Aetna Savings Plus plan guide
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1 Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Savings Plus plan guide New health plans designed with Tennessee businesses in mind For businesses with eligible employees TN (4/13)
2 Aetna Savings Plus plans The Aetna Savings Plus health insurance plans are helping Tennessee businesses access health services that fit their needs and their budgets. They give members access to an affordable network of health providers right in their own community. These lower-priced plans generate savings through a concentric network of quality providers. They are ideal for businesses that think affordable health coverage for their employees is out of reach. Building on a history of innovation These plans are built around fair value, freedom and flexibility, so that businesses get what matters most to them: solutions that offer personal service at a fair price, in a way that allows them to focus their time and efforts on running their business. Not only is Aetna Savings Plus the solution, but it includes these benefits: Benefits for doctor visits, hospital stays, preventive care and prescription drugs Secure member portal, Aetna Navigator Payment Estimator, to help members understand costs before receiving services Online health assessment and programs to help members manage their health Programs that treat individuals, not conditions, to help members achieve better health 2
3 Aetna Savings Plus makes it easier to save Same quality local care at a lower cost The Aetna Savings Plus health insurance plans provide Tennessee members with the same type of coverage as other Aetna medical plans, but at a lower premium cost. Savings are generated through the use of the Savings Plus network, a quality network of local health care providers. How do the Savings Plus insurance plans work? Let Aetna be your guide With 150 years of experience, we can deliver the right solution for your business. The Aetna Savings Plus insurance plans in Tennessee give businesses the flexibility and choice to best meet their needs. These plans use the Aetna MC Savings Plus network. It is a community-based network that is made up of local providers who understand community diversity, preferences and common medical conditions. When members use the Savings Plus network, they realize maximum savings. Members can select a primary care physician (PCP) from the network of preferred participating providers to coordinate care for covered services. All Savings Plus plans include coverage for doctor s office visits, hospital stays, preventive care, pharmacy and more. (Refer to the benefits summaries on pages 4 6 for details.) Each plan offers three levels of benefits to your employees. Premiums and out-of-pocket expense levels vary select the plan that s right for you and your employees. A smarter network strategy designed to... Reduce health care costs for employers and create savings opportunities for employees through a designated network of quality, cost-effective doctors and hospitals, plus provide employee access to online tools and services through a secure member website Fair Value Flexibility Freedom Everyone wants a good deal. Whether you re looking to cut costs as much as possible, or seeking long-term value and greater employee productivity. Choice matters. Every business is different. And the people who make up those businesses have different health needs. Time spent investing with a health plan, should be time well spent. Whether you re managing the business, or an employee on the front line, we try to make it easier with intelligent solutions. Network design = savings Performance network 100% preventive care Unlimited lifetime maximums Range of options Multiple benefits levels Use of physician or hospital Online enrollment and billing Easy to navigate Personal Health Record Member Payment Estimator 3
4 Savings Plus Plans Tennessee (2 100 Employees) MC 13-07T MC 13-07T MC 13-07T NET Tier 1 NET Tier 2 OON Lifetime Maximum Unlimited Unlimited Unlimited In-Network Services Coinsurance 20% 40% 50% Annual Deductible: Individual/Family $2,000/$4,000 $3,000/$6,000 $4,000/$8,000 Type of Deductible Aggregate Aggregate Aggregate Annual Out-of-Pocket Maximum (OOP): Individual/Family (deductible included) $4,000/$8,000 $6,000/$12,000 $12,000/$24,000 Wellness On Us TM Well Child Care (Age/Frequency schedules apply, includes coverage for immunizations) Preventive Care, including annual adult physicals, well-woman visits, mammograms, colorectal cancer screening and other preventive care services. Physician Services Primary Care Physician Office visit $30, ded waived $30, ded waived 50%, ded applies Specialist Office Visit $60, ded waived 40%, ded waived 50%, ded applies Walk In Clinic visit $30, ded waived $30, ded waived N/A Outpatient Mental Health (25 visits per year Mental Health Parity applies $60, ded waived 40%, ded waived 50%, ded applies Inpatient Services Hospital Inpatient Mental Health Inpatient (30 days per year Mental Health Parity applies Outpatient/Other Services Diagnostic Lab $0, ded waived 40%, ded applies 50%, ded applies Diagnostic X-ray $60, ded waived 40%, ded applies 50%, ded applies Diagnostic Complex Imaging (CAT, MRI, MRA/MRS and PET scans) Outpatient Surgery Emergency Room (Copay waived if admitted) $300, ded waived $300, ded waived $300, ded waived Urgent Care $100, ded waived $100, ded waived 50%, ded applies Ambulance (emergency transport) 20%, ded applies 20%, ded applies 20%, ded applies Durable Medical Equipment ($3,000 maximum per year) Outpatient Rehabilitative Therapy (60 visits per year) Pharmacy Retail Pharmacy Copay Step therapy and precertification apply; mail-order drugs (MOD) available at 2X copay for a day supply Aetna Specialty Pharmacy (after first refill must use Aetna Specialty Pharmacy) $15/$45/$60 /30% $15/$45/$60 /30% 30% after copay $15/$45/$60 /30% 30% max. copay $120 30% max. copay $120 30% max. copay $120 4
5 Savings Plus Plans Tennessee (2 100 Employees) MC 13-09T MC 13-09T MC 13-09T NET Tier 1 NET Tier 2 OON Lifetime Maximum Unlimited Unlimited Unlimited In-Network Services Coinsurance 20% 40% 50% Annual Deductible: Individual/Family $2,500/$5,000 $3,500/$7,000 $5,000/$10,000 Type of Deductible Aggregate Aggregate Aggregate Annual Out-of-Pocket Maximum (OOP): Individual/Family (deductible included) $5,000/$10,000 $7,000/$14,000 $15,000/$30,000 Wellness On Us TM Well Child Care (Age/Frequency schedules apply, includes coverage for immunizations) Preventive Care, including annual adult physicals, well-woman visits, mammograms, colorectal cancer screening and other preventive care services. Physician Services Primary Care Physician Office visit $30, ded waived $30, ded waived 50%, ded applies Specialist Office Visit $60, ded waived 40%, ded waived 50%, ded applies Walk In Clinic visit $30, ded waived $30, ded waived N/A Outpatient Mental Health (25 visits per year Mental Health Parity applies $60, ded waived 40%, ded waived 50%, ded applies Inpatient Services Hospital Inpatient Mental Health Inpatient (30 days per year Mental Health Parity applies Outpatient/Other Services Diagnostic Lab $0, ded waived 40%, ded applies 50%, ded applies Diagnostic X-ray $60, ded waived 40%, ded applies 50%, ded applies Diagnostic Complex Imaging (CAT, MRI, MRA/MRS and PET scans) Outpatient Surgery Emergency Room (Copay waived if admitted) $300, ded waived $300, ded waived $300, ded waived Urgent Care $100, ded waived $100, ded waived 50%, ded applies Ambulance (emergency transport) 20%, ded applies 20%, ded applies 20%, ded applies Durable Medical Equipment ($3,000 maximum per year) Outpatient Rehabilitative Therapy (60 visits per year) Pharmacy Retail Pharmacy Copay Step therapy and precertification apply; mail-order drugs (MOD) available at 2X copay for a day supply Aetna Specialty Pharmacy (after first refill must use Aetna Specialty Pharmacy) $15/$45/$60 /30% $15/$45/$60 /30% 30% after copay $15/$45/$60 /30% 30% max. copay $120 30% max. copay $120 30% max. copay $120 5
6 Savings Plus Plans Tennessee (2 100 Employees) MC 13-21T HSA MC 13-21T HSA MC 13-21T HSA NET Tier 1 NET Tier 2 OON Lifetime Maximum Unlimited Unlimited Unlimited In-Network Services Coinsurance 20% 40% 50% Annual Deductible: Individual/Family $2,500 / $5,000 $3,500/$7,000 $5,000/$10,000 Type of Deductible Aggregate Aggregate Aggregate Annual Out-of-Pocket Maximum (OOP): Individual/Family (deductible included) $5,000/$10,000 $7,000/$14,000 $15,000/$30,000 Wellness On Us TM Well Child Care (Age/Frequency schedules apply, includes coverage for immunizations) Preventive Care, including annual adult physicals, well-woman visits, mammograms, colorectal cancer screening and other preventive care services. Physician Services Primary Care Physician Office visit Specialist Office Visit Walk In Clinic visit 20%, ded applies 40%, ded applies N/A Outpatient Mental Health (25 visits per year Mental Health Parity applies Inpatient Services Hospital Inpatient Mental Health Inpatient (30 days per year Mental Health Parity applies Outpatient/Other Services Diagnostic Lab Diagnostic X-ray Diagnostic Complex Imaging (CAT, MRI, MRA/MRS and PET scans) Outpatient Surgery Emergency Room (Copay waived if admitted) 20%, ded applies 20%, ded applies 20%, ded applies Urgent Care Ambulance (emergency transport) 20%, ded applies 20%, ded applies 20%, ded applies Durable Medical Equipment ($3,000 maximum per year) Outpatient Rehabilitative Therapy (30 visits per year) Pharmacy Retail Pharmacy Copay Step therapy and precertification apply; mail-order drugs (MOD) available at 2X copay for a day supply Aetna Specialty Pharmacy (after first refill must use Aetna Specialty Pharmacy) $10$/30/$60/30% $10$/30/$60/30% 30% after copay $10/$/30/$60 30% max. copay $120 30% max. copay $120 30% max. copay $120 6
7
8 Health insurance plans are offered or underwritten by Aetna Life Insurance Company (Aetna). 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 may vary by location. Health insurance plans contain exclusions and limitations. Providers are independent contractors and not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features 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 Aetna Inc TN (4/13)
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203 IBM Health Benefit Comparison Charts for IBM Active Employees These Health Benefit Comparison Charts provide a summary overview of the coverage available for medical services, mental health/substance
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This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com/ca/sisc or by calling 1-855-333-5730. Important
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthfirstny.org or by calling 1-888-250-2220. Important
$0 See the chart starting on page 2 for your costs for services this plan covers.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthfirstny.org or by calling 1-888-250-2220. Important
Blue Cross of NEPA: Custom PPO Option 10014 Coverage Period: 03/01/2015-02/29/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcnepa.com or by calling 1-888-345-2346. Important Questions
Additional Information Provided by Aetna Life Insurance Company
Additional Information Provided by Aetna Life Insurance Company Inquiry Procedure The plan of benefits described in the Booklet-Certificate is underwritten by: Aetna Life Insurance Company (Aetna) 151
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com or by calling 1-800-445-7490. Important Questions
Deductible: $500/$1000* Out-of-Pocket Max: $2,000/$4,000** including deductible
First State Basic Plan (highmark delaware) Description of Benefit Deductible: $500/$1000* Out-of-Pocket Max: $2,000/$4,000** Deductible: $1,000/$2,000* Out-of-Pocket Max: $4,000/$8,000** Inpatient Room
What is the overall deductible? Are there other deductibles for specific services?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com/cuhealthplan or by calling 1-800-735-6072.