Take charge of your health

Transcription

1 Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Take charge of your health Choose Aetna, choose affordable coverage The information you need to choose quality and affordable health benefits and insurance coverage B (1/14 )

2 First things first. Is my doctor covered? We believe a healthier experience begins with what matters most to you. And we have helpful tools like our online provider directory to help you find your doctor or hospital. Just visit to find the doctors and hospitals you trust most.

3 Table of contents C (1/15) Aetna Health Plans for Individuals, Families and the Self-Employed are underwritten by Aetna Life Insurance Company or Aetna Health Inc. (together, Aetna ). In some states, individuals may qualify as a business group of one and may be eligible for guaranteed issue, small group health plans. IN CT, THIS PLAN IS ISSUED ON AN INDIVIDUAL BASIS AND IS REGULATED AS AN INDIVIDUAL HEALTH INSURANCE PLAN. Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

4 Thank you for your interest in Aetna Health Plans We know how important it is for you to make the right choice. This packet contains helpful tools and important tips to consider along the way. Or, if you prefer, you can call us. We re here to help Call MY-HEALTH ( , TTY: 711). We re available 8 a.m. to 9:30 p.m. ET, Monday through Friday.

5 Shouldn t your plan give YOU the advantage? Your care is important to us. We know there are few things more important than making the best choice for your health coverage. That s why every insurance plan we provide begins with what matters most: 160 years Your confidence Aetna has been in business for more than 160 years. We strive to direct our business and our industry toward more simple and honest services. Your doctors Our goal is to provide you with quality health care at an affordable price. And we have tools to help you find your doctor (or a new doctor in your area) who will help you get the most out of your benefits. For 2015 benefits, the open enrollment period is November 15, 2014 through February 15, If you miss this window, you must wait until the next open enrollment period, unless you qualify for an exception. Your prescriptions All of our plans combine prescription drug coverage and medical care. Your way Good news your way begins with choice. We have plans to meet your needs and offer you more control over how you manage your health: whether by phone, online, in print or in person A (1/15)

6 What does that mean? Here are a few definitions of terms you ll see throughout this brochure. For a full, A Z listing, visit Under Tools & Resources, select Glossary. * Coinsurance The portion of the cost of covered medical services you pay under a health plan, after first meeting any applicable plan deductible. Copayment A set dollar amount or portion that you pay for your medical services. Usually, copays start after you first pay any plan deductible. Copays may differ by type of service. Deductible A set amount that you must pay for your medical services before the health plan starts to pay. Out-of-pocket maximum The limit on the amount an individual is required to pay for health care services that his/her benefits plan covers. Premiums The amount a health insurer charges for a health insurance policy. If you have a health plan through your employer, you and your employer may share this cost. If you buy a health plan yourself, you pay the full amount. * Plan for Your Health is a public education program from Aetna and the Financial Planning Association. Exclusions and limitations Specific conditions or circumstances that aren t covered under a plan.

7 It s easy to enroll Many people have never had to shop for health insurance. An employer often provides it. But if you have to buy health insurance on your own, it s important to understand the process. Once you choose your plan, select the enrollment method that works best for you. Broker You have an ally in the process. Get personalized assistance from your broker, who can answer your questions, help you choose the plan that s right for you and guide you through the enrollment process. Online Go to for easy ways to find the plan that is best for you. By mail Complete and return the enclosed enrollment form. By phone Call us toll-free at MY-HEALTH ( , TTY: 711). We re available from 8 a.m. to 9:30 p.m. ET, Monday through Friday. We can also help you complete the application.

8 What happens next? After you enroll, you can use this checklist to keep track of your new plan. Material name Description Delivery Questions? Welcome Quick start guide Doctor visit Plan documents (Certificate of Coverage, etc.) This welcome letter will let you know when to expect your member ID card and plan documents. We ll also tell you how to sign up for Aetna Navigator, your secure member website, and get Aetna discounts. This will remind you to register for Aetna Navigator, our secure member website. You can also download our mobile app and find out how to talk with a registered nurse. The guide also includes your member ID card and a copy of our privacy notice. See your doctor to take advantage of the annual health care services available to you. Think of this as your owner s manual. It includes important information about how to use your plan, what s covered and how benefits are paid. It also tells you who to call if you have questions. Call us toll free at MY-HEALTH ( , TTY: 711). We re available from 8 a.m. to 9:30 p.m. ET, Monday through Friday. Or visit us at

9 Top reasons to choose Aetna Robust coverage, competitive costs We offer health benefits and health insurance plans with valuable features, which include an excellent combination of quality coverage and competitively priced premiums. Most plans also include: The freedom to see doctors whenever you need to without referrals* Coverage for preventive care, prescription drugs, doctor visits, hospitalization and immunizations No copayments for preventive care when you visit a network provider No claim forms to fill out when you use a network provider Our goal is to provide you with quality health care at an affordable price. And we have tools to help you find your doctor (or a new doctor in your area) that will help you get the most out of your benefits. Walk-in clinics These health care clinics are located in retail stores, supermarkets and pharmacies. They treat uncomplicated, minor illnesses. They also provide preventive health care services. Walk-in clinics (or convenient care clinics) are often open nights, weekends and holidays when you can t see your regular provider. E-visits These are electronic visits between you and your health care providers. You can send a medical concern to them, and they can securely give you medical advice and/or care. They can also prescribe medication/therapy online. Tax advantages with health savings accounts (HSAs) It s easy you set up a personal account that lets you pay for qualified medical expenses. Then, you or an eligible family member makes contributions, and that money earns interest. All contributions and withdrawals for qualifying expenses are tax free, so you pay less. Once you are enrolled in a qualifying high-deductible health plan, Aetna will send you a letter outlining how to enroll in an HSA. Once you are enrolled in an HSA, we will send you a welcome letter. Review the material so we can help you start using your HSA. Embedded deductible An embedded deductible, also known as aggregate, means one person on a plan with 2+ members can meet the individual deductible and begin receiving covered benefits. Scenario: Suppose you have a plan with four family members, John, Jane, Billy and Katie. Each family member has a $500 individual deductible OR $1,000 for the family. John meets his $500 individual deductible; therefore, he can start receiving covered plan benefits. The remaining 3 family members can contribute any portion to satisfy the $1,000 family deductible. Jane can contribute $125, Billy $275 and Katie can contribute the final $100. Or Jane can contribute the entire $500. Then the family deductible is met. Note: This is an example for illustrative purposes only. The amounts above do not reflect an actual plan deductible. Family coverage Apply for coverage for yourself, for you and your spouse, or for your whole family E (1/15) * Referrals are required for HMO plans and all plans in New York and New Jersey.

10 Get more from your plan Scan to watch a video about our discount program. It offers you savings on fitness, weight management, books, vision, hearing and so much more. You want to look and feel your best for many years to come. So give yourself a healthy advantage and use discounts available to you through our plans. Or visit Discount programs are not insurance, and program features are not guaranteed under the plan contract and may be discontinued at any time. The member is responsible for the full cost of the discounted services. Discount programs are in addition to any plan benefits and may require a separate charge to access such programs. Discounts offered hereunder are not insurance.

11 Health care reform What you need to know Since President Obama signed the Affordable Care Act (ACA), we have periodically updated the Aetna Health Plans for Individuals, Families and the Self-Employed to include any necessary changes. Be assured your Aetna Health Plan will always meet the federal health care reform legislation requirements. Quick facts about health care reform Most people must have insurance or risk paying a fine. In 2015, the fine is 2 percent of your income or $325 per person, whichever amount is higher. Preventive care (including immunizations) is provided without cost share, including enhanced coverage of women s preventive health benefits. Coverage will include Essential Health Benefits. Subsidies and tax credits are available for some through the exchanges to help cover monthly payments. There are no annual or lifetime limits on Essential Health Benefits. There are no pre-existing condition exclusions. There are public exchanges ( online marketplaces where you can compare/buy plans). Five factors can affect marketplace plan prices: location, age, family size, tobacco use, and plan category. Health status and gender don t affect pricing. Young adults up to age 26 can stay on their parents plan.

12 Learn more about health care reform Visit

13 Accountable care health care focused on you Your care. Your choice. There are many choices in health care. Sometimes it s hard to know the best option for you and your family. But it s important to know that you have the power to choose and make decisions about your care. Accountable care is a way of organizing and delivering health care. The goal is better care, an improved patient experience and lower cost. Your health care team includes doctors, nurses, therapists and other health care providers. Their goal is to work together and with you to coordinate your care and meet your unique needs. Better health, better care, better cost Accountable care is a new way of looking at health care. It s a team approach tailored to your health care needs. Your health care team: Focuses on your overall health, not just treating you when you re sick or injured. Works together to manage your care. This allows you and your doctors to make informed health care decisions. Uses the latest medical guidelines to make your health care more effective. Gives you better care at a lower cost. Why does coordinated care matter? Doctors in the network can work together to build a care plan around you. And they can share information about your care more easily with each other. Coordinated care is simply more effective and efficient. It can cut down on duplicate medical tests and other things that increase your costs. You can visit hospitals and doctors not in the accountable care network. They will be out of network unless it s an emergency. Check your plan documents to understand your costs if you use out-of-network providers. More ways to get care Sometimes you may need to seek other types of care. You can always use any walk-in clinic in the accountable care network. But if it s an emergency, go to the nearest hospital or call 911. You ll be covered as if you stayed in the accountable care network. Choosing your doctors We know that finding the right doctors is important to you and your family. And, to get the most out of your plan you ll need to choose doctors and facilities that are part of the accountable care network. It s easy to see who s in the accountable care network. Visit Then search by doctor or facility name, specialty, procedure or location (1/15)

14 Use our online tools Once you re a member you can use the Aetna Navigator Member Payment Estimator* to compare costs for many health care services. You can also see the cost savings of being an accountable care network member. When you know costs, you can make the most out of your benefits. This can help you save by: See what you ll pay for hundreds of doctor and hospital services in most parts of the country, based on your actual health benefits and insurance plan. Compare estimates for up to 10 doctors or hospitals at a time. Compare in- and out-of-network cost estimates for office visits, surgeries, medical tests and more. Look up costs for prescription drugs before you fill a prescription. And find out what you can save by using our home delivery service. Have questions? Just call us To find out more about accountable care networks and how you can improve your health while lowering your health care costs, visit individual.com or call MY-HEALTH ( , TTY: 711). * Estimated costs not available in all markets. Actual costs may differ for a number of reasons, including if other or different services are performed by the doctor or facility at the time of your visit, and/or additional claims/member payments are processed before the actual claim for the estimated service is processed.

15 Save money use Aetna s provider network Maybe you ve read that one of the best ways to save on health care costs is to stay in network. But you re not sure what that means. You re not alone. Many people find the term confusing. We re here to help you understand what in network means for you. How our network helps you save A network is a group of health care providers. It includes doctors, specialists, dentists, hospitals and other facilities. These health care providers have a contract with us. As part of the contract, they provide services to our members at a lower rate. This contract rate is usually much lower than what the doctor would charge if you were not an Aetna member. And the network doctor agrees to accept the contract rate as payment. You pay your coinsurance or copay, along with your deductible, if applicable. So what does this all mean? It means you have access to the care you need at a lower price. And the difference in cost can be huge for the same type of service or procedure. Find doctors and hospitals in the network It s easy to look up in network doctors and hospitals using our DocFind directory. It s a good idea to check every time you make an appointment. Visit individual.com and select Find a Doctor, or call MY-HEALTH ( , TTY: 711), and ask for provider information. How much you can save You can see detailed examples of how much you might save on the same service just by staying in network. Example 1 You have been getting care for an ongoing condition from a specialist who is not in the Aetna network. You are thinking about switching to a specialist in the Aetna network. This example illustrates what you may save if you switch. Office visit In Network Out of Network C (1/14) Doctor bill Amount billed $150 $150 Amount Aetna uses to Aetna s rate* in network $90* calculate payment Recognized amount** out of network $90** What your plan Aetna s negotiated rate/recognized amount $90 $90 will pay Percent your plan pays 80% 60% Amount of Aetna s negotiated rate/recognized amount covered under plan $72* $54** What you owe Your coinsurance responsibility $18 $36 Amount that can be balance billed to you $0 $60 Your total responsibility $18*** $96*** View more examples on the following page.

16 Example 2 You need outpatient surgery for a simple procedure and are deciding if you will have it done by a physician in the Aetna network. This example gives you an idea of how much you might owe depending on your choice. Outpatient surgery In network Out of network Surgery bill Amount billed $2,000 $2,000 Amount Aetna uses Aetna s rate* in network $600* to calculate payment Recognized amount** out of network $600** What your plan Aetna s negotiated rate/recognized amount $600 $600 will pay Percent your plan pays 80% 60% Amount of Aetna s negotiated rate/recognized amount covered under plan $480* $360** What you owe Your coinsurance responsibility $120 $240 Amount that can be balance billed to you $0 $1,400 Your total responsibility $120*** $1,640*** Example 3 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 the Aetna network. Five-day hospital stay In network Out of network Hospital bill Amount billed $25,000 $25,000 Amount Aetna uses Aetna s rate* in network $8,750* to calculate payment Recognized amount** out of network $8,750** What your plan Aetna s negotiated rate/recognized amount $8,750 $8,750 will pay Percent your plan pays 80% 60% Amount of Aetna s negotiated rate/recognized amount covered under plan $7,000* $5,250** What you owe Your coinsurance responsibility $1,750 $3,500 Amount that can be balance billed to you $0 $16,250 Your total responsibility $1,750*** $19,750*** * Doctors, hospitals and other health care providers in the Aetna network accept our payment rate and agree that you owe only your copay, coinsurance and deductible. ** When you go out of network, the plan determines a recognized amount. You may be responsible for the difference between the billed amount and the recognized amount. See your plan documents for details. 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 outside the network, the difference between the health care provider s bill and the recognized amount does not count toward that cap. 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.

17 Costs for out-of-network doctors and hospitals People are paying more of their health care costs these days. It s no wonder there is a lot of interest in keeping these costs down. A smart way to do this is to avoid using doctors and hospitals that are out of network. We do not have a contract for reduced rates with an out-of-network doctor or hospital. So you could end up with higher costs and more work. Why out-of-network costs more There are a few reasons you probably will pay more out of pocket: Your Aetna health benefits or insurance plan may pay part of the doctor s bill. But it pays less of the bill than if you get care from a network doctor. Some plans may not pay any benefits if you go out of network. Some plans cover out of network only in an emergency. Cost sharing is more With most plans, your coinsurance is higher for out-ofnetwork care. Coinsurance is the part of the covered service you pay for. (For example, the plan pays 80 percent of the covered amount, and you pay 20 percent coinsurance.) Out-of-network rates are higher An out-of-network doctor sets the rate to charge you. It is usually higher than the amount your Aetna plan recognizes or allows. An out-of-network doctor can bill you for anything over the amount that Aetna recognizes or allows. This is called balance billing. A network doctor has agreed not to do that. We do not base our payments on what the out-ofnetwork doctor bills you. We do not know in advance what the doctor will charge A (1/14)

18 Deductibles are separate, higher What you pay when you are balance billed does not count toward your deductible. And it is not part of any cap your plan has on how much you have to pay for covered services. Many plans have a separate out-of-network deductible. This is usually higher than your in-network deductible. (Sometimes, you have no deductible at all for care in the network.) You must meet the out-of-network deductible before your plan pays any out-of-network benefits. You ll have more work, too Plus, when you visit an out-of-network doctor, you handle precertification, or preapproval of some health care services, if needed. This means more time and more paperwork for you. Emergency care is covered You re covered for emergency care. You have this coverage while you re traveling or at home. This includes students who are away at school. Detailed information can be found in the disclosure section of this packet. Know your costs before you go Before you decide where to receive care, look up your estimated costs. It s easy with our cost-of-care tools. Once you re a member, log in to your secure Aetna Navigator website to use these tools.

19 Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Your Aetna bronze plan options Bronze-level plans pay for about 60 percent of the health care costs for covered services under the plan. They tend to have lower monthly payments, but you will pay more for your deductible, copayments and coinsurance. All plans listed include pediatric dental (PD). Featuring: TX Aetna Bronze $20 Copay PD TX Aetna Bronze HSA Eligible PD TX G (1/15) Request a quote now To get a quote or ask a question, you can: Call your broker Call Aetna at My-Health ( ) Monday Friday, 8:00 a.m. to 9:30 p.m., ET Visit

20 Bronze Aetna Health Plan options in Texas Plan TX Aetna Bronze $20 Copay PD Member benefits In network Out of network* Deductible (ded) individual/family1 (Applies to out-of-pocket maximum) $5,750/$11,500 $11,500/$23,000 Member coinsurance 0% 50% Out-of-pocket maximum individual/family1 (Maximum you will pay for all covered services) $6,600/$13,200 Unlimited/unlimited Primary care visit $20 copay; ded waived Specialist visit $50 copay after ded Hospital stay $250 copay per admission after ded Outpatient surgery (ambulatory surgical center/hospital) $250 copay after ded Emergency room (copay waived if admitted) $250 copay after ded $250 copay after ded Urgent care $60 copay after ded Preventive care (age and frequency limits apply) Covered in full; ded waived Diagnostic lab Diagnostic X-ray $100 copay after ded Imaging (CT/PET scans, MRIs) $250 copay after ded Vision Pediatric eye exam (1 visit per year)2 Covered in full; ded waived Pediatric dental Dental checkup/preventive dental care (2 visits per year)2 Covered in full; ded waived Covered in full; ded waived Basic dental care 30% after ded 30% after ded Pharmacy Pharmacy deductible Integrated with medical ded Integrated with medical ded Preferred generic drugs $15 copay; ded waived Preferred brand drugs $45 copay after ded Nonpreferred drugs** $75 copay after ded Specialty drugs*** P: 40% after ded; NP: * For important information on your costs and how Aetna pays for out-of-network care, read Costs for out-of-network doctors and hospitals. ** Includes nonpreferred generic and brand drugs. *** P=Preferred specialty drugs; NP=Nonpreferred specialty drugs. 1 The family deductible and/or out-of-pocket limit can be met by a combination of family members. Each covered family member only needs to satisfy his or her individual deductible and/or out-of-pocket limit. Deductible and/or out-of-pocket limit are separate in and out of network. 2Any applicable benefit maximums are combined in and out of network. Aetna Health Plans for Individuals, Families and the Self-Employed are underwritten by Aetna Life Insurance Company or Aetna Health Inc. (together, Aetna ). In some states, individuals may qualify as a business group of one and may be eligible for guaranteed issue, small group health plans.

21 Bronze Aetna Health Plan options in Texas (Continued) TX G (1/15) TX Aetna Bronze HSA Eligible PD In network Out of network* $6,300/$12,600 $12,600/$25,200 0% 50% $6,300/$12,600 Unlimited/unlimited Covered in full; ded waived Covered in full; ded waived Integrated with medical ded Integrated with medical ded If you live in Austin or San Antonio, you can choose one of our Community plans. The Community plans have the same benefits listed in the plans on these pages, but you have to see doctors and hospitals that are part of the Community plan network. This network is made up of local hospitals and doctors that are part of a health system. While you can visit hospitals and doctors not in the Community network, they ll be out of network unless it s an emergency. Look at the out-of-network column in the plans to understand your costs if you use out-of-network providers. Finding a Community plan doctor is easy. Follow these simple steps: 1. Go to docfind.com. 2. Type a name, specialty, procedure or condition in the What are you looking for? box or search from a list of conditions, procedures or provider types. 3. Enter your ZIP code or city and state. 4. Select a plan with either Austin Community plan or San Antonio Community plan in the plan name, depending on where you live, from the drop-down menu. 5. If you search by provider name, make sure to click on see accepted plans to see if the Community plan you want is listed. Request a quote now To find out more about Community plans, call your broker or MY-HEALTH ( ). This material is for information only. A summary of exclusions is listed in the Aetna Health Plan brochure. For a full list of benefits coverage and exclusions, refer to the plan documents. Rates and benefits vary by location. 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. Health insurance plans contain exclusions and limitations. Investment services are independently offered by the HSA Administrator. Information is believed to be accurate as of the production date; however, it is subject to change.

22 Page intentionally left blank

23 Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Your Aetna silver plan options Silver-level plans pay for about 70 percent of the health care costs for covered services under the plan. They tend to have higher monthly payments compared to bronze plans, but you will pay less for your deductible, copayments and coinsurance. All plans listed include pediatric dental (PD). Featuring: TX Aetna Silver $10 Copay PD TX Aetna Silver $5 Copay 2750 PD TX G (1/15) Request a quote now To get a quote or ask a question, you can: Call your broker Call Aetna at My-Health ( ) Monday Friday, 8:00 a.m. to 9:30 p.m., ET Visit

24 Silver Aetna Health Plan options in Texas Plan TX Aetna Silver $10 Copay PD Member benefits In network Out of network* Deductible (ded) individual/family1 (Applies to out-of-pocket maximum) $3,750/$7,500 $7,500/$15,000 Member coinsurance 30% 50% Out-of-pocket maximum individual/family1 (Maximum you will pay for all covered services) $6,600/$13,200 Unlimited/unlimited Primary care visit $10 copay; ded waived Specialist visit $75 copay; ded waived Hospital stay Outpatient surgery (ambulatory surgical center/hospital) $500 copay per admission after ded; then 30% $250 copay after ded; then 30% Emergency room (copay waived if admitted) $500 copay after ded $500 copay after ded Urgent care $75 copay; ded waived Preventive care (age and frequency limits apply) Covered in full; ded waived Diagnostic lab 30% after ded Diagnostic X-ray 30% after ded Imaging (CT/PET scans, MRIs) Vision $250 copay after ded; then 30% Pediatric eye exam (1 visit per year)2 Covered in full; ded waived Pediatric dental Dental checkup/preventive dental care (2 visits per year)2 Covered in full; ded waived Covered in full; ded waived Basic dental care 30% after ded 30% after ded Pharmacy Pharmacy deductible $500 per member $1,000 per member Preferred generic drugs** T1A-$5 copay; ded waived/ T1-$15 copay; ded waived Preferred brand drugs $45 copay after ded Nonpreferred drugs*** $75 copay after ded Specialty drugs P: 40% after ded; NP: * For important information on your costs and how Aetna pays for out-of-network care, read Costs for out-of-network doctors and hospitals. ** T1A=Value drugs; T1=Preferred generic drugs. *** Includes nonpreferred generic and brand drugs. P=Preferred specialty drugs; NP=Nonpreferred specialty drugs. 1 The family deductible and/or out-of-pocket limit can be met by a combination of family members. Each covered family member only needs to satisfy his or her individual deductible and/or out-of-pocket limit. Deductible and/or out-of-pocket limit are separate in and out of network. 2Any applicable benefit maximums are combined in and out of network. Aetna Health Plans for Individuals, Families and the Self-Employed are underwritten by Aetna Life Insurance Company or Aetna Health Inc. (together, Aetna ). In some states, individuals may qualify as a business group of one and may be eligible for guaranteed issue, small group health plans.

25 Silver Aetna Health Plan options in Texas (Continued) TX G (1/15) TX Aetna Silver $5 Copay 2750 PD In network Out of network* $2,750/$5,500 $7,500/$15,000 30% 50% $6,000/$12,000 Unlimited/unlimited $5 copay; ded waived $75 copay; ded waived 30% after ded 30% after ded $500 copay after ded $500 copay after ded $75 copay; ded waived Covered in full; ded waived 30% after ded 30% after ded 30% after ded Covered in full; ded waived Covered in full; ded waived Covered in full; ded waived 30% after ded 30% after ded Integrated with medical ded T1A-$5 copay; ded waived/ T1-$15 copay; ded waived Integrated with medical ded $45 copay after ded $75 copay after ded P: 40% after ded; NP: If you live in Austin or San Antonio, you can choose one of our Community plans. The Community plans have the same benefits listed in the plans on these pages, but you have to see doctors and hospitals that are part of the Community plan network. This network is made up of local hospitals and doctors that are part of a health system. While you can visit hospitals and doctors not in the Community network, they ll be out of network unless it s an emergency. Look at the out-of-network column in the plans to understand your costs if you use out-of-network providers. Finding a Community plan doctor is easy. Follow these simple steps: 1. Go to docfind.com. 2. Type a name, specialty, procedure or condition in the What are you looking for? box or search from a list of conditions, procedures or provider types. 3. Enter your ZIP code or city and state. 4. Select a plan with either Austin Community plan or San Antonio Community plan in the plan name, depending on where you live, from the drop-down menu. 5. If you search by provider name, make sure to click on see accepted plans to see if the Community plan you want is listed. Request a quote now To find out more about Community plans, call your broker or MY-HEALTH ( ). This material is for information only. A summary of exclusions is listed in the Aetna Health Plan brochure. For a full list of benefits coverage and exclusions, refer to the plan documents. Rates and benefits vary by location. 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. Health insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change.

26 Page intentionally left blank

27 Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Your Aetna gold plan option Gold-level plans pay for about 80 percent of the health care costs for covered services under the plan. They tend to have higher monthly payments, but you will pay less for your deductible, copayments and coinsurance. This plan includes pediatric dental (PD). Featuring: TX Aetna Gold $5 Copay PD TX G (1/15) Request a quote now To get a quote or ask a question, you can: Call your broker Call Aetna at My-Health ( ) Monday Friday, 8:00 a.m. to 9:30 p.m., ET Visit

28 Gold Aetna Health Plan option in Texas Plan TX Aetna Gold $5 Copay PD Member benefits In network Out of network* Deductible (ded) individual/family1 (Applies to out-of-pocket maximum) $1,400/$2,800 $6,750/$13,500 Member coinsurance 20% 50% Out-of-pocket maximum individual/family1 (Maximum you will pay for all covered services) $5,000/$10,000 Unlimited/unlimited Primary care visit $5 copay; ded waived Specialist visit $40 copay; ded waived Hospital stay 20% after ded Outpatient surgery (ambulatory surgical center/hospital) 20% after ded Emergency room (copay waived if admitted) $250 copay after ded $250 copay after ded Urgent care $75 copay; ded waived Preventive care (age and frequency limits apply) Covered in full; ded waived Diagnostic lab 20% after ded Diagnostic X-ray 20% after ded Imaging (CT/PET scans, MRIs) 20% after ded Vision Pediatric eye exam (1 visit per year)2 Covered in full; ded waived Pediatric dental Dental checkup/preventive dental care (2 visits per year)2 Covered in full; ded waived Covered in full; ded waived Basic dental care 30% after ded 30% after ded Pharmacy Pharmacy deductible $250 per member $500 per member Preferred generic drugs** T1A-$3 copay; ded waived/ 50%; ded waived T1-$10 copay; ded waived Preferred brand drugs $35 copay after ded Nonpreferred drugs*** $70 copay after ded Specialty drugs P: 30% after ded; NP: * For important information on your costs and how Aetna pays for out-of-network care, read Costs for out-of-network doctors and hospitals. ** T1A=Value drugs; T1=Preferred generic drugs. *** Includes nonpreferred generic and brand drugs. P=Preferred specialty drugs; NP=Nonpreferred specialty drugs. 1 The family deductible and/or out-of-pocket limit can be met by a combination of family members. Each covered family member only needs to satisfy his or her individual deductible and/or out-of-pocket limit. Deductible and/or out-of-pocket limit are separate in and out of network. 2 Any applicable benefit maximums are combined in and out of network. Aetna Health Plans for Individuals, Families and the Self-Employed are underwritten by Aetna Life Insurance Company or Aetna Health Inc. (together, Aetna ). In some states, individuals may qualify as a business group of one and may be eligible for guaranteed issue, small group health plans.

29 If you live in Austin or San Antonio, you can choose one of our Community plans. The Community plans have the same benefits listed in the plans on these pages, but you have to see doctors and hospitals that are part of the Community plan network. This network is made up of local hospitals and doctors that are part of a health system. While you can visit hospitals and doctors not in the Community network, they ll be out of network unless it s an emergency. Look at the out-of-network column in the plans to understand your costs if you use out-of-network providers. Finding a Community plan doctor is easy. Follow these simple steps: 1. Go to docfind.com. 2. Type a name, specialty, procedure or condition in the What are you looking for? box or search from a list of conditions, procedures or provider types. 3. Enter your ZIP code or city and state. 4. Select a plan with either Austin Community plan or San Antonio Community plan in the plan name, depending on where you live, from the drop-down menu. 5. If you search by provider name, make sure to click on see accepted plans to see if the Community plan you want is listed TX G (1/15) Request a quote now To find out more about Community plans, call your broker or MY-HEALTH ( ). This material is for information only. A summary of exclusions is listed in the Aetna Health Plan brochure. For a full list of benefits coverage and exclusions, refer to the plan documents. Rates and benefits vary by location. 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. Health insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change.

30 Page intentionally left blank

31 Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Your Memorial Hermann bronze plan options Bronze-level plans pay for about 60 percent of the health care costs for covered services under the plan. They tend to have lower monthly payments, but you will pay more for your deductible, copayments and coinsurance. Memorial Hermann plans are only available to members living in the metro Houston area. All plans listed include pediatric dental (PD). Featuring: TX Aetna Memorial Hermann Bronze $20 Copay PD TX Aetna Memorial Hermann Bronze HSA Eligible PD TX G (1/15) Request a quote now To get a quote or ask a question, you can: Call your broker Call Aetna at My-Health ( ) Monday Friday, 8:00 a.m. to 9:30 p.m., ET Visit

32 Bronze Memorial Hermann Health Plan options in Texas Plan TX Aetna Memorial Hermann Bronze $20 Copay PD Member benefits In network Out of network* Deductible (ded) individual/family1 (Applies to out-of-pocket maximum) $5,750/$11,500 $11,500/$23,000 Member coinsurance 0% 50% Out-of-pocket maximum individual/family1 (Maximum you will pay for all covered services) $6,600/$13,200 Unlimited/unlimited Primary care visit $20 copay; ded waived Specialist visit $50 copay after ded Hospital stay $250 copay per admission after ded Outpatient surgery (ambulatory surgical center/hospital) $250 copay after ded Emergency room (copay waived if admitted) $250 copay after ded $250 copay after ded Urgent care $60 copay after ded Preventive care (age and frequency limits apply) Covered in full; ded waived Diagnostic lab Diagnostic X-ray $100 copay after ded Imaging (CT/PET scans, MRIs) $250 copay after ded Vision Pediatric eye exam (1 visit per year)2 Covered in full; ded waived Pediatric dental Dental checkup/preventive dental care (2 visits per year)2 Covered in full; ded waived Covered in full; ded waived Basic dental care 30% after ded 30% after ded Pharmacy Pharmacy deductible Integrated with medical ded Integrated with medical ded Preferred generic drugs $15 copay; ded waived Preferred brand drugs $45 copay after ded Nonpreferred drugs** $75 copay after ded Specialty drugs*** P: 40% after ded; NP: * For important information on your costs and how Aetna pays for out-of-network care, read Costs for out-of-network doctors and hospitals. ** Includes nonpreferred generic and brand drugs. *** P=Preferred specialty drugs; NP=Nonpreferred specialty drugs. 1 The family deductible and/or out-of-pocket limit can be met by a combination of family members. Each covered family member only needs to satisfy his or her individual deductible and/or out-of-pocket limit. Deductible and/or out-of-pocket limit are separate in and out of network. 2 Any applicable benefit maximums are combined in and out of network. Aetna Health Plans for Individuals, Families and the Self-Employed are underwritten by Aetna Life Insurance Company or Aetna Health Inc. (together, Aetna ). In some states, individuals may qualify as a business group of one and may be eligible for guaranteed issue, small group health plans.

33 Bronze Memorial Hermann Health Plan options in Texas (Continued) TX Aetna Memorial Hermann Bronze HSA Eligible PD In network Out of network* $6,300/$12,600 $12,600/$25,200 0% 50% $6,300/$12,600 Unlimited/unlimited Covered in full; ded waived Covered in full; ded waived TX G (1/15) Integrated with medical ded Integrated with medical ded This material is for information only. A summary of exclusions is listed in the Aetna Health Plan brochure. For a full list of benefits coverage and exclusions, refer to the plan documents. Rates and benefits vary by location. 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. Health insurance plans contain exclusions and limitations. Investment services are independently offered by the HSA Administrator. Information is believed to be accurate as of the production date; however, it is subject to change.

34 Page intentionally left blank

35 Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Your Memorial Hermann silver plan options Silver-level plans pay for about 70 percent of the health care costs for covered services under the plan. They tend to have higher monthly payments compared to bronze plans, but you will pay less for your deductible, copayments and coinsurance. Memorial Hermann plans are only available to members living in the metro Houston area. All plans listed include pediatric dental (PD). Featuring: TX Aetna Memorial Hermann Silver $5 Copay 2750 PD TX Aetna Memorial Hermann Silver $10 Copay PD TX G (1/15) Request a quote now To get a quote or ask a question, you can: Call your broker Call Aetna at My-Health ( ) Monday Friday, 8:00 a.m. to 9:30 p.m., ET Visit

36 Silver Memorial Hermann Health Plan options in Texas Plan TX Aetna Memorial Hermann Silver $5 Copay 2750 PD Member benefits In network Out of network* Deductible (ded) individual/family1 (Applies to out-of-pocket maximum) $2,750/$5,500 $7,500/$15,000 Member coinsurance 30% 50% Out-of-pocket maximum individual/family1 (Maximum you will pay for all covered services) $6,000/$12,000 Unlimited/unlimited Primary care visit $5 copay; ded waived Specialist visit $75 copay; ded waived Hospital stay 30% after ded Outpatient surgery (ambulatory surgical center/hospital) 30% after ded Emergency room (copay waived if admitted) $500 copay after ded $500 copay after ded Urgent care $75 copay; ded waived Preventive care (age and frequency limits apply) Covered in full; ded waived Diagnostic lab 30% after ded Diagnostic X-ray 30% after ded Imaging (CT/PET scans, MRIs) 30% after ded Vision Pediatric eye exam (1 visit per year)2 Covered in full; ded waived Pediatric dental Dental checkup/preventive dental care (2 visits per year)3 Covered in full; ded waived Covered in full; ded waived Basic dental care 30% after ded 30% after ded Pharmacy Pharmacy deductible Integrated with medical ded Integrated with medical ded Preferred generic drugs** T1A-$5 copay; ded waived/ T1-$15 copay; ded waived Preferred brand drugs $45 copay after ded Nonpreferred drugs*** $75 copay after ded Specialty drugs P: 40% after ded; NP: * For important information on your costs and how Aetna pays for out-of-network care, read Costs for out-of-network doctors and hospitals. ** T1A=Value drugs; T1=Preferred generic drugs. *** Includes nonpreferred generic and brand drugs. P=Preferred specialty drugs; NP=Nonpreferred specialty drugs. 1 The family ded and/or out-of-pocket limit can be met by a combination of family members. Each covered family member only needs to satisfy his or her individual ded and/or out-of-pocket limit. Deductible and/or out-of-pocket limit are separate in and out of network. 2 Any applicable benefit maximums are combined in and out of network. Aetna Health Plans for Individuals, Families and the Self-Employed are underwritten by Aetna Life Insurance Company or Aetna Health Inc. (together, Aetna ). In some states, individuals may qualify as a business group of one and may be eligible for guaranteed issue, small group health plans.

37 Silver Memorial Hermann Health Plan options in Texas (Continued) TX Aetna Memorial Hermann Silver $10 Copay PD In network Out of network* $3,750/$7,500 $7,500/$15,000 30% 50% $6,600/$13,200 Unlimited/unlimited $10 copay; ded waived $75 copay; ded waived $500 copay per admission after ded; then 30% $250 copay after ded; then 30% $500 copay after ded $500 copay after ded $75 copay; ded waived Covered in full; ded waived 30% after ded 30% after ded $250 copay after ded; then 30% Covered in full; ded waived Covered in full; ded waived Covered in full; ded waived 30% after ded 30% after ded TX G (1/15) $500 per member $1,000 per member T1A-$5 copay; ded waived/ T1-$15 copay; ded waived $45 copay after ded $75 copay after ded P: 40% after ded; NP: This material is for information only. A summary of exclusions is listed in the Aetna Health Plan brochure. For a full list of benefits coverage and exclusions, refer to the plan documents. Rates and benefits vary by location. 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. Health insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change.

38 Page intentionally left blank

39 Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Your Memorial Hermann gold plan option Gold-level plans pay for about 80 percent of the health care costs for covered services under the plan. They tend to have higher monthly payments, but you will pay less for your deductible, copayments and coinsurance. Memorial Hermann plans are only available to members living in the metro Houston area. This plan includes pediatric dental (PD). Featuring: TX Aetna Memorial Hermann Gold $5 Copay PD TX G (1/15) Request a quote now To get a quote or ask a question, you can: Call your broker Call Aetna at My-Health ( ) Monday Friday, 8:00 a.m. to 9:30 p.m., ET Visit

40 Gold Memorial Hermann Health Plan option in Texas Plan TX Aetna Memorial Hermann Gold $5 Copay PD Member benefits In network Out of network* Deductible (ded) individual/family1 (Applies to out-of-pocket maximum) $1,400/$2,800 $6,750/$13,500 Member coinsurance 20% 50% Out-of-pocket maximum individual/family1 (Maximum you will pay for all covered services) $5,000/$10,000 Unlimited/unlimited Primary care visit $5 copay; ded waived Specialist visit $40 copay; ded waived Hospital stay 20% after ded Outpatient surgery (ambulatory surgical center/hospital) 20% after ded Emergency room (copay waived if admitted) $250 copay after ded $250 copay after ded Urgent care $75 copay; ded waived Preventive care (age and frequency limits apply) Covered in full; ded waived Diagnostic lab 20% after ded Diagnostic X-ray 20% after ded Imaging (CT/PET scans, MRIs) 20% after ded Vision Pediatric eye exam (1 visit per year)2 Covered in full; ded waived Pediatric dental Dental checkup/preventive dental care (2 visits per year)2 Covered in full; ded waived Covered in full; ded waived Basic dental care 30% after ded 30% after ded Pharmacy Pharmacy deductible $250 per member $500 per member Preferred generic drugs** T1A-$3 copay; ded waived/ 50%; ded waived T1-$10 copay; ded waived Preferred brand drugs $35 copay after ded Nonpreferred drugs*** $70 copay after ded Specialty drugs P: 30% after ded; NP: * For important information on your costs and how Aetna pays for out-of-network care, read Costs for out-of-network doctors and hospitals. ** T1A=Value drugs; T1=Preferred generic drugs. *** Includes nonpreferred generic and brand drugs. P=Preferred specialty drugs; NP=Nonpreferred specialty drugs. 1 The family ded and/or out-of-pocket limit can be met by a combination of family members. Each covered family member only needs to satisfy his or her individual ded and/or out-of-pocket limit. Deductible and/or out-of-pocket limit are separate in and out of network. 2 Any applicable benefit maximums are combined in and out of network. Aetna Health Plans for Individuals, Families and the Self-Employed are underwritten by Aetna Life Insurance Company or Aetna Health Inc. (together, Aetna ). In some states, individuals may qualify as a business group of one and may be eligible for guaranteed issue, small group health plans.

41 TX G (1/15) This material is for information only. A summary of exclusions is listed in the Aetna Health Plan brochure. For a full list of benefits coverage and exclusions, refer to the plan documents. Rates and benefits vary by location. 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. Health insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change.