Aetna Affordable Health Choices SM
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1 Aetna Affordable Health Choices SM A limited accident and sickness insurance plan designed for hourly, part-time or other employees without benefits (9/05) A
2 The Benefits of Aetna Affordable Health Choices SM Affordable Usually costs no more than the equivalent of one or two hours of wages per week Guaranteed issue Employees cannot be refused coverage Fully supported Claims are processed promptly; enrollment materials are provided; single point-of-contact for all employer and customer services available in English and Spanish Easy-to-administer Proprietary systems simplify the tracking of high-turnover employees
3 Medical Plans Hiring and keeping the right people is a critical factor of success for businesses such as retailers, restaurants, staffing companies, banks and hotels. When competing for the best employees, employers have an advantage if they offer medical insurance benefits. Unfortunately, medical insurance plans are often too costly for employers to offer. And, even if an employer can offer medical benefits, sometimes the plans are out of reach for the employee due to financial constraints or the number of hours worked. The breadth of Aetna s product portfolio is designed to meet the wide spectrum of your health benefits coverage needs; it includes Aetna Affordable Health Choices*, a solution for many employee groups such as: Low-income, high turnover, full-time employees Part-time employees Newly hired, full-time employees who must fulfill a waiting period before becoming eligible for the employer s medical plan These insurance plans offer coverage for accident- and sickness-related medical expenses and are affordable for both the employer and the employee. Medical portfolio Our medical plans feature: Access to Aetna s PPO Network 1 Access to Aetna s Informed Health Line 2 (IHL) and Employee Assistance Program 2 (EAP) Optional Wellness Care 2 Benefits Optional Prescription Drug Benefits 1 We offer a series of Supplemental Products, which the employer may offer as optional insurance coverages with the Aetna Affordable Health Choices plans, including: Dental Vision Care Hospital Indemnity Insurance Short-Term Disability Insurance Life and Accidental Death Insurance Plans contain exclusions and limitations. See inserts for a general listing. Underwriting guidelines for all plan designs The Aetna Affordable Health Choices medical plans are guaranteed issue and are available to: Groups with 51 or more employees 3 Any classification of employee not offered medical insurance Eligible employees, their spouses and dependent children Employee groups from 51 to 499 that have at least 10 enrolled lives Groups of 500 or more regardless of participation (no minimum requirement) 1099 employees are ineligible We have included medical and supplemental plan designs that are available in your market; please refer to inserts in this brochure. The value of wellness Aetna Affordable Health Choices plans offer limited accident and sickness coverage. But what about preventive care? Aetna Affordable Health Choices offers Wellness Care Coverage as an option with all plans unless coverage is required under applicable state law. If Wellness is elected, the plan pays up to $100 per coverage year for care in or out of network. The participant pays a $15 copayment (or $15 deductible), then the plan pays the network provider s discounted or Usual and Customary charges up to $100. *Medical plans are underwritten by Aetna Life Insurance Company. 1 Based on plan design 2 Service/benefit requires additional employee premiums 3 We also offer solutions for employers with 50 or fewer employees. Please contact your SRC Sales Representative at For more information, log onto or contact your local Aetna Small Group Sales Representative.
4 About Aetna For more than 150 years, Aetna has been an innovator in the delivery of insurance solutions. We helped shape the evolution of health benefits, with innovations and initiatives that focus on our approximately 13.6 million medical, 11.6 million dental, 8.3 million pharmacy and 13.3 million group life insurance members.* Providing our members with the power of information is at the center of all we do. Our award-winning and easy-to-use online tools help members gather information that can help them make informed decisions that are right for their needs. Because health benefits can be complicated, we are dedicated to clearly explaining how our members can make their health insurance plans work harder for them. Members have access to national networks that feature more than 646,000 health care professionals including 385,000 primary care and specialist doctors and more than 3,900 hospitals (Figures from Aetna s Enterprise Provider Data Base, September 2004). We also offer access to a variety of programs and services including wellness programs to help our members stay healthy and improve their quality of life. *Aetna Corporate Controller figures, 12/31/04
5 SRC, an Aetna Company: Administrative experience makes the difference Since 1976, Strategic Resource Company (SRC) has focused on the administration of group medical and other voluntary benefits for employees, particularly those paid on an hourly basis. This focus gives SRC a reputation for leadership in this specific arena. Through this experience, SRC has developed proprietary systems and technology to track high-turnover staff, minimizing administrative work for the employer and allowing plans to be offered in a cost-effective manner. This means that medical plans and other coverages are no longer out of reach for many employees who previously went uninsured. SRC serves businesses of all sizes, from small companies with a single location to employers with more than 175,000 eligible employees and more than 4,500 locations. Full support for employees For employees who enroll in Aetna Affordable Health Choices plans, SRC provides fast, accurate and courteous member services, including: Single, toll-free number for all member services, provided in English or Spanish Benefit explanations before and after enrollment Benefit verification Timely, accurate claims payment Member services from representatives who have online access to all systems COBRA and HIPAA administration Freedom from implementation hassles SRC s complete service package frees brokers, agents and employers from the time-consuming chores often associated with plan implementation. A dedicated account team provides a single contact for all pre- and post-enrollment support, including: Development, production and distribution of all enrollment and communication materials Enrollment and eligibility processing and maintenance Premium administration
6 SRC and Aetna: Helping stretch employee dollars through a broad services network Aetna Affordable Health Choices offers plans with network options. Network providers have agreed to provide services at a negotiated rate. When employees choose a network provider, they can utilize more services before their benefit limit is reached. There can be a real payoff to Aetna Affordable Health Choices network features for employees. The preferred provider network has providers nationwide. If an employee lives outside a certain range of network providers, SRC pays the provider s usual and customary charges, but pays the claim as though it were in network. This gives employees outside the network area the same benefit advantage. Easy access to more information For more information about Aetna Affordable Health Choices plans, or to locate a Sales Representative near you, call SRC at or visit online at Or, contact your local Aetna sales office. 4
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8 This material is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only a partial, general description of plan benefits or programs and does not constitute a contract. Aetna arranges for the provision of health and/or dental care services. However, Aetna itself is not a provider of those services and therefore cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change without notice. Consult the plan documents (i.e., Group Insurance Certificate and/or Group Policy) to determine governing contractual provisions, including procedures, exclusions and limitations relating to the plan. Preferred providers and vendors are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Some benefits are subject to limitations or visit maximums. Medical, Hospital Indemnity, Dental, Short-Term Disability, Vision Care and Term Life Insurance Plans are underwritten by Aetna Life Insurance Company. Plans are administered by Strategic Resource Company. The availability of a plan or program may vary by geographic service area. While this information is believed to be accurate as of the print date, it is subject to change (9/05) A 2005 Aetna Inc. An Aetna Company
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