30% after deductible $60 copay plus 30% after deductible Not covered Unlimited $30 copay $7,500 $15,000 $7,500 $15,000 $7,500 $15,000 $12,500 $25,000 Includes deductible $5,000,000 30% after deductible Lifetime Maximum* per insured Non-Specialist Office Visit Unlimited visits General Physician, Family Practitioner, Pediatrician or Internist Specialist Visit Unlimited visits Hospital Admission Outpatient Surgery Urgent Care Facility Emergency Room Annual Routine Gyn Exam No waiting period, no calendar year max. Annual Pap/Mammogram Maternity Preventive Health — Routine Physical Aetna will pay up to $200 per exam* No waiting period Lab/X-Ray Skilled Nursing — in lieu of hospital 30 days per calendar year* Physical/Occupational Therapy and Chiropractic Care 24 visits per calendar year* Home Health Care — in lieu of hospital 30 visits per calendar year* Durable Medical Equipment Aetna will pay up to $2000 per calendar year* phArmACy Pharmacy Deductible per individual Generic Oral Contraceptives Included Preferred Brand Oral Contraceptives Included Non-Preferred Brand Oral Contraceptives Included Self-Injectible Drugs Calendar Year Maximum per individual* + 20% after 50% after deductible up to deductible up to out-of-pocket max. out-of-pocket max. $0 once out-of-pocket max. is satisfied $2,500 $5,000 $5,000 $10,000 $5,000 $10,000 Coinsurance Maximum Individual Family Out-of-Pocket Maximum Individual Family $10,000 $20,000 Includes deductible $5,000,000 $30 copay 30% deductible waived after deductible $40 copay 30% 30% $50 copay 30% after deductible 50% after deductible 50% after deductible 50% after deductible $100 copay** (waived if admitted) 30% coinsurance $0 copay 30% after deductible $40 copay 30% deductible waived after deductible 20% 50% after deductible after deductible 20% 50% after deductible after deductible $50 copay 50% deductible waived after deductible $100 copay** (waived if admitted) 20% coinsurance after deductible $0 copay 30% deductible waived after deductible Not covered (except for pregnancy complications) $30 copay 30% after deductible Includes lab work and X-rays 30% 30% 30% 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible Not covered (except for pregnancy complications) 30% $30 copay deductible waived after deductible Includes lab work and X-rays 20% 50% after deductible after deductible 20% 50% after deductible after deductible 20% 50% after deductible after deductible Aetna will pay a max. of $25 per visit* 50% 20% after deductible after deductible 20% after deductible 50% after deductible Aetna will pay a max. of $25 per visit* 30% 30% $500 Does not apply to generic $15 copay $15 copay plus 30% deductible waived deductible waived $35 copay $35 copay plus 30% after deductible after deductible $50 copay $50 copay plus 30% after deductible after deductible 20% Not covered after deductible $5,000 $5,000 $500 * ** 6 Maximum applies to combined in and out-of-network benefits. Copay is billed separately and not due at time of service. Copay does not count towards coinsurance or out-of-pocket maximum. Payment for out-of-network facility covered expenses is determined based on Aetna’s Market Fee Schedule. Payment for out-of-network non-facility covered expenses is determined based on the negotiated charge that would apply if such services were received from a Network Provider. 7
Slide 6: managed Choice open Access and preferred provider benefits plans (ppo) 3500 managed Choice open Access and preferred provider benefits plans (ppo) 5000 member benefits Deductible Individual Family Coinsurance (Member’s responsibility) in-network $3,500 $7,000 20% after deductible up to out-of-pocket max. out-of-network+ $7,000 $14,000 50% after deductible up to out-of-pocket max. member benefits Deductible Individual Family Coinsurance (Member’s responsibility) in-network $5,000 $10,000 out-of-network+ $10,000 $20,000 20% after 50% after deductible up to deductible up to out-of-pocket max. out-of-pocket max. $0 once out-of-pocket max. is satisfied $0 once out-of-pocket max. is satisfied Coinsurance Maximum Individual Family Out-of-Pocket Maximum Individual Family Lifetime Maximum* per insured Non-Specialist Office Visit Unlimited visits General Physician, Family Practitioner, Pediatrician or Internist Specialist Visit Unlimited visits Hospital Admission Outpatient Surgery Urgent Care Facility Emergency Room Annual Routine Gyn Exam No waiting period, no calendar year max. Annual Pap/Mammogram Maternity $6,500 $13,000 $10,000 $20,000 $5,500 $11,000 $12,500 $25,000 Includes deductible $5,000,000 $35 copay deductible waived 30% after deductible Coinsurance Maximum Individual Family Out-of-Pocket Maximum Individual Family Lifetime Maximum* per insured Non-Specialist Office Visit Unlimited visits General Physician, Family Practitioner, Pediatrician or Internist Specialist Visit Unlimited visits Hospital Admission Outpatient Surgery Urgent Care Facility Emergency Room Annual Routine Gyn Exam No waiting period, no calendar year max. Annual Pap/Mammogram Maternity Preventive Health — Routine Physical Aetna will pay up to $200 per exam* No waiting period Lab/X-Ray Skilled Nursing — in lieu of hospital 30 days per calendar year* Physical/Occupational Therapy and Chiropractic Care 24 visits per calendar year* Home Health Care — in lieu of hospital 30 visits per calendar year* Durable Medical Equipment Aetna will pay up to $2000 per calendar year* phArmACy $500 $15 copay deductible waived $35 copay after deductible $50 copay after deductible 20% after deductible $5,000 $500 Does not apply to generic $15 copay plus 30% deductible waived $35 copay plus 30% after deductible $50 copay plus 30% deductible waived Not covered $5,000 Pharmacy Deductible per individual Generic Oral Contraceptives Included Preferred Brand Oral Contraceptives Included Non-Preferred Brand Oral Contraceptives Included Self-Injectible Drugs Calendar Year Maximum per individual* + $5,000 $10,000 $10,000 $20,000 $2,500 $5,000 $12,500 $25,000 Includes deductible $5,000,000 $40 copay deductible waived 30% after deductible $45 copay deductible waived 20% after deductible 20% after deductible $50 copay deductible waived 30% after deductible 50% after deductible 50% after deductible 50% after deductible $50 copay deductible waived 20% after deductible 20% after deductible $50 copay deductible waived 30% after deductible 50% after deductible 50% after deductible 50% after deductible $100 copay** (waived if admitted) 20% coinsurance after deductible $0 copay deductible waived 30% after deductible $100 copay** (waived if admitted) 20% coinsurance after deductible $0 copay deductible waived 30% after deductible Not covered (except for pregnancy complications) Not covered (except for pregnancy complications) $40 copay deductible waived 30% after deductible Preventive Health — $35 copay 30% Routine Physical deductible waived after deductible Aetna will pay up to $200 per exam* Includes lab work and X-rays No waiting period Lab/X-Ray Skilled Nursing — in lieu of hospital 30 days per calendar year* Physical/Occupational Therapy and Chiropractic Care 24 visits per calendar year* Home Health Care — in lieu of hospital 30 visits per calendar year* Durable Medical Equipment Aetna will pay up to $2000 per calendar year* phArmACy Pharmacy Deductible per individual Generic Oral Contraceptives Included Preferred Brand Oral Contraceptives Included Non-Preferred Brand Oral Contraceptives Included Self-Injectible Drugs Calendar Year Maximum per individual* * ** Includes lab work and X-rays 20% after deductible 20% after deductible 20% after deductible 20% after deductible 20% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible 20% after deductible 20% after deductible 20% after deductible 20% after deductible 20% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible Aetna will pay a max. of $25 per visit* Aetna will pay a max. of $25 per visit* $500 $15 copay deductible waived $35 copay after deductible $50 copay after deductible 20% after deductible $5,000 $500 Does not apply to generic $15 copay plus 30% deductible waived $35 copay plus 30% after deductible $50 copay plus 30% after deductible Not covered $5,000 8 Maximum applies to combined in and out-of-network benefits. Copay is billed separately and not due at time of service. Copay does not count towards coinsurance or out-of-pocket maximum. Payment for out-of-network facility covered expenses is determined based on Aetna’s Market Fee Schedule. Payment for out-of-network non-facility covered expenses is determined based on the negotiated charge that would apply if such services were received from a Network Provider. 9
Slide 7: managed Choice open Access and preferred provider benefits plans (ppo) 7500 3) member benefits Deductible Individual Family Coinsurance (Member’s responsibility) managed Choice open Access and preferred provider benefits plans (ppo) high deductible 3000 (hsA Compatible) in-network $3,000 $6,000 0% after deductible up to out-of-pocket max. out-of-network+ $6,000 $12,000 50% after deductible up to out-of-pocket max. member benefits Deductible Individual Family Coinsurance (Member’s responsibility) in-network $7,500 $15,000 20% after deductible up to out-of-pocket max. out-of-network+ $10,000 $20,000 50% after deductible up to out-of-pocket max. $0 once out-of-pocket max. is satisfied Coinsurance Maximum Individual Family Out-of-Pocket Maximum Individual Family Lifetime Maximum* per insured $2,500 $5,000 $10,000 $20,000 $2,500 $5,000 $12,500 $25,000 Includes deductible $5,000,000 30% after deductible Lifetime Maximum* per insured Non-Specialist Office Visit Unlimited visits General Physician, Family Practitioner, Pediatrician or Internist Specialist Visit Unlimited visits Hospital Admission Outpatient Surgery Urgent Care Facility Emergency Room Annual Routine Gyn Exam No waiting period, no calendar year max. Annual Pap/Mammogram Maternity Not covered Except for pregnancy complications $45 copay deductible waived 30% after deductible Preventive Health — Routine Physical Aetna will pay up to $200 per exam* No waiting period Lab/X-Ray Skilled Nursing — in lieu of hospital 30 days per calendar year* Physical/Occupational Therapy and Chiropractic Care 24 visits per calendar year* Home Health Care — in lieu of hospital 30 visits per calendar year* Durable Medical Equipment Aetna will pay up to $2000 per calendar year* phArmACy $500 $15 copay deductible waived $35 copay after deductible $50 copay after deductible 20% after deductible $5,000 $500 Does not apply to generic $15 copay plus 30% deductible waived $35 copay plus 30% after deductible $50 copay plus 30% after deductible Not covered $5,000 Pharmacy Deductible per individual Generic Oral Contraceptives Included Preferred Brand Oral Contraceptives Included Non-Preferred Brand Oral Contraceptives Included Self-Injectible Drugs Calendar Year Maximum per individual* + $0 once out-of-pocket max. is satisfied Coinsurance Maximum Individual Family Out-of-Pocket Maximum Individual Family $0 $0 $3,000 $6,000 $6,500 $13,000 $12,500 $25,000 Includes deductible $5,000,000 0% after deductible 30% after deductible Non-Specialist Office Visit $45 copay Unlimited visits deductible waived General Physician, Family Practitioner, Pediatrician or Internist Specialist Visit Unlimited visits Hospital Admission Outpatient Surgery Urgent Care Facility Emergency Room Annual Routine Gyn Exam No waiting period, no calendar year max. Annual Pap/Mammogram Maternity Preventive Health — Routine Physical Aetna will pay up to $200 per exam* No waiting period Lab/X-Ray Skilled Nursing — in lieu of hospital 30 days per calendar year* Physical/Occupational Therapy and Chiropractic Care 24 visits per calendar year* Home Health Care — in lieu of hospital 30 visits per calendar year* Durable Medical Equipment Aetna will pay up to $2000 per calendar year* phArmACy Pharmacy Deductible per individual Generic Oral Contraceptives Included Preferred Brand Oral Contraceptives Included Non-Preferred Brand Oral Contraceptives Included Self-Injectible Drugs Calendar Year Maximum per individual* * ** $50 copay deductible waived 20% after deductible 20% after deductible $50 copay deductible waived 30% after deductible 50% after deductible 50% after deductible 50% after deductible 0% after deductible 0% after deductible 0% after deductible 0% after deductible $0 copay deductible waived 30% after deductible 50% after deductible 50% after deductible 50% after deductible 30% after deductible $100 copay** (waived if admitted) 20% coinsurance after deductible $0 copay deductible waived 30% after deductible $0 copay after deductible Not covered (except for pregnancy complications) $20 copay deductible waived 30% after deductible Includes lab work and X-rays 20% after deductible 20% after deductible 20% after deductible 20% after deductible 20% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible Includes lab work and X-rays 0% after deductible 0% after deductible 0% after deductible 0% after deductible 0% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible Aetna will pay a max. of $25 per visit* Aetna will pay a max. of $25 per visit* Integrated Medical/Rx Deductible 0% after Medical/ Rx deductible 0% after Medical/ Rx deductible 0% after Medical/ Rx deductible 0% after Medical/ Rx deductible $5,000 30% after Medical/ Rx deductible 30% after Medical/ Rx deductible 30% after Medical/ Rx deductible Not covered $5,000 10 Maximum applies to combined in and out-of-network benefits. Copay is billed separately and not due at time of service. Copay does not count towards coinsurance or out-of-pocket maximum. Payment for out-of-network facility covered expenses is determined based on Aetna’s Market Fee Schedule. Payment for out-of-network non-facility covered expenses is determined based on the negotiated charge that would apply if such services were received from a Network Provider. 11
Slide 8: managed Choice open Access and preferred provider benefits plans (ppo) high deductible 5000 (hsA Compatible) 4) member benefits Deductible Individual Family Coinsurance (Member’s responsibility) managed Choice open Access and preferred provider benefits plans (ppo) value 1500 in-network out-of-network+ member benefits Deductible Individual Family Coinsurance (Member’s responsibility) in-network $5,000 $10,000 0% after deductible up to out-of-pocket max. out-of-network+ $10,000 $20,000 50% after deductible up to out-of-pocket max. $0 once out-of-pocket max. is satisfied Coinsurance Maximum Individual Family Out-of-Pocket Maximum Individual Family Lifetime Maximum* per insured $0 $0 $5,000 $10,000 $2,500 $5,000 $12,500 $25,000 Includes deductible $5,000,000 30% after deductible Non-Specialist Office Visit 0% Unlimited visits after deductible General Physician, Family Practitioner, Pediatrician or Internist Specialist Visit Unlimited visits Hospital Admission Outpatient Surgery Urgent Care Facility Emergency Room Annual Routine Gyn Exam No waiting period, no calendar year max. Annual Pap/Mammogram Maternity 0% after deductible 0% after deductible 0% after deductible 0% after deductible $0 copay deductible waived $1,500 $3,000 $3,000 $6,000 30% after 50% after deductible up to deductible up to out-of-pocket max. out-of-pocket max. $0 once out-of-pocket max. is satisfied $1,500 $3,000 $3,000 $6,000 $7,000 $14,000 30% after deductible 50% after deductible 50% after deductible 50% after deductible 30% after deductible $0 copay after deductible Not covered (except for pregnancy complications) Preventive Health — 30% $25 copay Routine Physical deductible waived after deductible Aetna will pay up to $200 per exam* Includes lab work and X-rays No waiting period Lab/X-Ray 0% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible $10,000 $20,000 Includes deductible Lifetime Maximum* per insured $5,000,000 Non-Specialist Office Visit Visits 1-2 $30 copay, 30% ded. waived; Visit 3+ after deductible Unlimited visits General Physician, Family Practitioner, 30% after deductible. Spec. and non- spec Pediatrician or Internist share visit max Specialist Visit Visits 1-2 $30 copay, 30% ded. waived; Visit 3+ after deductible Unlimited visits 30% after deductible. Spec. and non- spec share visit max Hospital Admission 30% 50% after deductible after deductible Outpatient Surgery 30% 50% after deductible after deductible Urgent Care Facility $50 copay 50% deductible waived after deductible Emergency Room $100 copay** (waived if admitted) 30% coinsurance after deductible Annual Routine Gyn Exam $0 copay 30% No waiting period, deductible waived after deductible no calendar year max. Annual Pap/Mammogram Maternity Not covered (except for pregnancy complications) Preventive Health — $50 copay 30% Routine Physical deductible waived after deductible Aetna will pay up to $200 per exam* Includes lab work and X-rays No waiting period Lab/X-Ray 30% 50% after deductible after deductible Skilled Nursing — in lieu of hospital 30% 50% 30 days per calendar year* after deductible after deductible Physical/Occupational Therapy 50% 30% and Chiropractic Care after deductible after deductible 24 visits per calendar year* Aetna will pay a max. of $25 per visit* 50% Home Health Care — 30% in lieu of hospital after deductible after deductible 30 visits per calendar year* Durable Medical Equipment 50% 30% Aetna will pay up to $2000 per after deductible after deductible calendar year* phArmACy Pharmacy Deductible per individual Generic Oral Contraceptives Included Preferred Brand Oral Contraceptives Included Non-Preferred Brand Oral Contraceptives Included Self-Injectible Drugs Calendar Year Maximum per individual* + Coinsurance Maximum Individual Family Out-of-Pocket Maximum Individual Family Skilled Nursing — in lieu of hospital 0% 30 days per calendar year* after deductible Physical/Occupational Therapy and Chiropractic Care 24 visits per calendar year* Home Health Care — in lieu of hospital 30 visits per calendar year* Durable Medical Equipment Aetna will pay up to $2000 per calendar year* phArmACy Pharmacy Deductible per individual Generic Oral Contraceptives Included Preferred Brand Oral Contraceptives Included Non-Preferred Brand Oral Contraceptives Included Self-Injectible Drugs Calendar Year Maximum per individual* 0% after deductible 0% after deductible 0% after deductible Aetna will pay a max. of $25 per visit* Integrated Medical/Rx Deductible 0% after Medical/ Rx deductible 0% after Medical/ Rx deductible 0% after Medical/ Rx deductible 0% after Medical/ Rx deductible $5,000 30% after Medical/ Rx deductible 30% after Medical/ Rx deductible 30% after Medical/ Rx deductible Not covered $5,000 $500 Does not apply to generic $20 copay $20 copay plus 30% deductible waived deductible waived $40 copay $40 copay plus 30% after deductible after deductible Not covered Not covered Aetna Discount Applies Not covered Not covered Aetna Discount Applies $5,000 $5,000 $500 * ** 12 Maximum applies to combined in and out-of-network benefits. Copay is billed separately and not due at time of service. Copay does not count towards coinsurance or out-of-pocket maximum. Payment for out-of-network facility covered expenses is determined based on Aetna’s Market Fee Schedule. Payment for out-of-network non-facility covered expenses is determined based on the negotiated charge that would apply if such services were received from a Network Provider. 13
Slide 9: managed Choice open Access and preferred provider benefits plans (ppo) value 2500 managed Choice open Access and preferred provider benefits plans (ppo) value 5000 member benefits Deductible Individual Family Coinsurance (Member’s responsibility) in-network $2,500 $5,000 30% after deductible up to out-of-pocket max. out-of-network+ $5,000 $10,000 50% after deductible up to out-of-pocket max. member benefits Deductible Individual Family Coinsurance (Member’s responsibility) in-network $5,000 $10,000 out-of-network+ $10,000 $20,000 $0 once out-of-pocket max. is satisfied Coinsurance Maximum Individual Family Out-of-Pocket Maximum Individual Family $2,500 $5,000 $5,000 $10,000 $5,000 $10,000 Coinsurance Maximum Individual Family Out-of-Pocket Maximum Individual Family Lifetime Maximum* per insured Non-Specialist Office Visit Unlimited visits General Physician, Family Practitioner, Pediatrician or Internist Specialist Visit Unlimited visits 30% after 50% after deductible up to deductible up to out-of-pocket max. out-of-pocket max. $0 once out-of-pocket max. is satisfied $5,000 $10,000 $10,000 $20,000 $2,500 $5,000 $12,500 $25,000 Includes deductible $5,000,000 Visits 1-2 $30 copay, 30% ded. waived; Visit 3+ after deductible 30% after deductible. Spec. and non- spec share visit max Visits 1-2 $30 copay, 30% ded. waived; Visit 3+ after deductible 30% after deductible. Spec. and non- spec share visit max 30% 50% after deductible after deductible 30% 50% after deductible after deductible 50% $50 copay deductible waived after deductible $100 copay** (waived if admitted) 30% after deductible 30% $0 copay deductible waived after deductible $10,000 $20,000 Includes deductible Lifetime Maximum* per insured $5,000,000 Non-Specialist Office Visit Visits 1-2 $30 copay, 30% ded. waived; Visit 3+ after deductible Unlimited visits General Physician, Family Practitioner, 30% after deductible. Spec. and non- spec Pediatrician or Internist share visit max Specialist Visit Visits 1-2 $30 copay, 30% ded. waived; Visit 3+ after deductible Unlimited visits 30% after deductible. Spec. and non- spec share visit max Hospital Admission 30% 50% after deductible after deductible Outpatient Surgery 30% 50% after deductible after deductible Urgent Care Facility $50 copay 50% deductible waived after deductible Emergency Room $100 copay** (waived if admitted) 30% coinsurance after deductible Annual Routine Gyn Exam $0 copay 30% No waiting period, deductible waived after deductible no calendar year max. Annual Pap/Mammogram Maternity Not covered (except for pregnancy complications) Preventive Health — $50 copay 30% Routine Physical deductible waived after deductible Aetna will pay up to $200 per exam* Includes lab work and X-rays No waiting period 30% 50% after deductible after deductible Skilled Nursing — in lieu of hospital 30% 50% 30 days per calendar year* after deductible after deductible Physical/Occupational Therapy 50% 30% and Chiropractic Care after deductible after deductible 24 visits per calendar year* Aetna will pay a max. of $25 per visit* Home Health Care — in lieu of hospital 30 visits per calendar year* Durable Medical Equipment Aetna will pay up to $2000 per calendar year* phArmACy Pharmacy Deductible per individual Generic Oral Contraceptives Included Preferred Brand Oral Contraceptives Included Non-Preferred Brand Oral Contraceptives Included Self-Injectible Drugs Calendar Year Maximum per individual* * ** Hospital Admission Outpatient Surgery Urgent Care Facility Emergency Room Annual Routine Gyn Exam No waiting period, no calendar year max. Annual Pap/Mammogram Maternity Lab/X-Ray 30% after deductible 30% after deductible 50% after deductible 50% after deductible $500 $500 Does not apply to generic $20 copay plus 30% deductible waived $40 copay plus 30% after deductible Not covered $20 copay deductible waived $40 copay after deductible Not covered Aetna Discount Applies Not covered Aetna Discount Applies $5,000 Not covered $5,000 Not covered (except for pregnancy complications) Preventive Health — $50 copay 30% Routine Physical deductible waived after deductible Aetna will pay up to $200 per exam* Includes lab work and X-rays No waiting period Lab/X-Ray 30% 50% after deductible after deductible Skilled Nursing — in lieu of hospital 30% 50% 30 days per calendar year* after deductible after deductible Physical/Occupational Therapy 50% 30% and Chiropractic Care after deductible after deductible 24 visits per calendar year* Aetna will pay a max. of $25 per visit* 50% 30% Home Health Care — after deductible after deductible in lieu of hospital 30 visits per calendar year* Durable Medical Equipment 50% 30% Aetna will pay up to $2000 per after deductible after deductible calendar year* phArmACy Pharmacy Deductible $500 $500 per individual Does not apply to generic Generic $20 copay $20 copay plus 30% Oral Contraceptives Included deductible waived deductible waived Preferred Brand $40 copay $40 copay plus 30% Oral Contraceptives Included after deductible after deductible Non-Preferred Brand Not covered Not covered Oral Contraceptives Included Aetna Discount Applies Self-Injectible Drugs Not covered Not covered Aetna Discount Applies Calendar Year Maximum $5,000 $5,000 per individual* + Payment for out-of-network facility covered expenses is determined based on Aetna’s Market Fee Schedule. Payment for out-of-network non-facility covered expenses is determined based on the negotiated charge that would apply if such services were received from a Network Provider. Maximum applies to combined in and out-of-network benefits. Copay is billed separately and not due at time of service. Copay does not count towards coinsurance or out-of-pocket maximum. 14 15
Slide 10: 5) member benefits Deductible Individual Family Coinsurance (Member’s responsibility) preventive and hospital Care 1250*** in-network $1,250 $2,500 20% after deductible up to out-of-pocket max. out-of-network+ $2,500 $5,000 50% after deductible up to out-of-pocket max. preventive and hospital Care 3000 (hsA Compatible) member benefits Deductible Individual Family Coinsurance (Member’s responsibility) in-network out-of-network+ $0 once out-of-pocket max. is satisfied Coinsurance Maximum Individual Family Out-of-Pocket Maximum Individual Family Lifetime Maximum* per insured Non-Specialist Office Visit Unlimited visits General Physician, Family Practitioner, Pediatrician or Internist Specialist Visit Unlimited visits Hospital Admission Outpatient Surgery Urgent Care Facility Emergency Room Annual Routine Gyn Exam No waiting period, no calendar year max. Annual Pap/Mammogram Maternity Preventive Health — Routine Physical Aetna will pay up to $200 per exam* No waiting period Lab/X-Ray Not covered $3,000 $6,000 $4,250 $8,500 $7,500 $15,000 $10,000 $20,000 Includes deductible $1,000,000 Not covered Lifetime Maximum* per insured Non-Specialist Office Visit Unlimited visits General Physician, Family Practitioner, Pediatrician or Internist Specialist Visit Unlimited visits Hospital Admission Outpatient Surgery Urgent Care Facility Emergency Room Annual Routine Gyn Exam No waiting period, no calendar year max. Annual Pap/Mammogram Maternity Preventive Health — Routine Physical Aetna will pay up to $200 per exam* No waiting period Lab/X-Ray Skilled Nursing — in lieu of hospital 30 days per calendar year* Physical/Occupational Therapy and Chiropractic Care 24 visits per calendar year* Home Health Care — in lieu of hospital 30 visits per calendar year* Durable Medical Equipment Aetna will pay up to $2000 per calendar year* phArmACy Not Applicable $15 copay Not covered Aetna Discount Applies Not covered Aetna Discount Applies Not covered Aetna Discount Applies $5,000 Not Applicable $15 copay plus 50% Not covered Pharmacy Deductible per individual Generic Oral Contraceptives Included Preferred Brand Oral Contraceptives Included Non-Preferred Brand Oral Contraceptives Included Self-Injectible Drugs Coinsurance Maximum Individual Family Out-of-Pocket Maximum Individual Family $3,000 $6,000 $6,000 $12,000 20% after 50% after deductible up to deductible up to out-of-pocket max. out-of-pocket max. $0 once out-of-pocket max. is satisfied $2,000 $4,000 $5,000 $10,000 $4,000 $8,000 $10,000 $20,000 Includes deductible $1,000,000 Not covered Not covered Not covered 20% after deductible 20% after deductible Not covered Not covered 50% after deductible 50% after deductible Not covered Not covered Not covered $100 copay** (waived if admitted); 20% coinsurance after deductible $0 copay deductible waived 50% after deductible 20% 50% after deductible after deductible 20% 50% after deductible after deductible Not covered Not covered $100 copay** (waived if admitted); 20% coinsurance after deductible $0 copay 50% deductible waived after deductible Not covered (except for pregnancy complications) $25 copay deductible waived 50% after deductible Not covered (except for pregnancy complications) $35 copay 50% deductible waived after deductible Includes lab work and X-rays Not covered 20% after deductible Not covered Not covered 50% after deductible Not covered Includes lab work and X-rays Not covered Not covered 50% after deductible Not covered Skilled Nursing — in lieu of hospital 20% 30 days per calendar year* after deductible Physical/Occupational Therapy and Chiropractic Care 24 visits per calendar year* Home Health Care — in lieu of hospital 30 visits per calendar year* Durable Medical Equipment Aetna will pay up to $2000 per calendar year* phArmACy Pharmacy Deductible per individual Generic Oral Contraceptives Included Preferred Brand Oral Contraceptives Included Non-Preferred Brand Oral Contraceptives Included Self-Injectible Drugs Not covered 20% after deductible 50% after deductible 20% after deductible 50% after deductible Not covered (except coverage for Diabetic Equipment and Supplies) Not covered (except coverage for Diabetic Equipment and Supplies) Not Applicable Not covered Aetna Discount Applies Not covered Aetna Discount Applies Not covered Aetna Discount Applies Not covered Aetna Discount Applies Not Applicable Not Applicable Not covered Not covered Not covered Not covered Not covered Not covered Calendar Year Maximum per individual* * ** $5,000 Calendar Year Maximum per individual* + Not Applicable 16 Maximum applies to combined in and out-of-network benefits. Copay is billed separately and not due at time of service. Copay does not count towards coinsurance or out-of-pocket maximum. *** Brokers: please see broker information about commissions for this plan. Payment for out-of-network facility covered expenses is determined based on Aetna’s Market Fee Schedule. Payment for out-of-network non-facility covered expenses is determined based on the negotiated charge that would apply if such services were received from a Network Provider. 17
Slide 11: 6) member benefits Deductible Individual Family Coinsurance (Member’s responsibility) managed Choice open Access and preferred provider benefits plans (ppo) 5000 with limited rx in-network out-of-network+ Aetna Advantage Plan option Individual Dental PDN Max plan member benefits Annual Deductible per Member (Does not apply to Diagnostic and Preventive Services) Annual Maximum Benefit preferred $25 $75 family max. Unlimited nonpreferred $25 $75 family max. Unlimited $5,000 $10,000 $10,000 $20,000 20% after 50% after deductible up to deductible up to out-of-pocket max. out-of-pocket max. $0 once out-of-pocket max. is satisfied $5,000 $10,000 $10,000 $20,000 $2,500 $5,000 $12,500 $25,000 Includes deductible $5,000,000 $40 copay deductible waived 30% after deductible diAgnostiC serviCes Oral exams Periodic oral exam Comprehensive oral exam Problem-focused oral exam X-rays Bitewing — single film Complete series 100% ded. waived 100% ded. waived 100% ded. waived 100% ded. waived 100% ded. waived 100% ded. waived 100% ded. waived 100% ded. waived 100% ded. waived 100% ded. waived Coinsurance Maximum Individual Family Out-of-Pocket Maximum Individual Family Lifetime Maximum* per insured Non-Specialist Office Visit Unlimited visits General Physician, Family Practitioner, Pediatrician or Internist Specialist Visit Unlimited visits Hospital Admission Outpatient Surgery Urgent Care Facility Emergency Room Annual Routine Gyn Exam No waiting period, no calendar year max. Annual Pap/Mammogram Maternity preventive serviCes Adult cleaning Child cleaning Sealants — per tooth Fluoride application — with cleaning Space maintainers 100% ded. waived 100% ded. waived Discount 100% ded. waived Discount 100% ded. waived 100% ded. waived Not covered 100% ded. waived Not covered $50 copay deductible waived 20% after deductible 20% after deductible $50 copay deductible waived 30% after deductible 50% after deductible 50% after deductible 50% after deductible bAsiC serviCes Amalgam fillings — 2 surfaces Resin fillings — 2 surfaces Oral Surgery Extraction — exposed root or erupted tooth Extraction of impacted tooth — soft tissue Discount Discount Not covered Not covered 100% after deductible Discount 100% after deductible Not covered $100 copay** (waived if admitted) 20% coinsurance after deductible $0 copay deductible waived 30% after deductible Not covered (except for pregnancy complications) Preventive Health — $40 copay 30% Routine Physical deductible waived after deductible Aetna will pay up to $200 per exam* No waiting period Includes lab work and X-rays Lab/X-Ray Skilled Nursing — in lieu of hospital 30 days per calendar year* Physical/Occupational Therapy and Chiropractic Care 24 visits per calendar year* Home Health Care — in lieu of hospital 30 visits per calendar year* Durable Medical Equipment Aetna will pay up to $2000 per calendar year* phArmACy Pharmacy Deductible per individual Generic Oral Contraceptives Included Preferred Brand Oral Contraceptives Included Non-Preferred Brand Oral Contraceptives Included Self-Injectible Drugs Calendar Year Maximum per individual* * ** + mAJor serviCes Complete upper denture Partial upper denture (resin based) Crown — Porcelain with noble metal Pontic — Porcelain with noble metal Inlay — Metallic (3 or more surfaces) Oral Surgery Removal of impacted tooth — partially bony Endodontic Services Bicuspid root canal therapy Discount Discount Discount Discount Discount Not covered Not covered Not covered Not covered Not covered Molar root canal therapy Periodontic Services Scaling & root planing — per quadrant Osseous surgery — per quadrant Discount Not covered Discount Discount Discount Discount Discount Not covered Not covered Not covered Not covered Not covered 20% after deductible 20% after deductible 20% after deductible 50% after deductible 50% after deductible 50% after deductible Aetna will pay up to $25 per visit max.* 20% 50% after deductible after deductible 20% after deductible 50% after deductible $1,000 $15 copay Not covered Not covered Not covered Unlimited $1,000 $15 copay plus 30% Not covered Not covered Not covered Unlimited orthodontiC serviCes 18 Maximum applies to combined in and out-of-network benefits. Copay is billed separately and not due at time of service. Copay does not count towards coinsurance or out-of-pocket maximum. Payment for out-of-network facility covered expenses is determined based on Aetna’s Market Fee Schedule. Payment for out-of-network non-facility covered expenses is determined based on the negotiated charge that would apply if such services were received from a Network Provider. Access to negotiated discounts: members are eligible to receive non-covered services, including cosmetic services such as tooth whitening, at the PDN negotiated rate when visiting a participating PDN dentist. Nonpreferred (Out-of-Network) Coverage is limited to a maximum of the Plan’s payment, which is based on the contracted maximum fee for participating providers in the particular geographic area. Above list of covered services is representative. A summary of exclusions is listed later in this brochure. For a full list of benefit coverage and exclusions refer to the plan documents. All products not available in all counties. This material is for informational purposes only and is neither an offer of coverage nor dental advice. It contains only a partial, general description of plan benefits or programs and does not constitute a contract. This material is for information only and is not an 19 offer or invitation to contract.
Slide 12: Aetna fitnesssm discount program Aetna special programs Aetna Advantage plans include special programs1 to complement our standard health insurance coverage. these programs include health information programs and tools, and offer you access to substantial savings on products to help you stay healthy. these programs are offered in addition to your Aetna Advantage plan and are not insurance. Eligible Aetna members and their families can access the GlobalFit™ national network of nearly 10,000 fitness clubs, in the United States and Canada, at preferred rates*. In addition, members can access other programs such as at-home weight loss programs, home fitness options and even one-on-one health coaching** services. Aetna weight managementsm discount program The Weight ManagementSM discount program can help you achieve your weight loss goals by providing you with a sensible weight loss plan and balanced nutrition guide to fit your lifestyle. This program provides Aetna members and their eligible family members access to discounts on Jenny Craig® weight loss programs and products. Aetna hearingsm discount program Aetna visionsm discount program Aetna VisionSM discount program offers special savings on eye exams, contact lenses, frames, lenses, LASIK eye surgery, and eye care accessories. Aetna’s HearingSM discount program helps Aetna members and their families save on hearing exams, hearing services and hearing aids. Aetna natural products and servicessm discount program Eligible Aetna members and their families can access complementary health care products and services at reduced rates through the Aetna Natural Products and Services discount program. Members can save on acupuncture, chiropractic care, massage therapy and dietetic counseling as well as on over-the-counter vitamins, herbal and nutritional supplements and other health-related products. Aetna rx home delivery® With this mail order prescription drug program, order prescription medications through our convenient and easy-to-use mail order pharmacy. To learn more or obtain order forms, visit www.AetnaRxHomeDelivery.com. informed health® line Our 24-hour toll-free number that puts you in touch with experienced registered nurses and an audio library for information on thousands of health topics. Aetna’s secure member website Register and log on to Aetna’s secure member website, to check claims status, contact Aetna Member Services, estimate the costs of health care services, and more. Our new Aetna’s Secure Member Website provides a starting point to find answers about health care, types of treatment, cost of services and more to help members make more informed decisions. Plus, members have access to their own Personal Health Record***, a single, secure place where they can view their medical history and add other health information. * At some clubs, participation in this program may be restricted to new club members. ** Provided by WellCall, Inc. through GlobalFit. *** The Aetna Personal Health Record should not be used as the sole source of information about your health conditions or medical treatment. 21 1 20 Availability varies by plan. Talk with your Aetna representative for details.
Slide 13: for more information on any of these programs, please visit us online at www.aetna.com. Things you need to know To qualify for an Aetna Advantage Plan, you must be: wAnt to sAve on dentAl expenses? Vital Savings by Aetna® is a discount program that provides you with dental savings. This is not insurance. Enrolling in the program will give you access to a network of providers who have agreed to accept discounted rates for services. To sign up today, visit www.vitalsavings.com or call 1-877-698-4825. n Under age 64 3/4 (If applying as a couple, both you and your spouse/partner must be under 64 3/4.) Under age 25 unmarried dependent children of the subscriber or enrolling spouse Legal residents in a state with products offered by the Aetna Advantage Plans Legal U.S. residents for at least six continuous months n n n Your premium payments Your rates are guaranteed not to increase for 12 months from your effective date once you’ve been accepted for coverage. After that, your premiums may change. Final rates are subject to underwriting review. The Vital Savings by Aetna® program (the “Program”) is not insurance. The Program provides Members with access to discounted fees pursuant to schedules negotiated by Aetna Life Insurance Company for the Vital Savings by Aetna® discount program. The Program does not make payments directly to the providers participating in the Program. Each Member is obligated to pay for all services or products but will receive a discount from the providers who have contracted with the Discount Medical Plan Organization to participate in the Program. Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, 1-877-698-4825, is the Discount Medical Plan Organization. Your coverage Your coverage remains in effect as long as you pay the required premium charges on time, and as long as you maintain eligibility in the plan. Coverage will be terminated if you become ineligible due to any of the following circumstances: n n Non-payment of premiums Becoming a resident of a state or location in which Aetna Advantage Plans are not available Obtaining duplicate coverage For other reasons permissible by law n n Discount programs provide access to discounted prices and are NOT insured benefits. 22 23
Slide 14: EASY-PAY simple Automatic payments via electronic funds transfer (eft) Registration: Complete the payment section of the Aetna Advantage Plans application. Select the EFT option to approve the automatic withdrawal of your initial premium and all subsequent premium payments. Invoices: You will not receive a paper invoice when you are enrolled in EFT. Payments will appear on your bank statement as “Aetna Autodebit Coverage.” Terminating: To terminate EFT, you will need to provide Aetna with 10 days written notice prior to the date your next EFT payment will be deducted. Without this written notice, your bank account may be debited for the next month’s premium. You will then need to contact Aetna to have funds placed back in the checking account. Refunds: To process an EFT refund (placing money back in member’s checking account), Aetna will require at least five days after the withdrawal was made to ensure valid payment. Rejected transactions: If the EFT payment rejects for any reason, Aetna will automatically terminate the EFT and send you a letter saying you will receive paper invoices. Processing time to reinstate EFT will be 30–60 days. If an EFT payment is rejected, you will need to pay that payment by paper check or credit card. Timing: Payments for Cycle 1 accounts (1st of the month effective date) will be taken from your bank account between the 3rd and the 10th of the month the premium is due. Payments for Cycle 2 accounts (15th of the month effective date) will be taken from your bank account between the 18th and 23rd of the month the premium is due. Levels of coverage & enrollment n You may be enrolled in your selected plan at the premium charge. You may be enrolled in your selected plan at a higher premium, based on medical underwriting. You may be declined coverage based on medical underwriting. n n Medical underwriting requirements The Aetna Advantage Plans are not guaranteed issue plans and require medical underwriting. Some individuals may qualify as federally eligible under the Health Insurance Portability Accountability Act (HIPAA) through the Texas Comprehensive Health Insurance Pool (CHIP). All applicants, enrolling spouses and dependents are subject to medical underwriting to determine eligibility and appropriate premium rate level. We offer various premium rate levels based on the medical underwriting of each applicant. 10-day right to review Do not cancel your current insurance until you are notified that you have been accepted for coverage. We’ll review your application to determine if you meet underwriting requirements. If you’re denied, you’ll be notified by mail. If you’re approved, you’ll be sent an Aetna Advantage Plan contract and ID card. If, after reviewing the contract, you find that you’re not satisfied for any reason, simply return the contract to us within 10 days. We will refund any premium you’ve paid (including any contract fees or other charges) less the cost of any services paid on behalf of you or any covered dependent. Duplicate coverage If you are currently covered by another carrier, you must agree to discontinue the other coverage before or on the effective date of the Aetna Advantage Plan. Do not cancel your current insurance until you are notified that you have been accepted for coverage and are certain that you are keeping your Aetna Advantage Plan coverage. 24 25
Slide 15: Limitations & exclusions Medical These medical plans do not cover all health care expenses and include exclusions and limitations. You should refer to your plan documents to determine which health care services are covered and to what extent. The following is a partial list of services and supplies that are generally not covered. However, your plan documents may contain exceptions to this list based on state mandates or the plan design or rider(s). Services and supplies that are generally not covered include, but are not limited to: n pre-existing Conditions During the first 12 months following your effective date of coverage, no coverage will be provided for the treatment of a pre-existing condition unless you have prior creditable coverage. A pre-existing condition is an illness, disease, physical condition, or injury for which medical advice, or treatment was recommended or received and/or the use of prescription drugs of any kind within 6 months preceding the effective date of coverage. Services or supplies for the treatment of a pre-existing condition are not covered for the first 12 months after the member’s effective date. If the member had continuous prior creditable coverage within the 63 days immediately preceding the signature on the application and meets certain other requirements, then the pre-existing condition exclusion of 12 months may not apply. n n n n n n n n n n n n n n n n All medical and hospital services not specifically covered in, or which are limited or excluded by your plan documents, including costs of services before coverage begins and after coverage terminates Ambulance coverage is limited to $1,000 per trip Cosmetic surgery Custodial care Donor egg retrieval Weight control services including surgical procedures for the treatment of obesity, medical treatment, and weight control/loss programs Experimental and investigational procedures, (except for coverage for medically necessary routine patient care costs for Members participating in a cancer clinical trial) Charges in connection with pregnancy care other than for pregnancy complications Immunizations for travel or work Implantable drugs and certain injectable drugs including injectable infertility drugs Infertility services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI and other related services unless specifically listed as covered in your plan documents Non-medically necessary services or supplies Orthotics Over-the-counter medications and supplies Radial keratotomy or related procedures Reversal of sterilization Services for the treatment of sexual dysfunction or inadequacies including therapy, supplies or counseling n n n n Special or private duty nursing Therapy or rehabilitation other than those listed as covered in the plan documents Rehabilation and detoxification services related to chemical dependency or substance abuse Maternity care and delivery charges Dental Listed below are some of the charges and services for which these dental plans do not provide coverage. For a complete list of exclusions and limitations, refer to plan documents. Dental Services or supplies that are primarily used to alter, improve or enhance appearance. Negotiated rates for cosmetic procedures available when a participating dentist is accessed. n Experimental services, supplies or procedures n Treatment of any jaw joint disorder, such as temporomandibular joint disorder n Replacement of lost or stolen appliances and certain damaged appliances n Services that Aetna defines as not necessary for the diagnosis, care or treatment of a condition involved n All other limitations and exclusions in your plan documents n 26 27
Slide 16: Notes 28
Slide 17: Call your broker. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje, por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only and is not an offer or invitation to contract. Plan features and availability may vary by location. Plans may be subject to medical underwriting or other restrictions. Rates and benefits may vary by location. Health/Dental insurance plans contain exclusions and limitations. Investment services are independently offered by the HSA Administrator. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Not all health services are covered. See health insurance plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features are subject to change. Aetna receives rebates from drug makers that may be taken into account in determining Aetna’s Preferred Drug List. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. Aetna Rx Home Delivery refers to Aetna Rx Home Delivery, LLC, a licensed pharmacy subsidiary of Aetna Inc., that operates through mail order. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Plan for Your Health is a public education program from Aetna and The Financial Planning Association. Information is believed to be accurate as of production date, however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com. FPO FSC logo here ©2010 Aetna Inc. AA.02.311.1-TX (4/10) G