MICHIGAN SMALL GROUP ENROLLMENT GUIDE

Transcription

1 MICHIGAN SMALL GROUP ENROLLMENT GUIDE Your Destination for Small Business Solutions SM MI (9/09)

2 Health insurance plans are offered and/or underwritten by Aetna Life Insurance Company (Aetna).

3 Table of Contents Aetna Navigator 3 Employee Assistance Program 4 Personal Health Record 5 Walk-in Clinics 6 Aetna Discount Programs 8 Aetna Vision SM discount program 9 Aetna Fitness SM discount program 10 Aetna Weight Management SM discount program 11 Aetna Natural Products and Services SM discount program 12 Aetna Hearing SM discount program 13 Special programs for women 15 Wellness and prevention programs 16 Aetna Pharmacy Management 18 Aetna Health Care Transparency tools 19 DocFind 20 How to complete the employee application 22 Aetna ID card 23 1

4 Welcome to Aetna! Health care is a journey. Aetna Avenue provides you and your family a direct route to valuable discounts and programs designed specifically to meet your health care needs. At Aetna Ave, we provide you the latest information and a holistic approach to health so you can maximize your benefits and make informed decisions. This brochure provides an overview of the member discount programs and services available to you as an Aetna member. You may access a variety of Aetna s member tools and resources that put you and your family in the driver s seat of your health and well-being. Whether you need help enrolling in one of our plans, finding a doctor or scheduling a web visit to maintain your personal health record so it goes where you go, Aetna Ave keeps you on track to effectively navigate the ever-changing world of health care. 2

5 Aetna Navigator Your gateway to managing your health Included with your plan are important tools and resources that make it easier to use your benefits and help you make more informed health care decisions. Aetna.com Aetna Navigator member self-service website When you need up-to-date information about your health insurance plan or want information about a particular health condition, here s where you ll find it! Aetna members can turn to Aetna Navigator, our member self-service website that provides you with a single source for online health and benefits information. It s convenient, and easy to use: 1. Go to Aetna.com 2. Click on Member Log In 3. Register as a new user, or log on using your secure password 4. Find a wealth of credible health care information and self-service functions available to you anytime of the day or night from wherever you have Internet access Our secure connection lets you: n View information about who is covered on your plan n Search for a participating provider on our DocFind online provider directory n Check the status of a claim or review an Explanation of Benefits (EOB) n Contact Member Services with benefits questions (also available in Spanish) Use Aetna Navigator s online tools to manage your benefits and help you make more informed health decisions: n Hospital Comparison tool helps you decide where to receive care for specific procedures, conditions and diagnoses. You can compare hospitals based on four factors you consider important: 1. Number of patients treated per year 2. Complication rates 3. Mortality rates 4. Length of stay n Price-A-Drug sm tool* helps you estimate the cost of prescriptions before you buy n Estimate the Cost of Care tool provides average in and out of network costs for certain procedures based on a geographic area. n Pharmacy benefits summary allows you to locate retail pharmacies; order prescriptions through Aetna s mail-order pharmacy, Aetna Rx Home Delivery ; search and learn about medications; and review the medications available in Aetna s formulary And, if you re interested in learning more about a particular health condition, Aetna Navigator provides credible health information resources. n Aetna SmartSource SM delivers relevant health information that s specific to each member, based on where they live, their Aetna health plan, and other information. Aetna SmartSource scans Aetna s vast resources to bring members, in a single search: - Specialists in their local area - Related medications, treatment options and estimated health costs - Aetna programs that may help them manage their condition - Easy-to-understand health articles and tips n Aetna InteliHealth website, our award-winning and interactive consumer website for credible health, dental and wellness information provided by Harvard Medical School n Healthwise Knowledgebase, a userfriendly online information tool that lets you research your own issues and preferences for health information n Interactive and streaming videos about topics such as asthma and heart health *If Included in your plan. 3

6 Employee Assistance Program* (EAP) Aetna s Employee Assistance Program is a confidential program that gives employees and members of their household access to useful services and support to help them manage the everyday challenges of work and home. The EAP is available at no additional charge to members and their family members and includes: Choice They ll find a range of resources to help them balance their personal and professional lives. Easy access Small Group EAP can be reached anytime toll-free at or on the Web at Aetnaeap.com. Professional assistance Our workplace-trained specialists provide confidential phone support, assessing needs and recommending an appropriate course of action. Employees and their household members receive three phone consultations per member in a calendar year. Employers can also take advantage of EAP Resources: Management and Human Resources assistance Employers get unlimited phone consultations with workplace-trained clinicians who can provide help in dealing with complex employee issues that may arise. Online tools Employers can also get online tools and materials to encourage employees to use the EAP by visiting (enter your company ID and select the Promotional Materials link). *EAP is administered by Aetna Behavioral Health, LLC and Aetna Life Insurance Company. 4

7 Put your Personal Health Record to work and make history! Members with Aetna medical coverage can now use Aetna s Personal Health Record.* Your Personal Health Record is a secure online tool that makes it easy to: keep your health information in a single, safe place track doctor visits, prescriptions and more for you and your family give your doctor a more complete health history receive timely, personalized health alerts and preventive care reminders Much of your health information is ready for you to see now. Information from your Aetna health claims automatically appear in your Personal Health Record. And, you can easily add more information. List your allergies, your family history and more. It s up to you. The more you enter, the better picture you and your doctors will get of your overall health. Stay safe and healthy with alerts and reminders. Personal Health Records helps you get the care you need. If you re due for a checkup or other important screening, you might see a reminder when you log on. You may also receive a message if there s an alternative treatment that may improve your care. And, if you give Aetna permission, you can get e- mails telling you that a new alert or reminder is in your secure Personal Health Record. Portability ensures your personal health records go where you go Aetna s relationship with Microsoft provides our members portability of their personal health information. You can transfer a copy of your Aetna Personal Health Record from Aetna Navigator directly to Microsoft HealthVault at com/personal. Your information will be stored on this secure, web-based consumer health platform and remains available if you change jobs or health plans. You can also print and save a PDF copy of your health record for your own files through the same Navigator location. Print your personalized Emergency Card You can print an Emergency Information Card that pulls information from several sections of your Personal Health Record. It provides first responders your emergency contact s name and phone number, your insurance details, any medications you are taking, allergies if you have any and if you have a living will or have designated your organs for donation. All this detail in a printout that folds and fits in your wallet. Be sure the information in these sections is accurate and up-to-date, and start using your Aetna Personal Health record today! Use it to talk to your doctors with ease. The Personal Health Record can help you team up with your doctors. You can share your Personal Health Record online with individual doctors by making it available through a secure website many doctors already use. You also can print your Health Summary to share at office visits or to help you fill out medical forms when you see a new doctor. It s easy to get started. Visit your Personal Health Record today or use our Walk Me Through guide to explore how this resource works on your own. Visit for answers to the most common questions from our members. * The Aetna Personal Health Record should not be used as the sole source of information about the member s health history. 5

8 A convenient solution for care on the go Walk-in clinics Looking for a convenient way to get medical care? Consider a walk-in clinic. It s a convenient alternative to the doctor s office. If you aren t feeling well and have trouble getting an appointment with your doctor, it s your answer to non-emergency care right away. And Walk-in Clinics are not just for when you are sick. You might be surprised by the full spectrum of services available at a Walk-in Clinic, many of which are staffed by physician assistants and nurse practitioners. They offer: n Treatment for minor burns, stings or bites, sprains, strains and cuts n Care for earaches, flu and cold symptoms, sinus infections and allergies n Physicals and pediatric and gynecologic services n Flu shots and other vaccinations n X-ray and lab services For care that is not minor, such as fractures, sprains or other urgent injuries, we contract with urgent care centers to offer you an economical alternative to visiting an emergency room. Urgent care sites are staffed with physicians to handle urgent medical needs, whereas walk-in clinics are staffed by nurse practitioners to care for minor ailments. And just like walk-in clinics, some urgent care centers offer evening and weekend hours with no appointments needed. Urgent care Check your Plan Design and Benefits Summary to get more information about coverage and costs to visit a walk-in clinic or urgent care center. Use DocFind through to find the closest clinic or care center near you. Follow these simple steps as your guide to locating a walk-in clinic near you: Step 1 Start your search in DocFind. Step 2 Complete all the category selections note there are required fields to complete. n Decide how you d like to search for a provider by zip code, city or county n Under PROVIDER CATEGORY, select Facilities (such as lab, walk-in clinics and X-ray) n Under PROVIDER TYPE, select Walk-In Clinics or Urgent Care Facilities n Finally, under PLAN, select your plan Step 3 Click START SEARCH for a listing of all the Walk-in Clinics in the geographical area you selected. 6

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10 There are many ways to stay healthy outside the doctor s office. Save on staying healthy! You get the discounts below with your Aetna health insurance plan to help make it easy. Save right away on: Gym memberships Home exercise products and equipment Eye care, eyewear and accessories LASIK eye surgery Over-the-counter vitamins Massage therapy Chiropractic visits Acupuncture Dietetic counseling Hearing aids and exams Weight-loss programs And more! If your health plan covers any of these discounts, use your plan first. Your out-of-pocket costs could be lower. These programs are not insurance. So there are no claims, no referrals, and no limits to how often you can use your discount. It s on-the-spot savings that your family members on your health plan can use, too! 8

11 Aetna Vision SM discount program See better for less This program helps you save on what you need to see better, like eye exams, glasses, contacts even LASIK. You also pay less for vision items that don t need a prescription. So pick up some shades for the summer or stock up on contact cleaners. There are plenty more savings where those came from! Program locations Choose from thousands of national chains such as: Pearle Vision Centers Sears LensCrafters Target JCPenney Plus, you can go to many eye doctors in private practice. To find one near you, go to How to start 1. Go to to find a doctor. Or call Make an appointment. 3. Choose your eyewear. 4. Show your Aetna ID card to save on the spot. What you save* Product or Service What You Pay Eye exams (For plans that cover eye exams) See your plan documents for details. Eye exams (For plans that DO NOT cover eye exams) Complete eye exam $42 Standard contact lens fit & follow up $40 (plus $42 exam fee) Specialty contact lens fit & follow up $10 off retail (plus $42 exam fee) (e.g. Toric, Bifocal, Gas Permeable) Lenses (per pair, uncoated plastic) Single vision $40 Bifocal $60 Trifocal $80 Standard Progressive (no-line bifocal) $120 Eyeglass frames 40% off retail price Lens options, per pair (add to lens price above) Standard polycarbonate (includes $40 ultraviolet and scratch-resistant coating) Scratch-resistant coating $15 Ultraviolet (UV) coating $15 Solid or gradient tint $15 Standard antireflective coating $45 Glass 20% off retail price Photochromic glass 20% off retail price Contact lenses 15% off retail price (5% for disposables) Contact lens replacement by mail Call LENS (5367) to order a new pair. More vision items 20% off retail price LASIK eye surgery 15% off retail prices (5% off special advertised prices) for U.S. Laser Network services. You must call to schedule an appointment. * EyeMed Services and Compensation Schedule, 3/09. Prices are subject to change. Discounts may not be available on certain brand name vision materials (i.e., designer eyeglass frames) in which the manufacturer imposes a no-discount practice. 9

12 Aetna Fitness SM discount program Shape up and save Regular exercise helps you look and feel healthy. With this program, you can save money, too. You can: Save on gym memberships.* Save on home exercise products and equipment, like treadmills and elliptical trainers. Try out an at-home weight-loss program. Get one-on-one health coaching** to stop smoking, lower stress and more! It s everything you need to get fit for less today. Why join a gym Thousands of gyms *** nationwide and in Canada (and growing!) all within the GlobalFit TM network Guest privileges at participating gyms when you travel. Transfer your membership to another person or another participating gym. Freeze your membership for up to two months per calendar year. Plus, family members on your health plan can use the program, too! How to start 1. Go to for a list of gyms you can visit. 2. Pick a gym. 3. Follow the steps to get your free guest pass. 4. Join a gym. Sign up online. Or call FREE guest pass Three flexible membership options: > 96 weeks (Lifestyle) > 48 weeks (Commit) > Month to month (Non-Commit) Easy billing through your bank account or major credit card. Did you know? Getting your daily dose of exercise helps keep your heart healthy and your bones strong. It can even give you a good night s sleep! 10 * Participation in GlobalFit is for new gym members only. Membership to a gym of which you are now, or were recently a member, may not be available. **Provided by WellCall, Inc., through GlobalFit. ***GlobalFit website, 3/09. Available at most gyms. Lifestyle and Commit memberships only.

13 Aetna Weight Management SM discount program Trim your waist, not your wallet Lose weight and feel great. This program can help. You ll save on programs and products to help you lose weight from Jenny Craig one of the largest weightloss firms in the world! What you get Free 30-day program* Weekly one-on-one consultations Plans to help you get active and stay motivated Online support and Jenny etools 24/7 customer care Program options Start with a FREE 30-Day Program* You can visit a Jenny Craig Centre or choose the Jenny Direct at-home program. You ll save either way. How to start 1. Sign on to your secure member website at 2. Click on Benefits, then Health Programs. 3. Click on Weight Management discounts. 4. Follow the steps to print your registration coupon instantly. 5. Call JENNY ( ) to find a centre near you.* 6. Bring your coupon and Aetna ID to get your free consultation. Then choose one of the following: > 50%* off the 6-month VIP (Gold/ Platinum) Program > 20%* off the 1-Year Premium Success Program * Plus the cost of food and shipping when applicable. Discounts apply to membership fee only. Offer good at participating centres and Jenny Direct in the United States, Canada and Puerto Rico. Shipping and handling charges apply to Jenny Direct orders. 11

14 Aetna Natural Products and Services SM discount program Relax, recharge and save There are many paths to healthy living. This program can help you find, and save, on a natural one. Pay less for massages, herbal supplements and other ways to complement your health. You get it through American Specialty Health (ASH), Inc., a leader in this market. It s a smart way to save on items not typically covered by your health plan.* Look what you save on! Massage therapy Massage can ease stress and improve your overall well-being. So rest your achy muscles and pay less. Acupuncture Pinpoint your areas of pain or stress with this 5,000-year old technique. And relax with savings. Chiropractice care Get realigned with savings on regular visits to the chiropractor. Dietetic counseling Get advice from registered dieticians on the foods you should eat. This can help you feel healthier, look leaner and improve your total health. How to start Sign on to your secure member website at Click on Benefits, then Health Programs. Click on Natural Products and Services Discounts. Follow the links to make an appointment. Let office staff know you re an Aetna member. Pay the discounted price on the spot. Save on natural products, too Get your daily dose of Vitamin C at a discount. Buy other over-the-counter vitamins, too. Or stock up and save on aromatherapy, nutritional and herbal supplements, and more. You can choose from thousands of products. It s easy to order: 1. Go to your secure member website at 2. Click on Benefits, then Health Programs. 3. Click on Natural Products and Services Discounts. 4. Follow the links to order and save! You can order by Web, phone, mail or fax. Plus, you get free standard shipping on all orders. * Check your plan to see if you have chiropractic and acupuncture benefits. 12

15 Aetna Hearing SM discount program Hear better, for less Hear life the way it s meant to be heard. And save at the same time! With this program, you pay less for hearing aids, exams and more through HearPO, a leading provider of hearing supplies. With over 1,800* locations in the U.S., it s easy to find one near you. What you get: Savings on all hearing aid styles, from behind-the-ear to in-the canal Your choice of models from leading manufacturers Digital hearing aids developed with the latest technology Discounts on hearing aid batteries Free follow-up service for one year How to start 1. Call HearPO at to ask for your authorization packet. 2. Use the packet to find a provider. Or go to 3. Make an appointment. 4. Bring your packet to your visit. 5. Pay the discounted price on the spot. Did you know? Hearing loss is the most preventable disability in the world. In fact, hearing aids can help up to 95% of people with the condition. 2 *HearPO website. Available at 4/09. 2 Facts about hearing loss. Available at www. hearpo.com. Accessed April 24,

16 More savings for you! To start saving on anything in this brochure, go to your secure member website at Save on e.diets, restaurant reviews and more It s nice to save. It s even nicer to save on things you already use to live healthy or have always wanted to. Save on sonic toothbrushes and water-jet flossers from Waterpik. Get a discount on Epic Dental products like gum, toothpastes, and mouth rinses. Eat healthier with 30% off a 1-year online membership to Zagat.com. View ratings and reviews on restaurants, hotels, movies, golf courses, attractions and more. ediets provides a 30% discount off monthly membership dues. Members can choose from more than 20 online diet plans. Plus get one-on-one support, unlimited access to the ediets interactive community and a customized fitness plan. Members can access information about ediets from the Weight Management discount program page. Remember all of the programs in this brochure give you instant savings with: No limits No claims No referrals No limits on use How to start 1. Log on to your secure member website at 2. Click on Benefits, then Health Programs. 3. Follow the link to any discount program. 4. Save on the spot! Save 10% at the MayoClinic.com Bookstore. Choose from books and DVDs, with recipes and tips for healthy living, managing conditions and more. Information about the MayoClinic.com Bookstore is available under the Book Discounts program page. Salon Wish - Give the gift of relaxation to yourself or to a friend through Salon Wish. Get a 10% discount on a $100 minimum gift certificate purchase from participating salons and day spas. There are over 4,000 participating salons and day spas in the U.S. and Canada to choose from. 14

17 Special programs for the special needs of women Ongoing health management Work, family, friends. Too much to do, too little time to do it. That s today s woman. Add health needs that change over time, and you ll know why we offer services and information to help you manage your health. Prevention programs for women Our preventive programs can help women benefit from: n Preventive screening reminders for breast and cervical cancer n Culturally focused initiatives to help reduce health disparities among women of diverse ethnic backgrounds Women s health online Go to for information on women s health issues from heart health, breast cancer and pregnancy to baby care and other topics important to women, as well as: n An interactive body mass index n A pregnancy guide n Food pyramid recommendations n Information on diet and nutrition For ob/gyn care, no referrals needed For an annual well-woman exam, unlimited visits for gynecological problems and routine maternity care, women may schedule an appointment with participating obstetrical, gynecological or women s health care professionals. Special maternity care From the start of pregnancy to birth, our maternity management program offers expectant mothers services and educational materials to help give their newborns a healthy start. Moms-to-be receive: n Educational materials, available in English or Spanish, that cover: > Prenatal care > Labor and delivery > Newborn and baby care > Breastfeeding > Postpartum depression n A pregnancy risk survey and nurse care coordination for high-risk pregnancies n A program to help you stop smoking Beginning Right maternity program Aetna s Beginning Right maternity program offers information and services to expectant mothers including care coordination by obstetrical nurses experienced in preterm labor education, breastfeeding support and more. We want to make sure expectant mothers have the information needed to make informed decisions about health care while pregnant or planning a pregnancy. Members enrolled in both our medical and dental plans, as well as our Beginning Right maternity program, may receive enhanced dental benefits (additional cleaning or treatment of periodontal (gum) disease, fully covered with no deductible) during pregnancy. Direct access applies to general ob/gyn care and basic infertility care only, not subspecialty care/ treatment such as additional infertility specialist care, perinatology care or gynecologic/oncologic care. 15

18 Good health begins with prevention. Prevention programs helping you and your family stay healthy Good health begins with prevention. So we ve developed an array of wellness programs and services to help you and your family stay healthy through all the stages of your life. Preventive care Member health education reminders To help prevent, detect and monitor problems early on, we mail women age 40 and over reminders encouraging them to schedule an annual mammogram. We also send important health information, a chart of recommended preventive care guidelines and a tear-off wallet card to schedule and track this important information. Aetna Health Connections sm disease management This program features Aetna nurses and programs, including MedQuery, and is an important part of our new Aetna Health Connections health and wellness portfolio. Our newly redesigned capabilities support more than 30 conditions and integrate care for members with multiple conditions. The program includes cutting-edge technology to help improve patient safety, doctor communication and more. This integrated, holistic approach using capabilities unique to Aetna, delivers premiere medical management for our members that no one in the industry can match. It includes innovative and individualized clinical programs, information and support for totally integrated health management that optimizes our members state of health. Members are viewed holistically considering multiple diseases or conditions across all benefit plans to deliver customized programs based on their individual needs and preferences. 16

19 Aetna Health Connections SM Disease Management Program Conditions/Clinical Content Vascular Heart Failure Diabetes Adult & Pediatric Coronary Artery Disease (CAD) Peripheral Artery Disease (PAD) Hypertension Adult & Pediatric (High Blood Pressure) Cerebrovascular Disease/Stroke (CVA) Hyperlipidemia (High Cholesterol) Pulmonary Asthma Adult & Pediatric Chronic Obstructive Pulmonary Disease (COPD) Orthopedic / Rheumatologic Osteoporosis Osteoarthritis (OA)* Rheumatoid Arthritis (RA) Chronic Lower Back Pain Gastrointestinal Gastro Esophageal Reflux Disease (GERD) Peptic Ulcer Disease Inflammatory Bowel Disease (IBD) (Crohn s Disease) Chronic Hepatitis Neuro-Geriatric Geriatrics Migraines Seizures Parkinsonism Cancer General Cancer Breast Cancer Lung Cancer Lymphoma/Leukemia Prostate Cancer Colorectal Cancer Renal Chronic Kidney Disease End Stage Renal Failure Other Weight Management Adult & Pediatric Cystic Fibrosis Adult & Pediatric HIV Hypercoagulable State Sickle Cell Disease Adult & Pediatric Depression** *Not scored by Clinical Stratification and Identification (CSID) identification process **Addressed as a comorbid condition 17

20 Why Aetna Pharmacy Management? Extra support promotes positive health outcomes Our ability to integrate and analyze pharmacy and medical claims helps us give health care professionals access to information that may improve outcomes, reduce medication errors and cut health care expenses. When potential drug-to-disease interactions are identified, the system automatically notifies Aetna Rx Home Delivery pharmacists that certain prescriptions may need to be reviewed with the treating physician before they should be dispensed. If a potentially severe drug-to-drug interaction is identified, the claim is blocked immediately at Aetna Rx Home Delivery. An Aetna Rx Home Delivery pharmacist can contact the prescribing physician or override the interaction message by providing additional information to reflect the action taken. Free online decision-support tools Our easy-to-use Web-based tools can help our members make informed decisions about their health and health care budgets. As members, you can check your secure Aetna Navigator website at www. aetna.com to: Read about your benefits and view prescription drug claims. Estimate prescription drug costs. Compare the estimated cost of filling prescriptions at participating retail pharmacies to Aetna Rx Home Delivery with our Price-A-Drug tool. Search the Aetna Preferred Drug List (formulary) to see if your medication is included, what coverage requirements apply, and what alternatives may exist for medications not on the list. Members can also link to the Aetna Pharmacy website at or through Aetna Navigator to get tips about medications and herbal remedies, learn about drug safety, and view educational videos about how to save money. It s easy to use Aetna Rx Home Delivery New orders Members who receive a prescription from their doctor for a maintenance supply of medication (typically a 90-day supply) can simply mail it to Aetna Rx Home Delivery with a completed form. Generally, medications will be delivered, postage-paid, within 14 days. Refills Members can order refills online, by phone or by mail. Plus, they can check the status of their orders online or by phone. No-charge standard shipping There are no shipping or handling charges. Standard delivery through the U.S. mail is free. (Expedited delivery is available for an extra charge.) Aetna Rx Home Delivery works with FSAs, HRAs and HSAs Claims can be automatically applied to an employee s flexible spending account (FSA) simplifying plan administration. They can also be applied to a member s Aetna HealthFund account, if available in your state. 18

21 Understanding the true cost for health care puts you in the driver s seat. Aetna s Health Care Transparency tools Since 2005, Aetna has empowered members with our industry-leading suite of member tools that inform you about doctors, hospitals and other medical facilities.* You can make more informed health care decisions by using our online transparency tools before visiting a doctor or hospital.** Our transparency tools allow you to: view and compare rates for participating doctors lookup costs for medical procedures at facilities in select locations around the country and quickly identify medical specialists who are knowledgeable in their field based on clinical quality and efficiency*** use at your convenience since the information is available 24/7 through Aetna Navigator, our secure member website, and DocFind, our online directory of doctors and facilities Your access as a member to this combination of physician-specific rates, clinical quality and efficiency, and facilityspecific medical procedure costs is a first from a national health carrier and demonstrates our commitment to you. Follow these steps to access our online Health Care Transparency tools: 1. Once registered, log on to Aetna Navigator and access the Cost of Care page from your Aetna Navigator home page 2. From the Cost of Care page, you can access a number of tools: Search for doctors rates and find Aexcel-designated specialists by: > Search for your doctor/specialist using DocFind s Search by Name function Aexcel-designated specialists are identified with a blue star > Click Provider Detail > Access the tabs at the top of the Provider Detail screen linking to View Rates for Aetna Members and View Clinical Quality and Efficiency Look up costs for medical procedures at hospitals and other facilities by selecting Compare actual cost ranges by facility Get estimated average costs for other procedures and services to compare in- and out-of-network costs * Aetna was bestowed the highest marks in the February 2006 edition of BusinessWeek in an article that compared websites and information tools offered by the top three national health insurers. BusinessWeek found the richest set of offers at Aetna s site and commended our online survey to help members evaluate and manage their health as the most comprehensive. ** Always consult your doctor about your health care decisions. Members cannot view rates for dentists, vision providers or certain types of health care professionals with these tools. *** Clinical quality and efficiency information is based on Aexcel designation for specialists in 12 specialty categories. You can learn more about our Aexcel designation in our Understanding Aexcel brochure available under the Learn More section of DocFind. We regularly upgrade our tools to provide the latest cost and clinical quality and efficiency information about our network providers. 19

22 How will I find a Doctor or Specialist? S t e p 1 : Start your search at Below the Shortcuts column on the right, select FIND A DOCTOR and I ACCEPT. First-time Aetna members can register with either their Aetna Member ID or Social Security number or conduct a general search. To reach DocFind if you are already enrolled in an Aetna plan, simply log in to Aetna Navigator. 20

23 S t e p 2 : Complete all the category selections. n Decide how you d like to search for a provider by zip code, city or county, or use Quick Search if you already have a provider s name. S t e p 3 : Click Start Search for a listing of all the providers in the geographical area you selected. n Next, select your personal search parameters: > Provider category includes doctors, dentists, hospitals, etc. > Provider type includes specialist and primary care providers. > The Aetna plan that you enrolled in. (See the instructions below on how to find your plan.) > Click the Additional Search Criteria for an enhanced search that includes criteria such as gender and language spoken. How to find your Michigan plan Some of the names for our Michigan plans appear differently in DocFind. This screen shot is a quick reference guide to identify your plan. PPO HSA 21

24 Now that I ve selected a plan, how do I enroll? Please be sure to complete your application thoroughly. The sections noted below are frequently overlooked. Include your date of hire. Insert your Social Security number here, as well as the Social Security numbers for your dependents. Select the medical plan(s) offered by your employer. If dental plans are offered, select your dental plan next. Enter your doctor s (and dentist s if enrolling in a DMO plan) ID number if enrolling in an HMO plan. Sign here if you are waiving coverage for yourself or any dependents. Sign and date here to complete the application. 22

25 Your member ID card After you enroll, you will receive ID cards that look like this. Make sure to present your Aetna ID card when receiving care from participating providers or when accessing emergency care. Your ID card identifies you as an Aetna member. PPO NAP SCALABLE INFORMATICS LLC ID W GRP: BIN# RX 01 DOUGLAS M PARKS 04 CAMPBELL M PARKS 02 TARA M PARKS O/V $ MADELINE S PARKS SPC $40.00 MEMBER SERVICES This health plan is administered by Aetna Life Insurance Company. While coverage remains in force, members are entitled to benefits under the applicable plan, subject to exclusions and limitations. THE PLAN DESCRIBES WHAT REQUIRES PRECERTIFICATION. TO SEEK PERCERT, CALL THE NUMBER ON THE FRONT OF THIS CARD. FAILURE TO OBTAIN PRECERT MAY RESULT IN REDUCED COVERAGE. Providers: This card does not guarantee coverage. For eligibility or benefit information, contact the office shown with the information on this card. Include the information on this card when completing forms or communicating with the claim office. Participating doctors and hospitals are independent providers and are neither agents nor employees of Aetna. PAYOR NUMBER AT0152 AETNA PO BOX EL PASO, TX Plan in which you are enrolled. Call this number to speak with a Member Services representative. Additional information, including precertification number for mental health and substance abuse services. 23

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28 Review the material in this brochure and speak with your employer or human resources representative about the choices available to you. We look forward to welcoming you and your family as our newest members! If you need this material translated into another language, please call Member Services at AETNA ( ). This material is for information only and is neither on offer or invitation to contract. An application must be completed to obtain coverage. Rates and benefits vary by location. 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. Health insurance plans contain exclusions and limitations. Aetna Rx Home Delivery refers to Aetna Rx Home Delivery, a licensed pharmacy subsidiary of Aetna Inc., that operates through mail order. The charges that Aetna negotiates with Aetna Rx Home Delivery may be higher than the cost they pay for the drugs and the cost of the mail order pharmacy services they provide. For these purposes, the pharmacies cost of purchasing drugs takes into account discounts, credits and other amounts that they may receive from wholesalers, manufacturers, suppliers and distributors. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Discount programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services. Aetna receives rebates from drug manufacturers 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. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to MI (9/09) 2009 Aetna Inc.