78Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

FL

Florida

18.25.029.1-125

79Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

Service areaFlorida: Orange, Osceola, Seminole

Market highlights• $0 monthly premium and no in-network

deductibles• Comprehensive dental benefits• Eyewear, hearing aid and over-the-counter (OTC)

benefits• SilverSneakers® fitness membership• 24/7 Nurse Health Line• Large pharmacy network, rich drug formulary and

coverage in the gap• Dual-Eligible Special Needs Plans (D-SNPs) for

those covered by both Medicare and Medicaid

Why sell our plansAetna’s portfolio of Medicare Advantage plans has been carefully designed to remain a top competitor across Florida by promoting health and wellness through our Aetna and Coventry products. We offer $0 monthly premium HMO, D-SNP, POS and PPO plans that include doctor, hospital and prescription drug coverage to fit individual lifestyles and budgets.

Strong networkComprehensive network of participating doctors, hospitals and pharmacies members have come to know and trust.

Number of Medicare eligiblesFL Central: 301,494

FL Central

18.25.029.1-125

80Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

FL CentralFlorida: Orange, Osceola, Seminole

Aetna Medicare Choice Plan (HMO-POS) (H1609-028)

Aetna Medicare Select Plan (HMO) (H1609-024)

Monthly premium $0 $0

PCP in network $0 $0

Specialist in network $45 $30

Inpatient hospital in network $375 per day, days 1-4; $0 per day, days 5-90 $200 per day, days 1-5; $0 per day, days 6-90

Out-of-pocket maximum in network $6,700 $6,700

Out-of-pocket maximum combined $10,000 N/A

Deductible $500 per year for out-of-network services $0

Prescription drugs (preferred pharmacies/standard pharmacies)All prescription copays are representative of a one-month supply.

Prescription deductible $200 $0

Tier 1 — Preferred generic $0/$10 $0/$10

Tier 2 — Generic $0/$15 $5/$15

Tier 3 — Preferred brand $42/$47 $42/$47

Tier 4 — Nonpreferred drug $100/$100 $100/$100

Tier 5 — Specialty 29%/29% 33%/33%

This plan includes Tier 1 and Tier 2 prescription gap coverage.

18.25.029.1-125

81Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

Service areaFlorida: Clay, Duval, Marion, St. Johns

Market highlights• $0 monthly premium and no in-network

deductibles• Comprehensive dental benefits• Eyewear, hearing aid and over-the-counter (OTC)

benefits• SilverSneakers® fitness membership• 24/7 Nurse Health Line• Large pharmacy network, rich drug formulary and

coverage in the gap• Dual-Eligible Special Needs Plans (D-SNPs) for

those covered by both Medicare and Medicaid.

Why sell our plansAetna offers customers a range of Medicare plans to fit their lifestyles, health needs and budgets. Our plans include medical, hospital and prescription drug coverage plus access to a wide network of doctors. Our HMO plan features a $0 premium for medical and prescription drug coverage in one simple plan, plus extra benefits like SilverSneakers® fitness benefit.

Strong networkComprehensive network of participating doctors, hospitals and pharmacies members have come to know and trust.

Number of Medicare eligiblesFL North: 346,591

FL North

New

18.25.029.1-125

82Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

FL NorthFlorida: Clay, Duval, Marion, St. Johns

Aetna Medicare Choice Plan (HMO-POS) (H1609-028)

Aetna Medicare Premier Plan (PPO) (H5521-033)

Coventry Medicare Summit Plan (HMO) (H1609-021)

Monthly premium $0 $0 $0

PCP in network $0 $10 $0

Specialist in network $45 $50 $40

Inpatient hospital in network $375 per day, days 1-4; $0 per day, days 5-90

$395 per day, days 1-4; $0 per day, days 5-90

$300 per day, days 1-6; $0 per day, days 7-90

Out-of-pocket maximum in network $6,700 $6,700 $6,700

Out-of-pocket maximum combined $10,000 $10,000 N/A

Deductible $500 per year for out-of-network services

$975 per year for out-of-network services $0

Prescription drugs (preferred pharmacies/standard pharmacies)All prescription copays are representative of a one-month supply.

Prescription deductible $200 $250 $0

Tier 1 — Preferred generic $0/$10 $0/$10 $0/$10

Tier 2 — Generic $0/$15 $0/$15 $0/$15

Tier 3 — Preferred brand $42/$47 $42/$47 $42/$47

Tier 4 — Nonpreferred drug $100/$100 $100/$100 $100/$100

Tier 5 — Specialty 29%/29% 28%/28% 33%/33%

This plan includes Tier 1 and Tier 2 prescription gap coverage.

18.25.029.1-125

83Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

Service areaFlorida: Broward, Miami-Dade, Palm Beach

Market highlights• $0 monthly premium and no in-network

deductibles• Part B premium reduction on some plans• Comprehensive dental benefits• Eyewear, hearing aid and over-the-counter (OTC)

benefits• SilverSneakers® fitness membership• 24/7 Nurse Health Line• Large pharmacy network, rich drug formulary and

coverage in the gap• Dual-Eligible Special Needs Plans (D-SNPs) for

those covered by both Medicare and Medicaid

Why sell our plansAetna offers customers a range of Medicare plans to fit their lifestyles, health needs and budgets. Our plans include medical, hospital and prescription drug coverage plus access to a wide network of doctors. Our HMO plan features a $0 premium for medical and prescription drug coverage in one simple plan, plus extra benefits like SilverSneakers® fitness benefit.

Strong networkComprehensive network of participating doctors, hospitals and pharmacies members have come to know and trust.

Number of Medicare eligiblesFL South: 1,054,298

FL South

18.25.029.1-125

84Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

FL SouthFlorida: Broward

Coventry Medicare Summit Plan (HMO) (H1609-018)

Monthly premium $0

PCP in network $0

Specialist in network $0

Inpatient hospital in network $50 per day, days 1-7; $0 per day, days 8-90

Out-of-pocket maximum in network $6,700

Out-of-pocket maximum combined N/A

Deductible $0

Prescription drugs (preferred pharmacies/standard pharmacies)All prescription copays are representative of a one-month supply.

Prescription deductible $0

Tier 1 — Preferred generic $0/$10

Tier 2 — Generic $0/$15

Tier 3 — Preferred brand $3/$47

Tier 4 — Nonpreferred drug $100/$100

Tier 5 — Specialty 33%/33%

This plan includes Tier 1 and Tier 2 prescription gap coverage.

18.25.029.1-125

85Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

FL SouthFlorida: Broward, Miami-Dade, Palm Beach

Aetna Medicare Choice Plan (HMO-POS) (H1609-028)

Aetna Medicare Premier Plan (PPO) (H5521-033)

Monthly premium $0 $0

PCP in network $0 $10

Specialist in network $45 $50

Inpatient hospital in network $375 per day, days 1-4; $0 per day, days 5-90 $395 per day, days 1-4; $0 per day, days 5-90

Out-of-pocket maximum in network $6,700 $6,700

Out-of-pocket maximum combined $10,000 $10,000

Deductible $500 per year for out-of-network services $975 per year for out-of-network services

Prescription drugs (preferred pharmacies/standard pharmacies)All prescription copays are representative of a one-month supply.

Prescription deductible $200 $250

Tier 1 — Preferred generic $0/$10 $0/$10

Tier 2 — Generic $0/$15 $0/$15

Tier 3 — Preferred brand $42/$47 $42/$47

Tier 4 — Nonpreferred drug $100/$100 $100/$100

Tier 5 — Specialty 29%/29% 28%/28%

This plan includes Tier 1 and Tier 2 prescription gap coverage.

18.25.029.1-125

86Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

FL SouthFlorida: Miami-Dade

Coventry Medicare Summit Plan (HMO) (H1609-016)

Monthly premium $0

PCP in network $0

Specialist in network $0

Inpatient hospital in network $0 per stay

Out-of-pocket maximum in network $3,400

Out-of-pocket maximum combined N/A

Deductible $0

Prescription drugs (preferred pharmacies/standard pharmacies)All prescription copays are representative of a one-month supply.

Prescription deductible $0

Tier 1 — Preferred generic $0/$10

Tier 2 — Generic $0/$15

Tier 3 — Preferred brand $3/$47

Tier 4 — Nonpreferred drug $100/$100

Tier 5 — Specialty 33%/33%

This plan includes Tier 1 and Tier 2 prescription gap coverage.

18.25.029.1-125

87Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

FL SouthFlorida: Palm Beach

Coventry Medicare Summit Plan (HMO) (H1609-020)

Monthly premium $0

PCP in network $0

Specialist in network $35

Inpatient hospital in network $195 per day, days 1-6; $0 per day, days 7-90

Out-of-pocket maximum in network $6,700

Out-of-pocket maximum combined N/A

Deductible $0

Prescription drugs (preferred pharmacies/standard pharmacies)All prescription copays are representative of a one-month supply.

Prescription deductible $0

Tier 1 — Preferred generic $0/$10

Tier 2 — Generic $0/$15

Tier 3 — Preferred brand $42/$47

Tier 4 — Nonpreferred drug $100/$100

Tier 5 — Specialty 33%/33%

This plan includes Tier 1 and Tier 2 prescription gap coverage.

18.25.029.1-125

88Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

Service areaFlorida: Charlotte, Lee, Manatee, Sarasota

Market highlights• $0 monthly premium and no in-network

deductibles• Comprehensive dental benefits• Eyewear, hearing aid and over-the-counter (OTC)

benefits• SilverSneakers® fitness membership• 24/7 Nurse Health Line• Large pharmacy network, rich drug formulary and

coverage in the gap• Dual-Eligible Special Needs Plans (D-SNPs) for

those covered by both Medicare and Medicaid.

Why sell our plansAetna offers customers a range of Medicare plans to fit their lifestyles, health needs and budgets. Our plans include medical, hospital and prescription drug coverage plus access to a wide network of doctors. Our HMO plan features a $0 premium for medical and prescription drug coverage in one simple plan, plus extra benefits like SilverSneakers® fitness benefit.

Strong networkComprehensive network of participating doctors, hospitals and pharmacies members have come to know and trust.

Number of Medicare eligiblesFL Southwest: 467,697

FL Southwest

18.25.029.1-125

89Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

FL SouthwestFlorida: Charlotte, Lee, Manatee, Sarasota

Aetna Medicare Premier Plan (PPO) (H5521-033)

Monthly premium $0

PCP in network $10

Specialist in network $50

Inpatient hospital in network $395 per day, days 1-4; $0 per day, days 5-90

Out-of-pocket maximum in network $6,700

Out-of-pocket maximum combined $10,000

Deductible $975 per year for out-of-network services

Prescription drugs (preferred pharmacies/standard pharmacies)All prescription copays are representative of a one-month supply.

Prescription deductible $250

Tier 1 — Preferred generic $0/$10

Tier 2 — Generic $0/$15

Tier 3 — Preferred brand $42/$47

Tier 4 — Nonpreferred drug $100/$100

Tier 5 — Specialty 28%/28%

This plan includes Tier 1 and Tier 2 prescription gap coverage.

18.25.029.1-125

90Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

FL SouthwestFlorida: Charlotte, Manatee, Sarasota

Aetna Medicare Choice Plan (HMO-POS) (H1609-028)

Aetna Medicare Select Plan (HMO) (H1609-025)

Monthly premium $0 $0

PCP in network $0 $0

Specialist in network $45 $35

Inpatient hospital in network $375 per day, days 1-4; $0 per day, days 5-90 $175 per day, days 1-5; $0 per day, days 6-90

Out-of-pocket maximum in network $6,700 $3,400

Out-of-pocket maximum combined $10,000 N/A

Deductible $500 per year for out-of-network services $0

Prescription drugs (preferred pharmacies/standard pharmacies)All prescription copays are representative of a one-month supply.

Prescription deductible $200 $0

Tier 1 — Preferred generic $0/$10 $0/$10

Tier 2 — Generic $0/$15 $0/$15

Tier 3 — Preferred brand $42/$47 $42/$47

Tier 4 — Nonpreferred drug $100/$100 $100/$100

Tier 5 — Specialty 29%/29% 33%/33%

This plan includes Tier 1 and Tier 2 prescription gap coverage.

18.25.029.1-125

91Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

FL SouthwestFlorida: Lee

Aetna Medicare Select Plan (HMO) (H1609-027)

Monthly premium $0

PCP in network $15

Specialist in network $50

Inpatient hospital in network $425 per day, days 1-4; $0 per day, days 5-90

Out-of-pocket maximum in network $6,700

Out-of-pocket maximum combined N/A

Deductible $0

Prescription drugs (preferred pharmacies/standard pharmacies)All prescription copays are representative of a one-month supply.

Prescription deductible $0

Tier 1 — Preferred generic $2/$10

Tier 2 — Generic $5/$15

Tier 3 — Preferred brand $42/$47

Tier 4 — Nonpreferred drug $100/$100

Tier 5 — Specialty 33%/33%

This plan includes Tier 1 and Tier 2 prescription gap coverage.

18.25.029.1-125

92Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

Service areaFlorida: Martin, St. Lucie

Market highlights• $0 monthly premium and no in-network

deductibles• Comprehensive dental benefits• Eyewear, hearing aid and over-the-counter (OTC)

benefits• SilverSneakers® fitness membership• 24/7 Nurse Health Line• Large pharmacy network, rich drug formulary and

coverage in the gap• Dual-Eligible Special Needs Plans (D-SNPs) for

those covered by both Medicare and Medicaid

Why sell our plansAetna offers customers a range of Medicare plans to fit their lifestyles, health needs and budgets. Our plans include medical, hospital and prescription drug coverage plus access to a wide network of doctors. Our HMO plan features a $0 premium for medical and prescription drug coverage in one simple plan, plus extra benefits like SilverSneakers® fitness benefit.

Strong networkComprehensive network of participating doctors, hospitals and pharmacies members have come to know and trust.

Number of Medicare eligiblesFL Treasure Coast: 117,362

FL Treasure Coast

18.25.029.1-125

93Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

FL Treasure CoastFlorida: Martin

Coventry Medicare Summit Plan (HMO) (H1609-020)

Monthly premium $0

PCP in network $0

Specialist in network $35

Inpatient hospital in network $195 per day, days 1-6; $0 per day, days 7-90

Out-of-pocket maximum in network $6,700

Out-of-pocket maximum combined N/A

Deductible $0

Prescription drugs (preferred pharmacies/standard pharmacies)All prescription copays are representative of a one-month supply.

Prescription deductible $0

Tier 1 — Preferred generic $0/$10

Tier 2 — Generic $0/$15

Tier 3 — Preferred brand $42/$47

Tier 4 — Nonpreferred drug $100/$100

Tier 5 — Specialty 33%/33%

This plan includes Tier 1 and Tier 2 prescription gap coverage.

18.25.029.1-125

94Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

FL Treasure CoastFlorida: Martin, St. Lucie

Aetna Medicare Choice Plan (HMO-POS) (H1609-028)

Aetna Medicare Premier Plan (PPO) (H5521-033)

Monthly premium $0 $0

PCP in network $0 $10

Specialist in network $45 $50

Inpatient hospital in network $375 per day, days 1-4; $0 per day, days 5-90 $395 per day, days 1-4; $0 per day, days 5-90

Out-of-pocket maximum in network $6,700 $6,700

Out-of-pocket maximum combined $10,000 $10,000

Deductible $500 per year for out-of-network services $975 per year for out-of-network services

Prescription drugs (preferred pharmacies/standard pharmacies)All prescription copays are representative of a one-month supply.

Prescription deductible $200 $250

Tier 1 — Preferred generic $0/$10 $0/$10

Tier 2 — Generic $0/$15 $0/$15

Tier 3 — Preferred brand $42/$47 $42/$47

Tier 4 — Nonpreferred drug $100/$100 $100/$100

Tier 5 — Specialty 29%/29% 28%/28%

This plan includes Tier 1 and Tier 2 prescription gap coverage.

18.25.029.1-125

95Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

FL Treasure CoastFlorida: St. Lucie

Coventry Medicare Summit Plan (HMO) (H1609-021)

Monthly premium $0

PCP in network $0

Specialist in network $40

Inpatient hospital in network $300 per day, days 1-6; $0 per day, days 7-90

Out-of-pocket maximum in network $6,700

Out-of-pocket maximum combined N/A

Deductible $0

Prescription drugs (preferred pharmacies/standard pharmacies)All prescription copays are representative of a one-month supply.

Prescription deductible $0

Tier 1 — Preferred generic $0/$10

Tier 2 — Generic $0/$15

Tier 3 — Preferred brand $42/$47

Tier 4 — Nonpreferred drug $100/$100

Tier 5 — Specialty 33%/33%

This plan includes Tier 1 and Tier 2 prescription gap coverage.

18.25.029.1-125

96Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

Service areaFlorida: Hillsborough, Pasco, Pinellas, Polk

Market highlights• $0 monthly premium and no in-network

deductibles• Comprehensive dental benefits• Eyewear, hearing aid and over-the-counter (OTC)

benefits• SilverSneakers® fitness membership• 24/7 Nurse Health Line• Large pharmacy network, rich drug formulary and

coverage in the gap• Dual-Eligible Special Needs Plans (D-SNPs) for

those covered by both Medicare and Medicaid

Why sell our plansAetna offers customers a range of Medicare plans to fit their lifestyles, health needs and budgets. Our plans include medical, hospital and prescription drug coverage plus access to a wide network of doctors. Our HMO plan features a $0 premium for medical and prescription drug coverage in one simple plan, plus extra benefits like SilverSneakers® fitness benefit.

Strong networkComprehensive network of participating doctors, hospitals and pharmacies members have come to know and trust.

Number of Medicare eligiblesFL West: 718,606

FL West

18.25.029.1-125

97Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

FL WestFlorida: Hillsborough, Pasco, Pinellas, Polk

Aetna Medicare Premier Plan (PPO) (H5521-033)

Monthly premium $0

PCP in network $10

Specialist in network $50

Inpatient hospital in network $395 per day, days 1-4; $0 per day, days 5-90

Out-of-pocket maximum in network $6,700

Out-of-pocket maximum combined $10,000

Deductible $975 per year for out-of-network services

Prescription drugs (preferred pharmacies/standard pharmacies)All prescription copays are representative of a one-month supply.

Prescription deductible $250

Tier 1 — Preferred generic $0/$10

Tier 2 — Generic $0/$15

Tier 3 — Preferred brand $42/$47

Tier 4 — Nonpreferred drug $100/$100

Tier 5 — Specialty 28%/28%

This plan includes Tier 1 and Tier 2 prescription gap coverage.

18.25.029.1-125

98Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

FL WestFlorida: Hillsborough, Pinellas

Coventry Medicare Summit Plan (HMO) (H1609-020)

Monthly premium $0

PCP in network $0

Specialist in network $35

Inpatient hospital in network $195 per day, days 1-6; $0 per day, days 7-90

Out-of-pocket maximum in network $6,700

Out-of-pocket maximum combined N/A

Deductible $0

Prescription drugs (preferred pharmacies/standard pharmacies)All prescription copays are representative of a one-month supply.

Prescription deductible $0

Tier 1 — Preferred generic $0/$10

Tier 2 — Generic $0/$15

Tier 3 — Preferred brand $42/$47

Tier 4 — Nonpreferred drug $100/$100

Tier 5 — Specialty 33%/33%

This plan includes Tier 1 and Tier 2 prescription gap coverage.

18.25.029.1-125

99Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

FL WestFlorida: Hillsborough, Pinellas, Polk

Aetna Medicare Choice Plan (HMO-POS) (H1609-028)

Monthly premium $0

PCP in network $0

Specialist in network $45

Inpatient hospital in network $375 per day, days 1-4; $0 per day, days 5-90

Out-of-pocket maximum in network $6,700

Out-of-pocket maximum combined $10,000

Deductible $500 per year for out-of-network services

Prescription drugs (preferred pharmacies/standard pharmacies)All prescription copays are representative of a one-month supply.

Prescription deductible $200

Tier 1 — Preferred generic $0/$10

Tier 2 — Generic $0/$15

Tier 3 — Preferred brand $42/$47

Tier 4 — Nonpreferred drug $100/$100

Tier 5 — Specialty 29%/29%

This plan includes Tier 1 and Tier 2 prescription gap coverage.

18.25.029.1-125

100Plan designs and service areas described in this document are pending government approval and are therefore subject to change. For producer use only. Confidential and proprietary. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

FIRST LOOK 2018Medicare Advantage

FL WestFlorida: Polk

Coventry Medicare Summit Plan (HMO) (H1609-022)

Monthly premium $0

PCP in network $0

Specialist in network $35

Inpatient hospital in network $250 per day, days 1-6; $0 per day, days 7-90

Out-of-pocket maximum in network $6,700

Out-of-pocket maximum combined N/A

Deductible $0

Prescription drugs (preferred pharmacies/standard pharmacies)All prescription copays are representative of a one-month supply.

Prescription deductible $0

Tier 1 — Preferred generic $0/$10

Tier 2 — Generic $0/$15

Tier 3 — Preferred brand $42/$47

Tier 4 — Nonpreferred drug $100/$100

Tier 5 — Specialty 33%/33%

This plan includes Tier 1 and Tier 2 prescription gap coverage.

18.25.029.1-125