Easy steps to renew your coverage€¦ · LIFE 1-800-523-5065 Aetna Life Insurance P.O. Box 14548 Lexington, KY 40512-4548 DISABILITY For Short Term Disability Only 1-866-326-1380

Easy steps to renew your coverage

Florida renewal instructions

For 2 – 50 eligible employees

Effective March 1, 2012

14.02.991.1-FL (1/12)

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. Those companies include Aetna Health Inc., Aetna Health Insurance Company and Aetna Life Insurance Company (Aetna).2

Aetna makes the renewal process easy

It’s renewal time, with Aetna

Dear Valued Employer:

Thank you for choosing Aetna for your employee benefits. We value your business and appreciate your trust in us to protect you and your employees’ assets.

This booklet is your guide for current and new plan information and outlines the renewal process. If you are pleased with your current plan(s) and would like to renew on the plan that most closely matches the in force plan(s) — the renewal process is complete and your coverage will automatically renew before its effective date.

In order to comply with the Patient Protection and Affordable Care Act (PPACA) as well as make improvements that drive value as your health benefits carrier, we’ve modified some plans to introduce new plans that broaden your options with regard to price.

Aetna — The Health of Business

Aetna is committed to helping employers build healthy businesses. In today’s rapidly changing economy, we recognize the need for less expensive, less complex health plan choices. Now, Aetna offers a variety of newly streamlined medical and dental benefits and insurance plans to provide more affordable options and to help simplify plan selection and administration.

Now Aetna offers Consumer Flex Choice to groups with four or more eligible employees. It allows you to select as many plans from the portfolio as meets your group’s specific needs. With Consumer Flex Choice, you control expenses while providing employees superior health benefits coverage. And your employees will have access to care from one of Florida’s most solid provider networks.

In addition, Aetna offers you corporate buying power through Aetna’s Resource Connection, which features discounted goods and services. While not insurance, these discounts can help you save on office supplies, HR support, payroll, technology assistance and more.

If you have questions or need additional information, please contact your broker or Aetna at 1-888-422-2128. We understand you have a choice of carriers. Thank you for placing your confidence with Aetna.

Sincerely,

Sherry BakerFlorida Head of SalesAetna

3

Contact informationAetna Small Group Broker and General Agents

BROKER SERVICES

1-888-422-2128 phone 1-800-793-2304 fax

Choose the following numbers, when prompted, to access the information you need:

1 Claims Questions2 Billing or Eligibility3 Products or Services4 Underwriting or Rating Department5 Sales Support (Broker Liaisons, supply

requests, and other questions)6 Licensing and Appointments or

Commissions

[email protected]

New Business Quoting

ProducerWorld>SmallGroupBusiness>Quoting

E-mail: [email protected]: 1-800-704-1260

Prescreen RequestsE-mail: [email protected]: 1-888-648-5015

Sold Case SubmissionE-mail: [email protected]

Overnight DeliveryAetna New Business Underwriting841 Prudential Drive, F602Jacksonville, FL 32207

Renewal Business Underwriting

Aetna Small Group Renewal841 Prudential Drive, F390Jacksonville, FL 32207

E-mail: [email protected]: 1-800-793-2304

E.Technical Assistance Line

1-800-225-3375 Monday – Friday7 a.m. – 9 p.m. ET

Choose the following numbers, when prompted, to access the information you need:

Aetna Navigator®

(Our member website)Prompt 11 Assistance with registration2 Assistance with password, user name or

other website or technical assistance

Producer World®

Prompt 41 Assistance with password or user name2 Assistance with registration3 Access assistance4 All other website or technical assistance

EMPLOYER SERVICES

1-888-422-2128

Billing

For premium remittance and lockbox information, see customer bill or please contact the Employer Services toll-free number above.

Enrollment

For enrollment additions, changes, terms:Fax: [email protected]

or mail to:

Aetna Plan Sponsor ServicesP.O. Box 44129Jacksonville, FL 32231

eEnrollment Technical Support

1-866-910-9895

Brokers can access eEnrollment atwww.aetna.com/enroll.

4

For member benefit questions or claims inquiries

MEDICAL

For Aetna HMO or QPOS® Plans1-888-702-3862

AetnaP.O. Box 14079Lexington, KY 40512-4079

For Aetna PPO, Consumer-Directed Health or Aetna Indemnity Plans1-888-802-3862, Prompt 1

AetnaP.O. Box 981204El Paso, TX 79998-1204

DENTAL

1-877-238-6200Prompt 1 (Dental Plan Member)Prompt 2 (Dental Care Provider)

AetnaP.O. Box 14094Lexington, KY 40512-4066

LIFE

1-800-523-5065

Aetna Life InsuranceP.O. Box 14548Lexington, KY 40512-4548

DISABILITY

For Short Term Disability Only 1-866-326-1380

For Short Term Disability with FMLA 1-866-326-1379

Fax 1-866-667-1987

Aetna Life InsuranceP.O. Box 14560Lexington, KY 40512-4650

PHARMACY

1-800-AETNA RX (1-800-238-6279)Prompt 2 (Member or calling on behalf of a member)

Aetna Pharmacy ManagementP.O. Box 398106Minneapolis, MN 55439-8106

Mail-Order Drug

1-866-612-3862

Ordering AddressAetna Rx Home DeliveryP.O. Box 417019Kansas City, MO 64179-9892

To track and order Rx refills:www.aetnarxhomedelivery.com

OTHER PROGRAMS

Aetna VisionSM discount program

1-800-793-8616 Call for closest eye care provider

Informed Health® Line

1-800-556-1555 24-Hour Nurse Help Line

Aetna Behavioral Health 1-800-424-5679

For Aetna Natural Products and ServicesSM, Aetna FitnessSM program, DocFind® directory, member website and other information, visit www.aetna.com

Visit your personal self-service member website online

The Aetna Navigator®, our secure member website, is available 24 hours a day, 7 days a week. Members may use it to perform common transactions involving Aetna medical, dental, prescription drug or flexible spending account (FSA) plans. They can send a secure e-mail to Aetna Member Services, access claims, who’s covered, and general health information as well as decision-support tools. Log on to the Aetna Navigator site www.aetna.com.

Member Services

5

6

How to renew your Aetna health plans

Complete all items in full and send to us so we receive it no later than the day before the requested effective date.

Submit Dental and Life adds 15 days before the requested effective date.

Mail any correspondence to:

Aetna 841 Prudential Drive F390 Jacksonville, FL 32207

To renew to the plan that most closely matches your current plan(s) —The renewal process is complete for you. Your benefits will change to “renewal” plan(s) on the effective date.

The selected “renewal” plan(s) has been chosen as it most closely matches your current benefit(s). Please review plan documents for details on changes that apply to “renewal” plan(s).

To renew your “renewal” plan(s) AND select an additional alternate plan(s) — n Please check off the “Renewal” plan

and also check off any “Alternate” plans you’d like to add on the Plan Sponsor Signature Page in your renewal packet and fax it to 1-800-793-2304 or e-mail to [email protected].

n Please submit a letter or list of employees to identify the correct plan selection of all employees.

To move to an “Alternate” plan(s) — n Please check off any “Alternate” plans

you’d like to add on the Plan Sponsor Signature Page in your renewal packet and fax it to 1-800-793-2304 or e-mail to [email protected].

n Enrollment applications should be provided for any new enrollees or those adding or removing dependents.

n Employees moving plans within the same platform will not need to submit an Employee Change of Coverage Form.

n Please submit a letter or list of employees to identify the correct plan selection of all employees.

7

2012 Summary comparison Aetna is always looking to enhance our health care solutions to better serve you. Our goal is to provide flexible, affordable health benefits that align with your company’s objectives.

Please refer to the list below for an at-a-glance view of your 2012 options. This is a partial description of plans and benefits available; for more information, refer to the specific plan design summary. The dollar amount copayments indicate what the member is required to pay and the percentage copayments indicate what Aetna is required to pay unless otherwise noted. You may select any plan available in our new portfolio, but if you do not actively change your plan, you will be assigned to the “Renewal Plan” shown in this guide.

7

YOUR CURRENT PLAN YOUR RENEWAL PLAN CHANGES

HMO GK 1914 compared to HNOnly 12-2000-70 See page 8

HMO GK 1917S compared to HNOnly 12-10K-100S See page 9

HMO OA 1900 compared to HNOnly 12-1500-COMPASS See page 10

HMO OA 1902 compared to HNOnly 12-0-100 See page 11







HMO OA 1916 compared to HNOnly 12-3000A-50 See page 18

HMO OA 1917 compared to HNOnly 12-10K-100 See page 19

HMO OA 1917S compared to HNOnly 12-10K-100S See page 20



HMO OA 1936 (HDHP) compared to HNOnly 12-10K-100 See page 23

POS OA 1902 compared to HNOnly 12-0-100 See page 24

POS OA 1911 compared to HNOption 12-1000-80 See page 25





POS OA 1935 (HDHP) compared to HNOption 12-2500-80HSA See page 30

POS OA 1936 (HDHP) compared to HNOnly 12-10K-100 See page 31

MC OA 1911 compared to MC OA 12-1000-80 See page 32



MC OA 1917S compared to MC OA 12-10K-100S See page 35


MC OA 1935 (HDHP) compared to MC OA 12-2500-80HSA See page 37

SUMMARY OF PLANS AVAILABLE ON 3/1/2012 FOR NEW AND RENEWING BUSINESS See page 38

Plan changes effective March 1, 2012

8

Aetna Plan Options Current Plan Renewal Plan Suggested Alternate

PLAN NAME HMO GK 1914 HNOnly 12-2000-70 HNOnly 12-2000-50

IN-NETWORK SERVICES

Referral Required? Yes No No

Coinsurance 70% 70% 50%

Annual Deductible: Individual/Family

$2,000/$4,000 $2,000/$4,000 $2,000/$4,000

Type of Deductible Embedded Embedded Embedded

Total Annual Out-of-Pocket (OOP): Individual/Family

$7,000/$14,000 $6,000/$12,000 $7,000/$14,000

PREVENTIVE CARE SERVICES

Preventive Care Services $0, ded waived $0, ded waived $0, ded waived

Vision Screening Services (1 time every 24 months)

Not Covered $60, ded waived $50, ded waived

PHYSICIAN SERVICES

PCP Office Visit $25, ded waived $30, ded waived $25, ded waived

Specialist Office Visit $50, ded waived $60, ded waived $50, ded waived

INPATIENT SERVICES

Inpatient Hospital 70%, ded applies 70%, ded applies 50%, ded applies

OUTPATIENT/OTHER SERVICES

Outpatient Lab $0, ded waived $0, ded waived $0, ded waived

Outpatient X-ray $50, ded waived $60, ded waived 50%, ded waived

Complex Imaging 70%, ded applies 70%, ded applies 50%, ded applies

Outpatient Surgery 70%, ded applies 70%, ded applies 50%, ded applies

Emergency Room $250, ded waived $350, ded waived $400, ded waived

Urgent Care $75, ded waived $75, ded waived $75, ded waived

PRESCRIPTION SERVICES

Retail Pharmacy Copay $10/$45/$65 $10/$45/$65 $10/$45/$65

Specialty Rx 25% 20% up to $180 20% up to $180

Preventive Rx Waiver Not applicable Not applicable Not applicable

OUT-OF-NETWORK SERVICES

Coinsurance Not applicable Not applicable Not applicable



HMO GK 1914 compare to HNOnly 12-2000-70

9

HMO GK 1917S compare to HNOnly 12-10K-100S


PLAN NAME HMO GK 1917S HNOnly 12-10K-100S HNOnly 12-10K-80S

IN-NETWORK SERVICES

Referral Required? Yes No No



$10,000/$10,000 $10,000/$10,000 $10,000/$10,000

Type of Deductible Embedded (1x) Embedded (1x) Embedded (1x)


$10,000/$10,000 $10,000/$10,000 $15,000/$15,000





PHYSICIAN SERVICES



INPATIENT SERVICES



Outpatient Lab 100%, ded applies 100%, ded applies 80%, ded applies

Outpatient X-ray 100%, ded applies 100%, ded applies 80%, ded applies



Emergency Room 100%, ded applies 100%, ded applies 80%, ded applies

Urgent Care 100%, ded applies 100%, ded applies 80%, ded applies


Retail Pharmacy Copay $20/$50/$75 $20/$50/$75 $10 generic only







10

HMO OA 1900 (Compass) compare to HNOnly 12-1500 (Compass)


PLAN NAME HMO OA 1900 (Compass) HNOnly 12-1500 (Compass) HNOnly 12-2000-90HSA

IN-NETWORK SERVICES

Referral Required? No No No

Coinsurance 90% / 70% 90%/70% 90%


$1,000/$2,000 $1,500/$3,000 $2,000/$4,000

Type of Deductible Embedded Embedded Non-Embedded


$4,000/$8,000 $4,000/$8,000 $4,000/$8,000




$0, ded waived $0, ded waived $0, ded waived

PHYSICIAN SERVICES

PCP Office Visit $25, ded waived $25, ded waived 90%, ded applies

Specialist Office Visit 70%, ded applies 70%, ded applies 90%, ded applies

INPATIENT SERVICES

Inpatient Hospital 90% after $500/day, ded applies 90% after $500 copay, ded applies 90%, ded applies





Outpatient Surgery 90% after $250, ded applies 90% after $250 copay, ded applies 90%, ded applies




Retail Pharmacy Copay $5/$40/$60 $5/$40/$60 $20/$50/$75 ded applies


Preventive Rx Waiver Not applicable Not applicable Ded waived for certain Preventive Rx





11

HMO OA 1902 compare to HNOnly 12-0-100


PLAN NAME HMO OA 1902 HNOnly 12-0-100 HNOnly 12-1000-80

IN-NETWORK SERVICES


Coinsurance N/A N/A 80%


N/A N/A $1,000/$2,000

Type of Deductible N/A Embedded Embedded


$3,000/$6,000 $3,000/$6,000 $3,000/$6,000


Preventive Care Services $0 $0 $0, ded waived


Not Covered $50 $50, ded waived

PHYSICIAN SERVICES

PCP Office Visit $20 $25 $25, ded waived

Specialist Office Visit $50 $50 $50, ded waived

INPATIENT SERVICES

Inpatient Hospital $500/day, days 1-4 $500/day, days 1-4 80%, ded applies


Outpatient Lab $0 $0 $0, ded waived

Outpatient X-ray $50 $50 $50, ded waived

Complex Imaging 70% 70% 80%, ded applies

Outpatient Surgery $500 $500 80%, ded applies

Emergency Room $250 $250 $300, ded waived

Urgent Care $75 $75 $75, ded waived









12




IN-NETWORK SERVICES


Coinsurance N/A 80% 80%


N/A $1,000/$2,000 $1,500/$3,000

Type of Deductible N/A Embedded Embedded


$5,000/$10,000 $3,000/$6,000 $4,000/$8,000


Preventive Care Services $0 $0, ded waived $0, ded waived



PHYSICIAN SERVICES

PCP Office Visit $35 $25, ded waived $25, ded waived

Specialist Office Visit $70 $50, ded waived $50, ded waived

INPATIENT SERVICES

Inpatient Hospital $1000/day, days 1-3 80%, ded applies 80%, ded applies


Outpatient Lab $0 $0, ded waived $0, ded waived

Outpatient X-ray $70 $50, ded waived $50, ded waived

Complex Imaging $500 80%, ded applies 80%, ded applies

Outpatient Surgery $1000 80%, ded applies 80%, ded applies

Emergency Room $300 $300, ded waived $300, ded waived

Urgent Care $150 $75, ded waived $75, ded waived









13




IN-NETWORK SERVICES




$500/$1,000 $1,000/$2,000 $2,000/$6,000

Type of Deductible Embedded Embedded 3X


$4,500/$9,000 $3,000/$6,000 $2,000/$6,000





PHYSICIAN SERVICES



INPATIENT SERVICES




Outpatient X-ray $50, ded waived $50, ded waived $50, ded waived













14




IN-NETWORK SERVICES




$1,000/$2,000 $1,000/$2,000 $1,500/$3,000



$4,000/$8,000 $3,000/$6,000 $4,000/$8,000





PHYSICIAN SERVICES



INPATIENT SERVICES

















15




IN-NETWORK SERVICES




$1,500/$3,000 $1,500/$3,000 $2,000/$4,000



$4,500/$9,000 $5,000/$10,000 $6,000/$12,000





PHYSICIAN SERVICES



INPATIENT SERVICES

















16




IN-NETWORK SERVICES




$2,000/$4,000 $2,500/$5,000 $2,000/$4,000



$7,000/$14,000 $5,000/$10,000 $7,000/$14,000





PHYSICIAN SERVICES



INPATIENT SERVICES




Outpatient X-ray $50, ded waived $60, ded waived 50%, ded waived













17



PLAN NAME HMO OA 1915 HNOnly 12-2000-50 HNOnly 12-3000A-50

IN-NETWORK SERVICES




$2,000/$4,000 $2,000/$4,000 $3,000/$6,000



$7,000/$14,000 $7,000/$14,000 $9,000/$18,000





PHYSICIAN SERVICES



INPATIENT SERVICES




Outpatient X-ray 50%, ded waived 50%, ded waived 50%, ded applies













18

HMO OA 1916 compare to HNOnly 12-3000A-50


PLAN NAME HMO OA 1916 HNOnly 12-3000A-50 HNOnly 12-3000B-50

IN-NETWORK SERVICES




$3,000/$6,000 $3,000/$6,000 $3,000/$6,000



$9,000/$18,000 $9,000/$18,000 $9,000/$18,000





PHYSICIAN SERVICES



INPATIENT SERVICES




Outpatient X-ray 50%, ded waived 50%, ded applies 50%, ded applies



Emergency Room $250, ded waived $400, ded waived 50%, ded applies

Urgent Care $100, ded waived $100, ded waived 50%, ded applies









19

HMO OA 1917 compare to HNOnly 12-10K-100


PLAN NAME HMO OA 1917 HNOnly 12-10K-100 HNOnly 12-10K-80

IN-NETWORK SERVICES




$10,000/$10,000 $10,000/$10,000 $10,000/$10,000



$10,000/$10,000 $10,000/$10,000 $15,000/$15,000





PHYSICIAN SERVICES



INPATIENT SERVICES

















20

HMO OA 1917S compare to HNOnly 12-10K-100S


PLAN NAME HMO OA 1917S HNOnly 12-10K-100S HNOnly 12-10K-80S

IN-NETWORK SERVICES




$10,000/$10,000 $10,000/$10,000 $10,000/$10,000



$10,000/$10,000 $10,000/$10,000 $15,000/$15,000





PHYSICIAN SERVICES



INPATIENT SERVICES

















21




IN-NETWORK SERVICES




$2,000/$6,000 $2,000/$6,000 $3,000/$9,000

Type of Deductible 3X 3X 3X


$2,000/$6,000 $2,000/$6,000 $3,000/$9,000





PHYSICIAN SERVICES



INPATIENT SERVICES

















22




IN-NETWORK SERVICES




$3,000/$9,000 $3,000/$9,000 $5,000/$15,000



$3,000/$9,000 $3,000/$9,000 $5,000/$15,000





PHYSICIAN SERVICES



INPATIENT SERVICES

















23

HMO OA 1936 (HDHP) compare to HNOnly 12-10K-100


PLAN NAME HMO OA 1936 (HDHP) HNOnly 12-10K-100 HNOnly 12-10K-80

IN-NETWORK SERVICES




$5,950/$11,900 $10,000/$10,000 $10,000/$10,000

Type of Deductible Non-Embedded Embedded (1x) Embedded (1x)


$5,950/$11,900 $10,000/$10,000 $15,000/$15,000





PHYSICIAN SERVICES

PCP Office Visit 100%, ded applies $35, ded waived $35, ded waived


INPATIENT SERVICES










Retail Pharmacy Copay Discount card only $20/$50/$75 $10 generic only

Specialty Rx N/A 20% up to $225 20% up to $225

Preventive Rx Waiver N/A Not applicable Not applicable





24

POS OA 1902 compare to HNOnly 12-0-100


PLAN NAME POS OA 1902 HNOnly 12-0-100 HNOption 12-2000-100

IN-NETWORK SERVICES


Coinsurance N/A N/A 100%


N/A N/A $2,000/$6,000

Type of Deductible N/A Embedded 3X


$3,000/$6,000 $3,000/$6,000 $2,000/$6,000


Preventive Care Services $0 $0 $0, ded waived


Not Covered $50 $50, ded waived

PHYSICIAN SERVICES

PCP Office Visit $20 $25 $25, ded waived

Specialist Office Visit $50 $50 $50, ded waived

INPATIENT SERVICES

Inpatient Hospital $500/day, days 1-4 $500/day, days 1-4 100%, ded applies


Outpatient Lab $0 $0 $0, ded waived

Outpatient X-ray $50 $50 $50, ded waived

Complex Imaging 70% 70% 100%, ded applies

Outpatient Surgery $500 $500 100%, ded applies

Emergency Room $250 $250 $300, ded waived

Urgent Care $75 $75 $75, ded waived






Coinsurance 50% Not applicable 70%


$2,000/$4,000 $3,000/$9,000


$8,000/$16,000 $6,000/$18,000

25

POS OA 1911 compare to HNOption 12-1000-80


PLAN NAME POS OA 1911 HNOption 12-1000-80 HNOption 12-2000-100

IN-NETWORK SERVICES




$500/$1,000 $1,000/$2,000 $2,000/$6,000

Type of Deductible Embedded Embedded 3X


$4,500/$9,000 $3,000/$6,000 $2,000/$6,000





PHYSICIAN SERVICES



INPATIENT SERVICES












Preventive Rx Waiver No Not applicable Not applicable




$2,000/$4,000 $2,000/$4,000 $3,000/$9,000


$8,000/$16,000 $6,000/$12,000 $6,000/$18,000

26




IN-NETWORK SERVICES




$1,000/$2,000 $1,000/$2,000 $1,500/$3,000



$4,000/$8,000 $3,000/$6,000 $4,000/$8,000





PHYSICIAN SERVICES



INPATIENT SERVICES
















$2,000/$4,000 $2,000/$4,000 $2,000/$4,000


$8,000/$16,000 $6,000/$12,000 $6,000/$12,000

27




IN-NETWORK SERVICES




$1,500/$3,000 $1,500/$3,000 $2,000/$4,000



$4,500/$9,000 $5,000/$10,000 $6,000/$12,000





PHYSICIAN SERVICES



INPATIENT SERVICES
















$2,000/$4,000 $2,000/$4,000 $3,000/$6,000


$8,000/$16,000 $8,000/$16,000 $10,000/$20,000

28




IN-NETWORK SERVICES




$1,500/$4,500 $2,000/$6,000 $1,500/$3,000

Type of Deductible 3X 3X Embedded


$1,500/$4,500 $2,000/$6,000 $4,000/$8,000





PHYSICIAN SERVICES



INPATIENT SERVICES
















$2,000/$6,000 $3,000/$9,000 $2,000/$4,000


$5,000 /$15,000 $6,000/$18,000 $6,000/$12,000

29




IN-NETWORK SERVICES




$2,000/$6,000 $2,000/$6,000 $3,000/$9,000



$2,000/$6,000 $2,000/$6,000 $3,000/$9,000




Not Covered Not Covered $60, ded waived

PHYSICIAN SERVICES



INPATIENT SERVICES
















$3,000/$9,000 $3,000/$9,000 $4,000/$12,000


$6,000/$18,000 $6,000/$18,000 $6,000/$18,000

30

POS OA 1935 (HDHP) compare to HNOption 12-2500-80HSA


PLAN NAME POS OA 1935 (HDHP) HNOption 12-2500-80HSA HNOnly 12-3000-80HSA

IN-NETWORK SERVICES




$2,500/$5,000 $2,500/$5,000 $3,000/$6,000

Type of Deductible Non-Embedded Non-Embedded Non-Embedded


$5,000/$10,000 $5,000/$10,000 $6,000/$12,000





PHYSICIAN SERVICES

PCP Office Visit 80%, ded applies 80%, ded applies 80%, ded applies


INPATIENT SERVICES










Retail Pharmacy Copay $5/$40/$60 $20/$50/$75 ded applies $20/$50/$75 ded applies


Preventive Rx Waiver Not applicable Ded waived for certain Preventive Rx Ded waived for certain Preventive Rx


Coinsurance 70% 50% Not applicable


$3,000/$6,000 $3,000/$6,000


$6,000/$12,000 $6,000/$12,000

31

POS OA 1936 (HDHP) compare to HNOnly 12-10K-100


PLAN NAME POS OA 1936 (HDHP) HNOnly 12-10K-100 HNOnly 12-10K-80

IN-NETWORK SERVICES




$5,950/$11,900 $10,000/$10,000 $10,000/$10,000

Type of Deductible Non-Embedded Embedded (1x) Embedded (1x)


$5,950/$11,900 $10,000/$10,000 $15,000/$15,000





PHYSICIAN SERVICES

PCP Office Visit 100%, ded applies $35, ded waived $35, ded waived


INPATIENT SERVICES










Retail Pharmacy Copay Discount card only $20/$50/$75 $10 generic only

Specialty Rx Not applicable 20% up to $225 20% up to $225



Coinsurance 70% Not applicable Not applicable


$7,000/$14,000


$10,000 /$20,000

32

MC OA 1911 compare to MC OA 12-1000-80


PLAN NAME MC OA 1911 MC OA 12-1000-80 MC OA 12-1500-80

IN-NETWORK SERVICES




$500/$1,000 $1,000/$2,000 $1,500/$3,000



$4,500/$9,000 $3,000/$6,000 $4,000/$8,000





PHYSICIAN SERVICES



INPATIENT SERVICES
















$2,000/$4,000 $2,000/$4,000 $2,000/$4,000


$8,000/$16,000 $6,000/$12,000 $6,000/$12,000

33




IN-NETWORK SERVICES




$1,000/$2,000 $1,000/$2,000 $1,500/$3,000



$4,000/$8,000 $3,000/$6,000 $4,000/$8,000





PHYSICIAN SERVICES



INPATIENT SERVICES
















$2,000/$4,000 $2,000/$4,000 $2,000/$4,000


$8,000/$16,000 $6,000/$12,000 $6,000/$12,000

34




IN-NETWORK SERVICES




$1,500/$3,000 $1,500/$3,000 $2,000/$4,000



$4,500/$9,000 $5,000/$10,000 $6,000/$12,000





PHYSICIAN SERVICES



INPATIENT SERVICES
















$2,000/$4,000 $2,000/$4,000 $3,000/$6,000


$8,000/$16,000 $8,000/$16,000 $10,000/$20,000

35

MC OA 1917S compare to MC OA 12-10K-100S

Aetna Plan Options Current Plan Renewal Plan Suggested Alternate*

PLAN NAME MC OA 1917S MC OA 12-10K-100S MC OA 12-10K-100C

IN-NETWORK SERVICES




$10,000/$10,000 $10,000/$10,000 $10,000/$10,000



$10,000/$10,000 $10,000/$10,000 $10,000/$10,000





PHYSICIAN SERVICES



INPATIENT SERVICES



Outpatient Lab 100%, ded applies 100%, ded applies $25, ded waived

Outpatient X-ray 100%, ded applies 100%, ded applies $75, ded waived

Complex Imaging 100%, ded applies 100%, ded applies $400, ded waived



Urgent Care 100%, ded applies 100%, ded applies $75, ded waived








$10,000/$10,000 $10,000/$10,000 $10,000/$10,000


$15,000 / $30,000 $15,000 / $30,000 $15,000 / $30,000

*Note: this plan is not a lower cost plan than Renewal Plan.

36



PLAN NAME MC OA 1922 HNOption 12-3000-100 MC OA 12-1500-70

IN-NETWORK SERVICES




$2,000/$6,000 $3,000/$9,000 $1,500/$3,000

Type of Deductible 3X 3X Embedded


$2,000/$6,000 $3,000/$9,000 $5,000/$10,000





PHYSICIAN SERVICES



INPATIENT SERVICES
















$3,000/$9,000 $4,000/$12,000 $2,000/$4,000


$6,000/$18,000 $6,000/$18,000 $8,000/$16,000

37

MC OA 1935 (HDHP) compare to MC OA 12-2500-80HSA


PLAN NAME MC OA 1935 (HDHP) MC OA 12-2500-80HSA MC OA 12-3000-80HSA

IN-NETWORK SERVICES




$2,500/$5,000 $2,500/$5,000 $3,000/$6,000

Type of Deductible Non-Embedded Non-Embedded Non-Embedded


$5,000/$10,000 $5,000/$10,000 $6,000/$12,000





PHYSICIAN SERVICES

PCP Office Visit 80%, ded applies 80%, ded applies 80%, ded applies


INPATIENT SERVICES










Retail Pharmacy Copay $5/$40/$60 $20/$50/$75 ded applies $20/$50/$75 ded applies


Preventive Rx Waiver Not applicable Ded waived for certain Preventive Rx Ded waived for certain Preventive Rx




$3,000/$6,000 $3,000/$6,000 $6,000/$12,000


$6,000/$12,000 $6,000/$12,000 $10,000/$20,000

38

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39

P L A N VA L U E

PLAN NAME $ $$ $$$ $$$$

HNOnly 12-10K-80

HNOnly 12-10K-80S

HNOnly 12-10K-100

HNOnly 12-10K-100S

HNOnly 12-10K-100C

HNOnly 12-3000-80HSA

MC OA 12-10K-100S

HNOnly 12-5000-50


HNOnly 12-3000B-50

HNOption 12-2500-80HSA

HNOnly 12-3000A-50

MC OA 12-10K-100C

MC OA 12-3000-80HSA


MC OA 12-2500-80HSA

HNOnly 12-5000-100

HNOnly 12-2000-50


HNOnly 12-1500-COMPASS

MC OA 12-3000A-50

HNOnly 12-2500-70

HNOnly 12-2000-70

HNOnly 12-1500-70

HNOption 12-2000-70

HNOnly 12-3000-100

HNOnly 12-2000-80

MC OA 12-1500-80HSA

HNOnly 12-1500-80

HNOption 12-1500-70

HNOption 12-3000-100

HNOption 12-2000-80

MC OA 12-2500-70

HNOnly 12-2000-100

MC OA 12-2000-70

HNOption 12-1500-80

HNOnly 12-1000-80

MC OA 12-1500-70

HNOption 12-2000-100

MC OA 12-3000-100

MC OA 12-2000-80

HNOption 12-1000-80

MC OA 12-1500-80

MC OA 12-1000-80

HNOnly 12-0-100

HNOnly - HMO Open Access style plan

HNOption - POS Open Access style Plan

MC OA - Managed Choice Open Access Plan

Limitations and exclusions

Medical

These plans do not cover all health care expenses and includes exclusions and limitations. Members should refer to their plan documents to determine which health care services are covered and to what extent. The following is a partial list of services and supplies that are generally not covered.

All medical and hospital services not specifically covered or that are limited or excluded by your plan documents, including costs of services before coverage begins and after coverage terminates.

�Cosmetic surgery

�Custodial care

�Dental care and dental X-rays

�Donor egg retrieval

�Hearing aids

�Home births

� Immunizations for travel or work

� Implantable drugs and certain injectable drugs

� Infertility services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI and other related services unless specifically listed as covered in your plan documents

� Nonmedically necessary services or supplies

�Orthotics

� Over-the-counter medications and supplies

� Radial keratotomy or related procedures

� Reversal of sterilization

� Services for the treatment of sexual dysfunction or inadequacies, including therapy, supplies, or counseling

� Special duty nursing

� Therapy or rehabilitation other than those listed as covered in the plan documents

40

Pre-existing conditions exclusion provisions – all plansThese plans do not immediately cover pre-existing conditions unless the enrollee has creditable prior coverage from another health benefits carrier. A pre-existing conditions exclusion means that if the enrollee has a medical condition before coming to our plan, he or she might have to wait a certain period of time before the plan will provide coverage for that condition. This exclusion applies only to conditions for which medical advice, diagnosis or treatment was recommended or received or for which the individual took prescribed drugs within 180 days.

Generally, this period ends the day before coverage becomes effective. However, if the enrollee was in a waiting period for coverage, the 180-day period ends on the day before the waiting period begins. The exclusion period, if applicable, may last up to 365 days from the first day of coverage or, if the enrollee was in a waiting period, from the first day of the waiting period.

If the enrollee had prior creditable coverage within 63 days immediately before the date enrolled under this plan, then the pre-existing conditions exclusion in the plan, if any, will be waived.

If the individual had no prior creditable coverage within the 63 days prior to the enrollment date (either because of no prior coverage or because there was more than a 63-day gap from the date the prior coverage terminated to the enrollment date), we will apply the plan’s pre-existing exclusion.

In order to reduce or possibly eliminate the exclusion period based on creditable coverage, enrollees should provide us a copy of a Certificate of Creditable Coverage. Enrollees may call Aetna Member Services at 1-800-80-AETNA for help with getting a Certificate of Creditable Coverage from the prior carriers.

The pre-existing conditions exclusion does not apply to pregnancy nor to an individual under the age of 19. For late enrollees, coverage will be delayed until the plan’s next open enrollment; the pre-existing exclusion will be applied from the individual’s effective date of coverage.

41

How are renewal rates calculated?Renewal rates include census characteristics, trends in health care costs, coverage selected (single vs. family), location of employees, your group’s benefits and demographics.

Current medical and pharmacy trend is also an important component of your medical premium. Some of the most significant causes for increases include:n Advances in medical technology

and new drug development n Provider reimbursementsn An aging populationn Increased use of health servicesn Escalating costs of treatment for

serious illnessn Employee contributions — shifting

medical expenses from the public to the private sector

What are participation requirements?Your plan is contingent upon meeting participation guidelines as follows:n Employers with less than four

employees: Enrollment in an Aetna plan must be equal to 100% of total eligible employees excluding valid waivers, such as coverage through a spouse. Waiver forms are required.

n Employers with four to 50 employees: Enrollment in an Aetna plan must be equal to at least 70% of eligible employees excluding valid benefit waivers, such as coverage through a spouse. Waiver forms are required.

Can I get a blended (i.e., composite) rate?n Rating structure for 2-9 eligible

employees will be tabular rates (rates for individual employees based on age, rating area and benefit tier).

n Composite rates are available in Florida for employers with 10 or more eligible employees.

Besides alternative plans presented as part of our proposal, are there additional options that we may consider?If available, Aetna has included a number of lower cost alternative plan designs for your consideration. Generally, the alternative plans listed in your proposal do not require underwriting approval and may represent potential savings versus your current plan design. There are, however, richer plan options from this portfolio that may not be included in your renewal, but would be available for quoting and may require underwriting approval.n Florida now offers Consumer Flex

Choice which will allow an employer to offer as many plans that are available in the portfolio. One person must enroll and remain enrolled in each plan for it to be active.

n Medical rates are guaranteed for a 12-month period.

n If there is an employee on COBRA and the employer moves plans, the former employee has to move as well.

n The group must have four or more eligible employees for Consumer Flex Choice.

How much may our employees contribute to premiums?You may choose to have your employees pay a portion of the medical premium up to a maximum of 50% of the employee-only rate.

For Consumer Flex Choice, the employer must contribute 50%of the employee-only cost of the lowest cost plan in the portfolio (even if the employer does not select that plan).

How much may our employees’ dependents contribute to premiums?You may choose to have your employees pay all or part of the premium cost for their dependent coverage.

Are new ID cards issued at renewal time?If you are covered under a new plan, new ID cards will be issued. ID cards will be sent directly to enrollee’s home address.

Frequently asked questions

42

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 or dental services and, therefore, cannot guarantee any results or outcomes. Consult the plan documents (Schedule of Benefits, Evidence of Coverage, Group Agreement, Group Insurance Certificate, 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 geographic service area. Participating providers and vendors are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. 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. Certain primary care providers are affiliated with integrated delivery systems or other provider groups (such as independent practice associations and physician-hospital organizations), and members who select these providers will generally be referred to specialists and hospitals within those systems or groups. However, if a system or group does not include a provider qualified to meet a member’s medical needs, the member may request to have services provided by non-system or non-group providers. Member’s request will be reviewed and will require prior authorization from the system or group and/or Aetna to be a covered service. Aetna assumes no responsibility for any circumstances arising out of the use, misuse, interpretation or application of any information supplied by Aetna InteliHealth®. Information supplied by InteliHealth 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. Informed Health® Line nurses cannot diagnose, prescribe, or give medical advice. Specific questions should be addressed to your doctor. Aetna Natural Products and ServicesSM, Aetna VisionSM and Aetna FitnessSM discount programs are rate-access programs and may be in addition to any plan benefits. Program providers are solely responsible for the products and services provided thereunder. Aetna does not endorse any vendor, product, or service associated with these programs. Discounts offered hereunder are not insurance. Aetna may receive a percentage of the fee paid to the discount vendor.Some benefits are subject to limitations or visit maximums. Members and providers may be required to precertify, or obtain prior approval of coverage, for certain services such as non-emergency inpatient hospital care. Depending upon the plan selected, new prescription drugs not yet reviewed by our medication review committee are either available at the highest copay under the plans with an open formulary, or excluded from coverage unless a medical exception is obtained under plans that use a closed formulary. They may also be subject to precertification or step therapy. Non-prescription drugs and drugs in the Limitations and Exclusions section of the plan documents (received upon enrollment) are not covered, and medical exceptions are not available for them.

©2012 Aetna Inc.14.02.991.1-FL (1/12)

Documents

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