AETNA DISCOUNT PLANS AND DISCLOSURES

Transcription

1 AETNA DISCOUNT PLANS AND DISCLOSURES Includes: o Aetna Discount Plans o HMO Medical Plan Disclosure Information o PPO Medical Plan Disclosure Information /12

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3 Dear Aetna Member: To make it easier for you to make informed health care decisions, we ve put your Summary of Coverage/ Schedule of Benefits and your Booklet on line on your Aetna Navigator secure member website. Your Summary of Coverage/Schedule of Benefits and your Booklet provide key detail about your health care benefits, including your share of the cost and which services are covered. You can log into Aetna Navigator on When you get to your secure home page, just select Benefits and then Details. If you change Aetna Health plans or if your coverage changes, you can always rely on Aetna Navigator to display the most up to date versions of the Summary of Coverage/Schedule of Benefits and your Booklet. If you do not have access to the Internet or would prefer a paper copy, please contact your employer s benefits office. Sincerely, Aetna

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5 Better manage your health and health care Aetna Navigator Secure Member Website It s the one place to go for coverage, claims, costs and more. Aetna Navigator is easy to use Aetna Navigator is your secure website for planning and managing your health and health care. It s organized to help you do what you want to do more easily. Get a new ID card. Check on a claim. Look up a health savings account* or health fund balance. Do all this and much more in one location, at Get support when you need it There are times when you may need support. Not to worry. Your member website has a resource section that includes: Answers to some common questions Easy ways to contact us Forms you might need Health info on the go Visit Aetna Navigator anytime, anywhere. You can log in using any mobile phone with web access. It s fast, easy and so convenient. *HSAs are currently not available to HMO members in IL and CA. Health benefits and health insurance plans are offered, underwritten and/or administered by Aetna Health Inc., Aetna Health of California Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT Each insurer has sole financial responsibility for its own products I (8/10)

6 Look what you can do There s so much you can do on Aetna Navigator! Just log in to plan and manage your: Health coverage and benefits: Estimate and compare costs you ll pay for some health care services and procedures Check health savings account, flexible savings account or health reimbursement arrangement** balances See benefits used and remaining See how benefits from your other health plans are coordinated with your Aetna health insurance or health benefits plan Claims: Get an explanation of how claims work See your claims status for a health plan, health savings account or health reimbursement arrangement Review an Explanation of Benefits Care and treatment: Find doctors, pharmacies and hospitals Change a primary care doctor Compare hospitals Research treatments Health records: Get a summary of your doctor visits, medical tests, prescriptions and other health activities Print records of preventive shots and checkups Look up health topics Health and wellness: Complete a Health Assessment Get healthy living tips Sign up for a wellness program Personalized information for you and your family Many Aetna Navigator features deliver personalized content, based on: Health history or claims information you ve entered Your Aetna health plan Your zip code Having meaningful information can help you save time, avoid guesswork and use your health plan more effectively. Some results you can get include: Info on a health condition including a list of neighborhood doctors who can treat the condition and programs that can help meet your health needs Health and wellness recommendations designed just for you New members go to and Register today. Already signed up for Aetna Navigator? Log in to make the most of your health and health plan. ** HRAs are currently not available to HMO members in IL. HRAs are currently not available for Small Group in Florida. This material is for information only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Rates and benefits vary by location. The availability of Aetna Navigator s key features may vary by plan. Health benefits and health insurance plans contain exclusions and limitations. 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. 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. The Health Assessment is used in a variety of ways to support Aetna products and services that help you manage your health. Aetna will use your Health Assessment information in compliance with all applicable state and federal laws, including the Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules. For more information, view Aetna s Notice of Privacy Practices, located at the bottom of Aetna s website; or call the number on the back of your ID card. 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 Policy forms issued in Oklahoma include: HMO OK COC-5 09/07, HMO/OK GA-3 11/01, HMO OK POS RIDER 08/07, GR-23 and/or GR-29/GR-29N I (8/10) 2010 Aetna Inc.

7 Find the right doctor DocFind Online Directory Search for health care professionals online, 24/7. Looking for a new primary care doctor? In need of a dentist? Do you want to find a specialist, hospital, walk-in clinic, urgent care facility or pharmacy? Or maybe you re thinking about signing up for an Aetna health benefits or health insurance plan. If so, you want to make sure your docs are in our network. Now you can find what you need fast. DocFind is your answer. It s great to have a ready resource! If you know a doctor s name, you can use our Search by Name feature. It lets you quickly find out if he or she is in our network. If you are looking for a new doctor, you can count on DocFind. It lets you find doctors and facilities for almost any need. Search by: City, state, zip Specialty Hospital relationship Provider name Gender Get extra information: Plans accepted by each doctor Medical schools attended Board certification Languages spoken Plus, check out: Office locations Disabled access (for medical searches) Maps and driving directions Tap the latest information We update DocFind three times a week. This means you have the latest information on participating doctors and facilities. You can even see facility listings for: Transplants Children s heart surgery Bariatric procedures They re included in the Institutes of Excellence /Institutes of Quality network. Talk about a terrific resource! J (8/10)

8 Necesita DocFind en español? No hay problema! Simplemente haga clic en el botón Versión en español en la parte superior de la página principal de DocFind para cambiar a la versión en español. See more about your doctor DocFind shows the added value your doctor offers. Plus, you can see whether he or she has earned recognition for quality care. DocFind tells you about many programs your doctor may work with, including: Aexcel designation* This is an Aetna program for specialists. These doctors have met certain care and cost standards. eprescribing With this service, doctors can use a computer to write your prescription. They can also check for harmful drug problems and suggest safer treatment options. National Committee for Quality Assurance (NCQA) recognition This program helps you find doctors who meet NCQA standards of care. NCQA is a non-profit group that works to improve health care quality. DocFind can do the work for you If you re already a member, you can register on your secure Aetna Navigator member website. Once you do, you ll get a personalized version of DocFind. Each time you sign on, it automatically fills in your plan name and zip code. That makes your search even easier! Aetna Navigator also lets you: Use tools that help you see and compare costs for some health care services Check claim status Get member ID cards Contact Member Services Need a paper directory? If you re a member, just call the toll-free Member Services number on your member ID card. If you re not yet a member, call AETNA ( ). To log in to DocFind Aetna members: Sign on to your Aetna Navigator member website. Nonmembers: Go to Click on Find a Doctor. Health info on the go Find our great plan tools on any mobile phone with web access. Wherever you go, there s so much you can do! Visit Aetna Navigator Send us a message Search for a claim and more *Aexcel is not available with HMO plans. The Aetna companies that offer, underwrite or administer benefits coverage include Aetna Health Inc., Aetna Health of California Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company. In Arizona and Texas, in-network and out-of-network referred benefits are underwritten by Aetna Health Inc. or Aetna Life Insurance Company. For selffunded accounts, benefits coverage is provided by your employer with administrative services only provided by Aetna Life Insurance Company (Aetna). In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT Each insurer has sole financial responsibility for its own products. If you need this material translated into another language, please call Member Services at AETNA ( ). Si usted necesita este documento en otro idioma, por favor llame a Servicios al Miembro al AETNA ( ). This material is for information only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Providers are independent contractors and are not agents of Aetna. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Health benefits and health insurance plans contain exclusions and limitations. Aexcel designation is only a guide to choosing a physician. Members should confer with their existing physicians before making a decision. Designations have the risk of error and should not be the sole basis for selecting a doctor. 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 Policy forms issued in Oklahoma: HMO OK COC-5 09/07, HMO/OK GA-3 11/01, HMO OK POS RIDER 08/07, GR-23 and/or GR-29 /GR-29N J (8/10) 2010 Aetna Inc.

9 Support like never before Aetna Health Connections SM Health and Wellness Resources Disease Management Program Finally a program that focuses on you, not just your condition C (8/09)

10 The focus is on you to help you live your best life Reach your own level of good health Not everyone can be perfectly healthy. But, even with an ongoing health condition, you can reach your own level of good health. Our disease management program can help. In this program, you can learn how to: Get the treatment and preventive care appropriate for you Understand and follow your doctor s treatment plan Better manage your ongoing conditions Make changes to reach your personal health goals Identify and manage your risks for other conditions You get this program as part of your Aetna health benefits or health insurance plan. There s nothing extra to pay, and participating is up to you. Get support from nurses for a healthier you Our nurses and clinicians can support you even if you have more than one condition. You get this support all in one program, and you get: Educational materials mailed to you Online resources you can use anytime Nurse case management if you re high risk State-of-the-art technology that looks out for your health and safety We focus on you, not your condition, so we can help you with your health needs. Our goal is to make it easier for you to manage your conditions and live your life well. Let us help you protect your health Another way we help is by putting our technology to work for you. Our CareEngine system continuously scans your health data. It compares it with current guidelines of care to help: Identify potential gaps, errors, and duplications in care Remind you to get the preventive care you need Search for potentially dangerous interactions, such as two drugs that shouldn t be taken together Our system can also notify your doctor to consider: Stopping a treatment Adding a treatment Trying a procedure or test not yet given You may also receive a call or a letter, depending on the situation. Health benefits and health insurance plans are offered, underwritten or administered by: Aetna Health Inc., Aetna Health of California Inc., Aetna Health of the Carolinas Inc., Aetna Health of Illinois Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT Each insurer has sole financial responsibility for its own products.

11 Support for more than 35 conditions How our program can work for you As an example, let s say you have diabetes. You may contact us to join. Or, we contact you to see if you want help managing your health issues. Our nurses then can: Teach you about and send you information on diabetes Give you online resources to use anytime Review the treatment plan and medications your doctor gave you Explain possible side effects and answer your questions Give you our 24-hour, toll-free disease management phone number Work with you over time to help you meet your goals for managing diabetes and other health conditions. After speaking with a nurse, you will receive a letter. The letter will list points you discussed and steps you should take before your next discussion with a nurse. Our support team can help you learn how to help protect yourself from future health problems. Heart and blood system > Heart failure > Diabetes (adult and child) > Coronary artery disease > Peripheral artery disease > High blood pressure (adult and child) > Cerebrovascular disease/stroke > High cholesterol Lungs > Asthma (adult and child) > COPD (chronic obstructive pulmonary disease) Bones > Osteopenia* > Osteoporosis > Osteoarthritis > Rheumatoid arthritis > Chronic low back pain Cancer > General cancer > Breast cancer > Lung cancer > Lymphoma/leukemia > Prostate cancer > Colorectal cancer Brain and old age > Geriatrics > Migraine > Seizure disorder > Parkinsonism Digestive > Heartburn/GERD (gastroesophageal reflux disease) > Peptic ulcer disease > IBD (inflammatory bowel disease), Crohn s disease and ulcerative colitis > Chronic hepatitis Kidney > Chronic kidney disease > End-stage kidney disease Other > Hypercoagulable state (increased blood clotting) > Sickle cell disease (adult and child) > Cystic fibrosis > HIV (human immunodeficiency virus) > Weight management (adult and child) > Depression* *Occurring with another condition.

12 Getting started is easy We may identify you for program participation through: Your doctor or self-referral Your request submitted through the Aetna Navigator member website at Our patient management staff Medical and pharmacy claims data If you are an Aetna member and have one of the conditions listed, call us at to get started. Or, call us if you think you re at risk for one of the conditions. The more quickly you act, the more in control you can be. We give you the information and resources you need. You decide what s best for you. Let our disease management program help you live your best life. If you re not yet an Aetna member, talk to your benefits administrator. Go to for more information. This material is for information only. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Health benefits and health insurance plans contain exclusions and limitations. Not all 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 group size and are subject to change. 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 Policy forms issued in Oklahoma include: HMO/OK COC-5 09/07; HMO/OK GA-3 11/01; HMO OK POS RIDER 8/07; GR 23 and/or GR 29/GR 29N Aetna Inc C (8/09)

13 Save lots on lab work! In-network lab benefits Ask your doctor to only use in-network labs, and pay less. There s a smart way to save at your next doctor s visit that you may not even know about: Lab work. With your Aetna plan, you can save big on testing and other lab services. All you have to do is be sure your testing is sent to labs that are in the Aetna network, such as Quest Diagnostics. But remember when your doctor refers you for lab work, he or she may or may not know which lab will save you the most. By knowing which labs are in your health plan s network before you go, you can share the news with your doctor. Here s how it works There are two ways to save on labs every time you need them. n If your doctor is collecting your sample in the office: Ask him or her to send your testing to a participating lab. n If your doctor is sending you outside the office to collect your sample: Ask him or her to give you a lab requisition form to a participating lab. This normally means that the lab is in Aetna s network. But it s always a good idea to call Aetna at the number on your ID card to make sure. Look how much you can save! Just look at how the savings add up for this patient who needs one lab test done four times a year.* In-network lab In-network hospital lab Cost of lab tests $30.00 $60.00 $ Patient s copay x20% x20% x40% Patient pays $6.00 $12.00 $ Out-ofnetwork lab * Aetna Strategic Contract Manager, Based on a patient whose deductible has already been met. Data is not representative of hospitals that have a separately negotiated laboratory agreement (10/09)

14 Don t forget to ask your doctor about in-network labs! The in-network advantage Remember to ask your doctor to use in-network labs to enjoy these benefits: n Convenient hours: Some labs, such as Quest Diagnostics ( offer online appointment scheduling 24/7 which moves you straight to the front of the line when you arrive. n Lower prices: Lower your out-of-pocket costs and put the savings where they belong in your pocket. n Many locations: With thousands of locations nationwide, it s easy to find one close to your job, home or doctor s office. Finding an in-network lab is easy It s a good idea to get familiar with the lab locations near you before you need them. Here s how: 1. Visit 2. Go to Find a doctor. 3. Enter your location details. 4. Choose Facilities under Provider Category. 5. Choose All Other (labs, radiology centers, etc.) under Provider Type. n Skilled staff: Locations are staffed with professionals to help you with all your lab needs. n Reminders: Some labs, such as Quest Diagnostics, will send out reminders to help you stay on top of your appointments and your health. Health benefits and health insurance plans are offered, underwritten or administered by Aetna Health Inc., Aetna Health of the Carolinas Inc., Aetna Health of California Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT Providers are independent contractors and are not agents of Aetna. Provider participation is subject to change without notice. Aetna does not provide care or guarantee access to health care services. Information is believed to be accurate as of the production date, but it subject to change. For more information about Aetna plans, refer to (10/09) 2009 Aetna Inc.

15 Get health answers 24/7 Aetna Health Connections SM Health and Wellness Resources Informed Health Line Talk to a registered nurse whenever you have a health question. When you have an Aetna health benefits and health insurance plan, you have instant access to the information you need. Our tools and resources can help you: n Make more informed decisions about your care n Communicate better with your doctors n Save time and money, by showing you how to get the right care at the right time Get health information from a nurse at any time When you call our Informed Health Line, you can: n Talk directly to a registered nurse. Our nurses can discuss a wide variety of health and wellness topics. n Listen to the Audio Health Library.* It explains thousands of health conditions in English and Spanish. Transfer easily to a registered nurse at any time during the call. Go online for even more health information Use the Healthwise Knowledgebase to find out more about a health condition you have or medications you take. It explains things in terms that are easy to understand. Get to it through your secure Aetna Navigator member website, at * Not all topics in the audio health service are covered expenses under your plan. Use our 24-hour Informed Health Line, online resources and more. Sign up for an Aetna health plan today. Health benefits and health insurance plans are offered, underwritten or administered by: Aetna Health Inc., Aetna Health of California Inc., Aetna Health of the Carolinas Inc., Aetna Health of Illinois Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT Each insurer has sole financial responsibility for its own products. Material is for information only. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Information is subject to change. Health benefits and health insurance plans contain exclusions and limitations. For more information about Aetna plans, refer to Policy forms issued in Oklahoma include: HMO/OK COC-5 09/07, HMO/OK GA-3 11/01, HMO OK POS RIDER 08/07, GR-23 and/or GR D (8/09) 2009 Aetna Inc.

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17 Shape up, and save! Aetna Fitness SM Discount Program Savings on gym memberships, treadmills and more. Regular exercise helps you stay healthy. It can also make you look and feel better. The Aetna Fitness discount program comes automatic with your health benefits or health insurance plan. So you can save money, too! You can: n Save on memberships to the gym n Save on treadmills, elliptical trainers and more n Try out a home weight-loss program n Get health coaching to stop smoking, lower stress and more! It s everything you need to get fit for less today. Pick a gym join a gym You ll get lower rates on gym memberships* in the GlobalFit network. With thousands of gyms** (and growing every day), it s easy to find one close to where you live or work. Step #1: Go to for a list of gyms you can visit. Step #2: Pick a gym and follow the steps to get your FREE guest pass (available at most gyms). It s your sneak peek at gym culture, services and equipment. Step #3: Join a gym today! You can sign up online. Or call GlobalFit toll free at More reasons to join a gym n Three flexible membership options > 96 weeks (Lifestyle) > 48 weeks (Commit) > Month to month (Non-Commit) n FREE guest pass*** n Easy billing through your bank account or major credit card n Guest privileges at participating gyms when you travel n Transfer your membership to another person or another participating gym n Stop your membership for up to two months per calendar year n Plus, family members on your health plan can use the program, too! * 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. ** GlobalFit website, 3/09. *** Not available at all gyms. Lifestyle and Commit memberships only J (8/09)

18 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. With the Aetna Fitness discount program, you can save money, too! Save on home exercise products and equipment Rather get fit in your own home? You ll also save on home exercise products and equipment like elliptical trainers and treadmills. Healthy programs outside the gym Starting a fitness program is just the start to a healthier you. You can also try out an at-home weight-loss program. Or you can get one-on-one health coaching to help you quit smoking, lower stress, lose weight and more. Stretch your body, and your dollars. Get fit with the Aetna Fitness discount program today! Provided by WellCall, Inc., through GlobalFit. Health benefits and health insurance plans are offered, underwritten or administered by Aetna Health Inc., Aetna Health of the Carolinas Inc., Aetna Health of Illinois Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT Each insurer has sole financial responsibility for its own products. This material is for information only. Discount programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services. Health benefits and health insurance plans contain exclusions and limitations. 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 Policy forms issued in Oklahoma include: HMO OK COC-5 09/07, HMO/OK GA-3 11/01, HMO OK POS RIDER 08/07, GR-23, GR-29 and/or GR-29N Aetna Inc J (8/09)

19 Save money with Aetna s provider network Aetna s provider network keeps quality care affordable. By using providers in Aetna s network, you can take advantage of the significant discounts we have negotiated to help lower your out-of-pocket costs for medically necessary care. This can help you get the care you need at an affordable price. Let s look at some examples, so you can see your network savings in action. These examples are based on the following Aetna plan features and assume you ve already met your deductible (the fixed amount that you must pay for covered medical services before your plan will pay benefits): What your plan pays (plan coinsurance): 80% in-network/60% out-of-network What you pay (coinsurance): 20% in-network/40% out-of-network Your out-of-pocket maximum: $4,000 Important Additional Information about the recognized amount : When you receive services from a provider who is not in Aetna s network, Aetna pays based on what the plan calls the recognized amount/charge, which is described in your benefit plan. In these examples, if you use a health care provider who is not in Aetna s network, you may be responsible for the entire difference between what the provider bills and the recognized amount/charge. As the examples show, that difference can be large. Example 1: Office visit You have been getting care for an ongoing condition from a specialist who is not in Aetna s network. You are thinking about switching to a specialist in Aetna s network. This example illustrates what you may save if you switch. In-network Out-ofnetwork Doctor bill Amount billed $150 $150 Amount Aetna uses to calculate payment What your plan will pay What you owe Aetna s rate* in-network Recognized amount** out-of-network $90* $90** Aetna s negotiated rate/ recognized amount $90 $90 Percent your plan pays 80% 60% Amount of Aetna s negotiated rate/recognized amount covered under plan $72* $54** Your coinsurance responsibility $18 $36 Amount that can be balance billed to you $0 $60 Your total responsibility $18*** $96*** Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna) (2/08)

20 Example 2: Outpatient surgery You need outpatient surgery for a simple procedure and are deciding if you will have it done by a physician in Aetna s network. This example gives you an idea of how much you might owe depending on your choice. Out-ofnetwork In-network Out-ofnetwork Surgery bill Amount billed $2,000 $2,000 Amount Aetna uses to calculate payment What your plan will pay What you owe Aetna s rate* in-network Recognized amount** out-of-network $600* $600** Aetna s negotiated rate/ recognized amount $600 $600 Percent your plan pays 80% 60% Amount of Aetna s negotiated rate/recognized amount covered under plan $480* $360** Your coinsurance responsibility Amount that can be balance billed to you $120 $0 $240 $1,400* Your total responsibility $120*** $1,640*** Example 3: A five-day hospital stay You also may be responsible for a portion of fees charged by the facility in which the surgery takes place. The figures in the example do not include those facility fees. * Doctors, hospitals and other health care providers in Aetna s network accept Aetna s payment rate and agree that you owe only your deductible and coinsurance. ** When you go out of network, Aetna determines a recognized amount. You may be responsible for the difference between the billed amount and the recognized amount. See the Important Additional Information on the previous page. Also, your plan may instead call the recognized amount the recognized charge. *** Most plans cap out-of-pocket costs for covered services. The deductible and coinsurance you owe count toward that cap. But when you go out-of-network, the difference between the health care provider s bill and the recognized amount does not count toward that cap. You need to go to the hospital but it is not an emergency. It turns out that you have to stay in the hospital for five days. This example gives you an idea of how much you might owe to the hospital depending on whether it is in Aetna s network. Innetwork Hospital bill Amount billed $25,000 $25,000 Amount Aetna uses to calculate payment What your plan will pay What you owe Aetna s rate* in-network Recognized amount** out-of-network $8,750* $8,750** Aetna s negotiated rate/ recognized amount $8,750 $8,750 Percent your plan pays 80% 60% Amount of Aetna s negotiated rate/recognized amount covered under plan $7,000* $5,250** Your coinsurance responsibility Amount that can be balance billed to you $1,750 $0 $3,500 $16,250* Your total responsibility $1,750*** $19,750*** This material is for information only and is not an offer or invitation to contract. Health benefits and health insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change (2/08) 2008 Aetna Inc.

21 Say goodbye to unnecessary ER visits! Participating Urgent Care Clinics Get convenient urgent care without the long wait! Make unnecessary ER visits a thing of the past Of course, it s second nature for many of us to hit the emergency room if we re suddenly sick or injured a sound idea, in many cases. But what if you have an urgent, but non-life threatening, medical issue like a broken arm or ankle sprain? A hefty ER wait time, and even heftier hospital bill, might not be your best option. In fact, quicker, more affordable and more convenient treatment is closer than you think: your local urgent care center. Many of these health care spots are open 7 days a week even nights, weekends and holidays with no appointments necessary. That makes them a convenient option for common ailments and accidents you d typically visit the ER for. Plus, when you opt for care from one of approximately 3,432 Aetna -contracted centers instead of your local ER, your savings can really add up! See the savings! If you re like many Americans, out-of-pocket costs like deductibles or copays are a part of your world. But the dramatically lower cost you ll pay for participating urgent care visits will feel like instant relief. Take a look at what you may save: Urgent Service Average ER Cost 1 Average Urgent Care 1 Cost Sprains $550-$750 $110-$150 Influenza $550-$750 $110-$150 Minor Lacerations $550-$750 $110-$150 Headaches Migraine and Tension $550-$750 $110-$150 8 GREAT REASONS TO TRY URGENT CARE If you ve already seen and saved at your local urgent care center congrats! You ve taken a giant step toward protecting your health and your wallet. If not, there are plenty of reasons to start: You re covered: All you need is your Aetna ID card. No appointments needed: Just walk right in! Convenient hours: Some clinics are open 7 days a week, with extended evening, weekend and holiday hours, just like the ER. Less waiting: The average ER visit tops 3 hours; 2 while urgent care visits are generally an hour or less. Lower prices: Lower copays and out-of-pocket costs, with prices averaging $110-$150, 1 compared to ER costs of $550 to $ Many locations: With approximately 3,432 (and growing) centers nationwide, you can find a location quickly near your home or job. Fully staffed by doctors: Clinics are overseen by doctors, with doctors providing the service. Connections with local ERs: If you need more extensive care, you ll be referred to the closest ER. 1 Average Urgent Care and Emergency Room Pricing. Aetna Strategic Contract Manager 9/08. Actual costs may vary. 2 Information and Publications. Urgent Care Association of American. Accessed September 23, 2008 on (10/08)

22 Want a cost-cutter? An urgent care visit typically costs 50 percent less than the ER. Have a minor medical need? Finding a spot is easy! Plenty of services If you need care for non-life threatening minor ailments after your doctor s office is closed, you have plenty of options, too. We also contract with retail, or walk-in clinics, to give you an affordable alternative to the ER at an average cost break of up to five times less! The sites are staffed with nurse practitioners and physician assistants to handle ear infections, routine allergies and other minor medical needs. And just like urgent care centers, evening and weekend hours are available, with no appointments needed. Get familiar with urgent care and walk-in locations in your neighborhood before you need them. Here s how: 1. Visit 2. Click on Find a doctor. 3. Enter your location details. 4. Choose Facilities under Provider Category. 5. Select Urgent-care facilities or Walk-in clinics. If your medical need is more than urgent for example, characterized by chest pain, trouble breathing, bad bleeding or other symptoms that are serious or put your life at risk you should go straight to your local ER. Protect your health, and your wallet. Consider the advantages of your local urgent care center. If you re thinking the ER is the only place that can handle your health issue, think again! Urgent care centers not only offer care for serious, non-life threatening medical matters, they also offer plenty of other services, too. Examples include: Fractures Whiplash Sports injuries Falls (less than 7 feet) Cuts and minor lacerations Allergies Infections Flu Gallstones Skin lesion removal Burns and rashes Immunizations & vaccinations And more! 1 Urgent care saves time, money plus eases overcrowding in ERs. Accessed September 23, 2008 at Health benefits and health insurance plans are offered, underwritten or administered by Aetna Health Inc., Health of the Carolinas Inc, Aetna Health of California Inc., Aetna Health of Illinois Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 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. 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 (10/08) 2008 Aetna Inc.

23 Walk right into convenient care! Participating Retail Walk-In Clinics Get convenient medical care without the long wait! Make ER waits a thing of the past! Of course, it s second nature for many of us to hit the emergency room if we re suddenly sick or injured a sound idea, in most cases. But if you ve come down with a minor illness or injury, like strep throat or the flu, a hefty ER wait time and even heftier hospital bill might not be your best option. In fact, quicker, more affordable and more convenient treatment is closer than you think: your local walk-in retail clinic. Many of these convenient health care spots are open 7 days a week, even nights and weekends. That makes them an easy option if you need medical care for common ailments after normal business hours when your doctor isn t available. Plus, when you opt for care from one of almost 650 Aetna -contracted clinics instead of your local ER, your savings can really add up! See the savings! If you re like many Americans, deductibles or coinsurance is a part of your world. But the dramatically lower costs you ll pay for clinic visits will feel like instant relief. Take a look at what you could save: Non-Emergency Service Average ER Cost 1 Average Walk-In Cost 1 Strep throat $ $59 Ear infection $ $59 Flu vaccination $ $59 Sinus infection $ $59 8 GREAT REASONS TO GO RETAIL If you ve already walked in to your local retail clinic congrats! You ve taken a great step toward protecting your health and your wallet at the same time. If not, there are plenty of reasons to start: You re covered: All you need is your Aetna ID card. No appointments needed: The name says it all just walk right in! Convenient hours: Some clinics are open 7 days a weeks, with extended evening and weekend hours, just like the ER. Quicker care: The average ER visit tops 3 hours, 2 while clinic visits are generally an hour or less. Lower prices: You ll pay an average or $44 to $59 per clinic visit 1 compared to the $550 to $750 average ER price.* Many locations: With almost 650 (and growing!) freestanding and retail-based clinics nationwide, you can find a spot close to your home or job. You might even find a spot in your neighborhood s Rite Aid, CVS/pharmacy or Walgreens Skilled staff: Clinics are overseen by a physician, with nurse practitioners or physician assistants on site. Recommendations: If you ever need more extensive care, clinics can refer you to a local doctor, emergency room or urgent care center. 1 Average Retail & ER Pricing. Aetna Strategic Contract Manager, 5/08. 2 Information and Publications. Urgent Care Association of America. Accessed June 18, 2008 at * Member responsibility may vary based on plan design; for some plans copays apply. Emergency room copays are typically higher than walk-in clinic copays (8/08)

24 Have an urgent medical need? If you need care that s more than minor, we also contract with urgent care centers to give you an affordable alternative to the ER, at an average cost break of up to 7 times less than your typical ER cost. The sites are staffed with physicians to handle urgent medical matters. And just like retail clinics, evening and weekend hours are available, with no appointments needed. If your medical need is more than urgent for example, characterized by chest pain, trouble breathing, bad bleeding or other symptoms that are serious or put your life at risk you should go straight to your local ER. Finding a clinic is easy! Get familiar with the urgent care and walk-in clinics in your neighborhood before you need them. Here s how: 1. Visit 2. Click on Find a doctor. 3. Enter your location details. 4. Choose Facilities under Provider Category. 5. Select Urgent care facilities or Walk-in clinics. Plenty of services If you re thinking an ER is the only place that can handle your health issue, think again! Retail clinics not only offer care for minor illnesses and injuries, they also offer plenty of other services you probably didn t realize. Examples include: Routine allergies Ear infections Strep throat Colds & flu Immunizations & vaccinations Athletes foot Minor insect bites Poison ivy Sprains Diabetes screening Heart screenings Pregnancy tests School physicals Well-baby exams And much more! Walk into convenience, savings and good health! Consider the advantages of your local walk-in retail clinic. Health benefits and health insurance plans are offered, underwritten or administered by Aetna Health Inc., Health of the Carolinas Inc., Aetna Health of California Inc., Aetna Health of Illinois Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 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. 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 (8/08) 2008 Aetna Inc.

25 A program to help you watch your weight and wallet Aetna Weight Management SM Discount Program Savings on Jenny Craig weight-loss programs Lose weight and feel great! The Aetna Weight Management discount program can help. You can save on weight-loss programs and products from Jenny Craig, one of the largest weight management firms in the world. Family members on your health benefits and health insurance plan can save too! Weight management that finally fits With Jenny Craig, you get a sensible weightloss plan and products that can help you lose weight and maintain your weight loss. And you can start with a free 30-day program!* You ll also receive: Weekly one-on-one consultations Menus planned and personalized for you Plans to help you get active and stay motivated Online support and Jenny etools 24/7 customer care support Message boards and live chat Here s how to get started: 1. Go to your secure member website at to sign up. 2. Print out your personalized registration coupon. 3. Call JENNY ( ) to find a centre close to you.* 4. Bring your coupon and Aetna ID to get your free consultation. Here are your program options: Start with a FREE 30-day program.* Then choose one of the following: > 50%* off the 6-month VIP (Gold/ Platinum) Program. > 20%* off the 1-Year Premium Success Program. You can visit a Jenny Craig centre or choose the Jenny Direct at-home program. You ll save either way. * 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 D (8/09)

26 Start with a FREE for 30-day program.* Then choose the program that s best for you! Get started today! Log on to your member website at Visit a Jenny Craig Centre Or call JENNY ( ) * 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. Health benefits and health insurance plans are offered, underwritten and/or administered by Aetna Health Inc., Aetna Health of the Carolinas Inc., Aetna Health of Illinois Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT Each insurer has sole financial responsibility for its own products. This material is for information only and is not an offer or invitation to contract. Discount programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services. Program providers are solely responsible for the products and services provided hereunder. Aetna does not endorse any vendor, product or service associated with these programs. Health benefits and health insurance plans contain exclusions and limitations. 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 Policy forms issued in Oklahoma include: HMO OK COC-5 09/07, HMO/OK GA-3 11/01, HMO/ OK POS RIDER 08/07, GR-23 and/or GR-29/GR-29N D (8/09) 2009 Aetna Inc.

27 See better for less Aetna Vision SM Discount Program Save on glasses, contacts, LASIK eye surgery and more J (8/09)

28 The eye-opening See your way to savings! It s easy with the Aetna Vision discount program. You ll pay less for eyeglasses, contact lenses even LASIK! You ll also save on eye care items not typically covered through your health plan. So you can buy eyeglass chains, designer frames, sunglasses and lots more for lots less. Plus, you enjoy: No referrals No waiting for reimbursement No limits to how often you can use the program You save on the spot every time you buy a product or service from one of our many program locations. Choose from thousands of locations* It s easy to find a location with thousands of national chains, like: Pearle Vision Centers Sears Optical LensCrafters Target Optical JCPenney Optical Plus, you can go to many eye doctors in private practice. To find a location near you, go to Or call Great rates on eye exams A routine eye exam does the eyes and the body good. They are the #1 way to find eye problems like glaucoma or astigmatism. They can also uncover the signs of diabetes, high blood pressure and other medical issues early, before they become bigger problems. 1 If you aren t covered for eye exams through your health benefits and insurance plan: Most locations have doctors of optometry onsite or nearby. So you still can get a great rate of $42 on eye exams with this program. If you are covered for eye exams through your health benefits and insurance plan: You can use this program if you need an additional eye exam not covered by your plan. You pay only $42. But check your plan documents first. Your costs could be lower if you follow your plan s requirements. *EyeMed Select Network and Provider List, 1/09. 1 Pavan-Langston, Deborah. Manual of Ocular Diagnosis and Therapy, Health benefits and health insurance plans are offered, underwritten and administered by Aetna Health Inc., Aetna Health of the Carolinas Inc., Aetna Health of Illinois Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT Each insurer has sole financial responsibility for its own products.

29 choice for healthy vision How to save on eye exams and eyewear Book Schedule an eye exam. Browse Choose from designer frames and the latest in lenses. Save Show your Aetna ID card for instant savings. Remember you can save on eye care items that don t need a prescription. Just stop in any program location and save, save, save! Contact lenses... sent straight to your doorstep! Lost a lens? It s easy to get a new pair by mail. Just buy your first pair of prescription contact lenses. Then call our mail-order center at LENS (5367) to get a new pair. Get LASIK for less If you have ever considered LASIK, you ll love these savings! You get a consultation, screening, surgery and follow-up care. All for one affordable package price! Something else to love: The consultation is always free. Even if you do not have the surgery. To get started: 1. Call the U.S. Laser Network at The rep can help you find a doctor. He or she can also call the doctor to reserve your free consultation. 2. Still ready? Set up a date for surgery. Then call the U.S. Laser Network to find out how to pay your $100 deposit. You get this money back even if you don t end up getting the surgery. 3. Save! Pay the entire bill before your surgery. Or check with your surgeon s office for an easy payment plan.

30 What you save** (when you visit any participating location) 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) Comprehensive 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. Need eye exams or eyewear? Monday through Saturday, 8 a.m. to 11 p.m. ET Sundays 11 a.m. to 8 p.m. ET Lost a lens? LENS (5367) Ready for LASIK? Weekdays 8 a.m. to 9 p.m. ET Saturdays 9 a.m. to 6 p.m. ET ** EyeMed Services and Compensation Schedule, 3/09. Prices are subject to change Discounts may not be available on all brand names. This material is for information only. Discount programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of services. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Health benefits and health insurance plans contain exclusions and limitations. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitation and conditions of coverage. Plan features and availability may vary by location and are subject to change. 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 Policy forms issued in Oklahoma include: HMO OK COC-5 09/07, HMO/OK GA-3 11/01, HMO OK POS RIDER 08/07, GR-23 and/or GR-29/GR-29N J (8/09) 2009 Aetna Inc.