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Aetna HMO forState of Delaware
Employees and Pre-65 Pensioners
State of Delaware©2006 Aetna Inc.
Highlights
Outstanding customer service located in the Blue Hen Corporate Center - Dover, DE
Dedicated Customer Service # :877-54-AETNA (877-542-3862)
Large local and national network
Tools to help members stay healthy and well informed Personal Health Record Aetna Health Connections Aetna Navigator
Proven track record
State of Delaware©2006 Aetna Inc.
The Basics….
Member chooses primary care physician (PCP) from our large network of participating providers
Member visits PCP for routine care, injury or illness
PCP referral generally required for specialist care, except for direct access benefits
Member pays copay at time of service
Coverage for dependents living away from home
State of Delaware©2006 Aetna Inc.
Direct Access Benefits
No referral needed for:
Routine and preventive care
Routine well-baby care
OB/GYN care
Routine eye exams
State of Delaware©2006 Aetna Inc.
Value Add Programs & Services
Aetna Health Connections
Aetna Navigator
Personal Health Record
DocFind
Moms-to-Babies
Informed Health® Line
Aetna Natural Products & Services
National Medical Excellence Program®
State of Delaware©2006 Aetna Inc.
Aetna Health Connections
In house disease management monitors 30+ diseases/conditions
Single Aetna nurse manages all member’s conditions
State-of-the-art predictive modeling tools
Patient safety is an integral part of the program
Care considerations
State of Delaware©2006 Aetna Inc.
Vascular Peripheral Artery Disease (PAD) Cerebrovascular Disease (CVA)/Stroke Congestive Heart Failure (CHF) Coronary Artery Disease CAD) Diabetes – Adult and Pediatric Hypertension (high blood pressure) Hyperlipidemia (high cholesterol)
Pulmonary Asthma – Adult and Pediatric Chronic Obstructive Pulmonary Disease (COPD)
Gastrointestinal Gastro Esophageal Reflux Disease (GERD) Chronic Hepatitis Peptic Ulcer Disease Inflammatory Bowel Disease (Crohn’s Disease
and Ulcerative Colitis) Neuro-Geriatric
Seizure Disorder Migraine Parkinsonism Geriatrics
Orthopedic Rheumatoid Arthritis (RA) Osteoporosis Osteoarthritis (OA)*
Cancer General Cancer Breast Cancer Lung Cancer Lymphoma/Leukemia Prostate Cancer Colorectal Cancer
Renal Chronic Kidney Disease End Stage Renal Disease
Other Cystic Fibrosis HIV Hypercoagulable State Chronic Low Back Pain Sickle Cell Disease - Adult and Pediatric Weight Management
Program Conditions/Clinical Content
State of Delaware©2006 Aetna Inc.
Navigator™
EngagingConsumers
ThroughAetna
State of Delaware©2006 Aetna Inc.
Links to Related Resources
Personal Health Record
Find Health Care in DocFind
Order a Member ID Card
Contact Member Services
Take Action On Your Health
SM
Member-
Centered
Design
State of Delaware©2006 Aetna Inc.
DRAFT
State of Delaware©2006 Aetna Inc.
What Is DocFind?
Aetna’s premier online directory of doctors and hospitals
Supports searches for network participating:– PCPs
– Specialists
– Dentists
– Urgent Care Facilities
– Pharmacies
Data refreshed three times per week
− Hospitals − Institutes of Excellence™
− Transplant Facilities− Behavioral Health Specialists− Vision One® locations− Other Facilities (e.g., Labs)
State of Delaware©2006 Aetna Inc.
Moms-to-Babies
Members:
Identified for participation by multiple means and encouraged to register and complete pregnancy risk survey
Risk stratified based on responses to pregnancy risk survey
At normal risk receive educational intervention and telephonic support when necessary
With high risk stratification assigned to OB nurse case managers to receive targeted outreach calls
State of Delaware©2006 Aetna Inc.
Informed Health® Line
24/7, toll-free access to registered nurses for health information
Access to Audio Health Library
Access to Healthwise Knowledgebase
Ongoing communications
Personal follow-up
Consistent, coordinated service
State of Delaware©2006 Aetna Inc.
Natural
Aetna
Products and ServicesProgramSM
State of Delaware©2006 Aetna Inc.
Health-Related Products
Purchase online for InterNatural and WebVitamins, Inc.
– InterNatural
Minimum 20% discount off retail prices for: – Over-the-counter vitamins – Herbal and nutritional supplements – Health-related products
– WebVitamins, Inc. 12% discount off retail prices for:
– Over-the-counter vitamins– Herbal and nutritional supplements
State of Delaware©2006 Aetna Inc.
National Medical Excellence
Out-of-country care program– Supports members who need emergency medical care while
temporarily traveling outside the United States
National special case program– Assists members with rare or complex conditions requiring
specialized treatment in evaluating their options and obtaining appropriate care
National transplant program– Case management, centralized claims/member service, Institutes
of ExcellenceTM (IOE) transplant network
State of Delaware©2006 Aetna Inc.
Our Customer Service Center Dover, DE
Our Customers
Our Site
Our People
Serving 700,000 members Focused exclusively on National
Accounts customers and members
Over 195 service staff Average 7.9 years Aetna experience 76% at Aetna over 5 years
High Quality Service Since 1987 Full Spectrum of Products Dedicated Customer Service #:
877 54-AETNA (877-542-3862)
State of Delaware©2006 Aetna Inc.
Our Customers Are at the Center
of Everything We Do
We deliver results for you
We organize
our people
around you
We focus our service and technology on you