Aetna Affordable Health Choices SM Plan Brochure

Transcription

1 Aetna Affordable Health Choices SM Plan Brochure CoWorx Staffing Services, LLC Affordable Premiums Family Coverage Available Enroll Today! Call SRC toll-free at Monday-Friday, 8 a.m. to 8 p.m. ET Guaranteed Acceptance B: NP12.4.ED-004 (03/05)

2 Your employer is giving you the opportunity to enroll in these payrolldeducted insurance coverages. Medical: Plan 1 A Limited Major Medical Insurance Plan. The table on the right will give you a quick overview of the Medical Coverage. Use any licensed provider for covered expenses or any certified hospital. You can save even more money by using a network provider or facility through the discounted PPO network. Chiropractic visits are covered. Maternity is a covered expense and covered the same as any other expenses, up to the annual benefit maximum. Prescription Drug Benefit pays up to a monthly maximum benefit of $50 with copays as low as $10 on covered prescription drugs. That's as much as $600 in prescription drug benefits each coverage year. Note that unused monthly benefits do not carry forward to the next month. If you live in an area that is not served by the PPO network and you use a nonparticipating provider that is also located outside a network area, your covered expenses would be reimbursed according to the in network provisions of the plan. An exception to this is the Office Visit Doctors Fees, for which there is no copay and the provisions of the in network outpatient benefit would apply. to the separate page in your enrollment kit for details. BENEFIT IN NETWORK OUT OF NETWORK Annual Deductible - Individual $250 $350 Annual Deductible - Family 2 $500 $700 Annual Benefit Maximum (per covered person) Subject to these annual limits: Outpatient expenses 3 Other hospital services 3 $5,000 in or out of network $2,000 in or out of network $1,000 in or out of network Doctors Office Visits Per visit copay or base deductible $15 copay $15 base deductible Percentage of remaining charges paid by plan 1,4,6 100% 50% Outpatient Care 1,3,4,6 70% 50% Wellness Care Benefit Per visit copay $15 copay not applicable Percentage of remaining charges paid by plan 1 100% 50% Maximum annual benefit $300 in or out of network Prescription Drug Benefit (Not subject to a deductible.) Monthly maximum $50 in or out of network Generic drugs $10 copay 50% 1 Branded drugs $20 copay 50% 1 (Covers only medical prescriptions, except for dental prescriptions issued in connection with treatment resulting from a covered accident.) Hospital Care 1,3,5,6 70% 50% Emergency Care 1,3,5,6 70% 50% Footnotes 1. Where benefit is expressed as a percentage, the lower of the recognized charge(s) or the discounted PPO charge(s) will be the basis of payment. 2. You will have met your "family deductible" when two covered family members have each paid their own deductibles in a coverage year. 3. Subject to the annual deductible. 4. Subject to the outpatient expenses benefit limit. 5. Subject to the other hospital expenses benefit limit. 6. Subject to the annual benefit maximum. Additional Benefits DocFind, Our Online Provider Directory, is available 24 hours a day, seven days a week. To find a preferred provider, call or visit our DocFind online directory at You can even get directions to the provider s office. The Prescription Drug Card gives you and your family access to more than 52,000 retail pharmacies across the continental U.S., Puerto Rico, and the Virgin Islands (as of 1/1/05). You can also use our Aetna Rx Home Delivery service; a fast, easy way to fill the prescriptions you take regularly. Aetna s Vision One discount program, a nationwide network of vision care providers, offers you and your family glasses, contact lenses, nonprescription sunglasses, contact lens solutions and other eye care accessories at a discounted price. Plus, you can receive up to a 25% discount on LASIK eye surgery. Aetna s Informed Health Line provides access to registered nurses experienced in providing information on a variety of health topics using the Healthwise Knowledgebase, one of the most advanced health databases. Contact Aetna s Informed Health Line toll-free 24 hours a day, seven days a week at

3 Medical: Plan 2 A Limited Major Medical Insurance Plan. The table on the right will give you a quick overview of the Medical Coverage. Use any licensed provider for covered expenses or any certified hospital. You can save even more money by using a network provider or facility through the discounted PPO network. Chiropractic visits are covered. Maternity is a covered expense and covered the same as any other expenses, up to the annual benefit maximum. Prescription Drug Benefit pays up to a monthly maximum benefit of $50 with copays as low as $10 on covered prescription drugs. That's as much as $600 in prescription drug benefits each coverage year. Note that unused monthly benefits do not carry forward to the next month. If you live in an area that is not served by the PPO network and you use a nonparticipating provider that is also located outside a network area, your covered expenses would be reimbursed according to the in network provisions of the plan. An exception to this is the Office Visit Doctors Fees, for which there is no copay and the provisions of the in network outpatient benefit would apply. to the separate page in your enrollment kit for details. BENEFIT IN NETWORK OUT OF NETWORK Annual Deductible - Individual $250 $350 Annual Deductible - Family 2 $500 $700 Annual Benefit Maximum (per covered person) Subject to these annual limits: Outpatient expenses 3 Other hospital services 3 $10,000 in or out of network $2,500 in or out of network $2,000 in or out of network Doctors Office Visits Per visit copay or base deductible $15 copay $15 base deductible Percentage of remaining charges paid by plan 1,4,6 100% 50% Outpatient Care 1,3,4,6 70% 50% Wellness Care Benefit Per visit copay $15 copay not applicable Percentage of remaining charges paid by plan 1 100% 50% Maximum annual benefit $300 in or out of network Prescription Drug Benefit (Not subject to a deductible.) Monthly maximum $50 in or out of network Generic drugs $10 copay 50% 1 Branded drugs $20 copay 50% 1 (Covers only medical prescriptions, except for dental prescriptions issued in connection with treatment resulting from a covered accident.) Hospital Care 1,3,5,6 70% 50% Emergency Care 1,3,5,6 70% 50% Footnotes 1. Where benefit is expressed as a percentage, the lower of the recognized charge(s) or the discounted PPO charge(s) will be the basis of payment. 2. You will have met your "family deductible" when two covered family members have each paid their own deductibles in a coverage year. 3. Subject to the annual deductible. 4. Subject to the outpatient expenses benefit limit. 5. Subject to the other hospital expenses benefit limit. 6. Subject to the annual benefit maximum. Additional Benefits DocFind, Our Online Provider Directory, is available 24 hours a day, seven days a week. To find a preferred provider, call or visit our DocFind online directory at You can even get directions to the provider s office. The Prescription Drug Card gives you and your family access to more than 52,000 retail pharmacies across the continental U.S., Puerto Rico, and the Virgin Islands (as of 1/1/05). You can also use our Aetna Rx Home Delivery service; a fast, easy way to fill the prescriptions you take regularly. Aetna s Vision One discount program, a nationwide network of vision care providers, offers you and your family glasses, contact lenses, nonprescription sunglasses, contact lens solutions and other eye care accessories at a discounted price. Plus, you can receive up to a 25% discount on LASIK eye surgery. Aetna s Informed Health Line provides access to registered nurses experienced in providing information on a variety of health topics using the Healthwise Knowledgebase, one of the most advanced health databases. Contact Aetna s Informed Health Line toll-free 24 hours a day, seven days a week at

4 Hospital Indemnity If you or a covered dependent are confined in the hospital as an inpatient and charged for room, board and general nursing services for private, semi-private or intensive care accommodations, then this coverage pays the following: Lump-Sum Hospital Indemnity Benefit: $1,000 for one confinement per year; plus Daily Hospital Indemnity Benefit: $100 per day of hospital confinement for up to 100 days per year. Vision Care Insurance Reimbursements of $25 for an eye examination once every 12 months. Aetna s Vision One discount program, a nationwide network of vision care providers, offers you and your family glasses, contact lenses, nonprescription sunglasses, contact lens solutions and other eye care accessories at a discounted price. Plus, you can receive up to a 25% discount on LASIK eye surgery. Eye exam benefits and discount eyewear purchases apply to each covered person. Fees for other services must be paid by you. The benefit period is 12 consecutive months beginning on the later of your effective date or your most recent eye exam that was covered under this coverage. Dental Insurance Plan Use any licensed dentist you want. $500 coverage year maximum after a $50 deductible per covered person. Covers most common services. This table will give you a quick overview of the Dental Coverage. You can sign up for a single coverage, a combination of coverages or all of the coverages! Pick the coverage(s) that best meet your needs. Short Term Disability (STD) Insurance Weekly benefits for up to 6 months while you are disabled. 50% of base pay received from the employer that sponsors this program (plus reported tips, but no overtime) up to $125 maximum weekly benefit. Benefits begin after a 14-day waiting period (if hospitalized, then plan begins paying immediately). Some states require employers to provide STD benefits. If you work in California, Hawaii, New Jersey, New York, or Rhode Island (or Puerto Rico), this coverage is not available to you. Only the employee can be covered under STD. Premiums double at age 65. COMMON DENTAL SERVICES Types of charges covered by the Plan Percent of recognized charges the schedule pays Checkups and Cleaning 80% None Waiting period of continuous enrollment before Plan pays Fillings 60% 3 Months Oral Surgery 60% 3 Months Crown and Bridge Repair 60% 3 Months Denture Repair 60% 3 Months Perio and Endodontic 50% 12 Months Crown and Bridge 50% 12 Months Dentures 50% 12 Months Term Life Insurance Plan with Accidental Death Benefit $20,000 of term life coverage for yourself. $20,000 matching accidental death benefit. Benefits paid to the beneficiary of your choice. Sign up for term life for yourself, and you can enroll your eligible dependents for: > $2,500 in term life for dependents over 6 months. > $500 for children from birth through 6 months of age. Your benefits are reduced by 50% when you reach age 70.

5 Questions & Answers Who is an eligible employee? Eligible employees include all CoWorx field employees. Who can I enroll? In addition to coverage for yourself, you can receive dependent coverage in the medical, hospital indemnity, vision care, dental, and term life coverages. Eligible dependents must be your dependents for income tax purposes. Your eligible dependents are your lawful spouse and your unmarried children (who depend on you for support) from birth through age 18, through age 24 if a full-time student, or through any age if handicapped and unable to earn a living. Dependent age and status requirements may vary by state. When does coverage begin? Your coverage is effective on the first day of the pay period following the pay period in which a deduction occurs, provided you are eligible (see Who is an eligible employee? ). Each pay period ends on Sunday with coverage beginning each Monday, provided you have had a payroll deduction during that pay period. Your dependents coverage begins when yours does unless you enroll them at a later date. More Questions? Call SRC toll-free at Monday through Friday, 8 a.m. to 8 p.m. Eastern Time

6 Exclusions and limitations for all coverages can be found on a separate page in your enrollment kit. If you did not receive the exclusions and limitations page, please see your supervisor. Coverages, features, limitations and exclusions may vary by state. This is not a contract. Only the insurance policy can provide the actual terms, coverages, amounts, conditions, limitations and exclusions. Insurance plans are underwritten by Aetna Life Insurance Company. Vision One discount program is available through Cole Managed Vision. Prescription Drug Card is provided by Aetna Pharmacy Management. Preferred Provider Organization (PPO) network is administered by Aetna PPO Network. Plans are administered by Strategic Resource Company. Florida registered agent: William H. Gilfillan. 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 does not provide health care services and, therefore, cannot guarantee any results or outcomes. Consult the plan documents (Booklet, Booklet-Certificate, Group Policy) to determine governing contractual provisions, including procedures, exclusions and limitations relating to the plan. The availability of a plan or program may vary by geographical service area. Some benefits are subject to limitations or visit maximums. With the exception of Aetna Rx Home Delivery, all participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. Aetna Rx Home Delivery, LLC, is a subsidiary of Aetna Inc. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. Notice of the change shall be provided in accordance with applicable state law. Information supplied by Aetna InteliHealth or Healthwise Knowledgebase is for informational purposes only, is not medical advice and is not intended to be a substitute for proper medical care provided by a physician. While this material is believed to be accurate as of the print date, it is subject to change. B: NP12.4.ED-004 (03/05)