easy steps to renew your coverage
TRANSCRIPT
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
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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
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.
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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
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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.
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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.
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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 1903 compared to HNOnly 12-1000-80 See page 12
HMO OA 1911 compared to HNOnly 12-1000-80 See page 13
HMO OA 1912 compared to HNOnly 12-1000-80 See page 14
HMO OA 1913 compared to HNOnly 12-1500-70 See page 15
HMO OA 1914 compared to HNOnly 12-2000-70 See page 16
HMO OA 1915 compared to HNOnly 12-2000-50 See page 17
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 1922 compared to HNOnly 12-2000-100 See page 21
HMO OA 1923 compared to HNOnly 12-3000-100 See page 22
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 1912 compared to HNOption 12-1000-80 See page 26
POS OA 1913 compared to HNOption 12-1500-70 See page 27
POS OA 1921 compared to HNOption 12-2000-100 See page 28
POS OA 1922 compared to HNOption 12-2000-100 See page 29
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 1912 compared to MC OA 12-1000-80 See page 33
MC OA 1913 compared to MC OA 12-1500-70 See page 34
MC OA 1917S compared to MC OA 12-10K-100S See page 35
MC OA 1922 compared to MC OA 12-3000-100 See page 36
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
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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
Annual Deductible: Individual/Family
Total Annual Out-of-Pocket (OOP): Individual/Family
HMO GK 1914 compare to HNOnly 12-2000-70
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HMO GK 1917S compare to HNOnly 12-10K-100S
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME HMO GK 1917S HNOnly 12-10K-100S HNOnly 12-10K-80S
IN-NETWORK SERVICES
Referral Required? Yes No No
Coinsurance 100% 0% 80%
Annual Deductible: Individual/Family
$10,000/$10,000 $10,000/$10,000 $10,000/$10,000
Type of Deductible Embedded (1x) Embedded (1x) Embedded (1x)
Total Annual Out-of-Pocket (OOP): Individual/Family
$10,000/$10,000 $10,000/$10,000 $15,000/$15,000
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 $35, ded waived $35, ded waived
PHYSICIAN SERVICES
PCP Office Visit $35, ded waived $35, ded waived $35, ded waived
Specialist Office Visit $70, ded waived $70, ded waived $70, ded waived
INPATIENT SERVICES
Inpatient Hospital 100%, ded applies 100%, ded applies 80%, ded applies
OUTPATIENT/OTHER SERVICES
Outpatient Lab 100%, ded applies 100%, ded applies 80%, ded applies
Outpatient X-ray 100%, ded applies 100%, ded applies 80%, ded applies
Complex Imaging 100%, ded applies 100%, ded applies 80%, ded applies
Outpatient Surgery 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
PRESCRIPTION SERVICES
Retail Pharmacy Copay $20/$50/$75 $20/$50/$75 $10 generic only
Specialty Rx 25% 20% up to $225 20% up to $225
Preventive Rx Waiver Not applicable Not applicable Not applicable
OUT-OF-NETWORK SERVICES
Coinsurance Not applicable Not applicable Not applicable
Annual Deductible: Individual/Family
Total Annual Out-of-Pocket (OOP): Individual/Family
10
HMO OA 1900 (Compass) compare to HNOnly 12-1500 (Compass)
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
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%
Annual Deductible: Individual/Family
$1,000/$2,000 $1,500/$3,000 $2,000/$4,000
Type of Deductible Embedded Embedded Non-Embedded
Total Annual Out-of-Pocket (OOP): Individual/Family
$4,000/$8,000 $4,000/$8,000 $4,000/$8,000
PREVENTIVE CARE SERVICES
Preventive Care Services $0, ded waived $0, ded waived $0, ded waived
Vision Screening Services (1 time every 24 months)
$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/OTHER SERVICES
Outpatient Lab 70%, ded applies 70%, ded applies 90%, ded applies
Outpatient X-ray 70%, ded applies 70%, ded applies 90%, ded applies
Complex Imaging 70%, ded applies 70%, ded applies 90%, ded applies
Outpatient Surgery 90% after $250, ded applies 90% after $250 copay, ded applies 90%, ded applies
Emergency Room 70%, ded applies 70%, ded applies 90%, ded applies
Urgent Care 70%, ded applies 70%, ded applies 90%, ded applies
PRESCRIPTION SERVICES
Retail Pharmacy Copay $5/$40/$60 $5/$40/$60 $20/$50/$75 ded applies
Specialty Rx 25% 20% up to $180 20% up to $225
Preventive Rx Waiver Not applicable Not applicable Ded waived for certain Preventive Rx
OUT-OF-NETWORK SERVICES
Coinsurance Not applicable Not applicable Not applicable
Annual Deductible: Individual/Family
Total Annual Out-of-Pocket (OOP): Individual/Family
11
HMO OA 1902 compare to HNOnly 12-0-100
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME HMO OA 1902 HNOnly 12-0-100 HNOnly 12-1000-80
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance N/A N/A 80%
Annual Deductible: Individual/Family
N/A N/A $1,000/$2,000
Type of Deductible N/A Embedded Embedded
Total Annual Out-of-Pocket (OOP): Individual/Family
$3,000/$6,000 $3,000/$6,000 $3,000/$6,000
PREVENTIVE CARE SERVICES
Preventive Care Services $0 $0 $0, ded waived
Vision Screening Services (1 time every 24 months)
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/OTHER SERVICES
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
PRESCRIPTION SERVICES
Retail Pharmacy Copay $5/$40/$60 $10/$45/$65 $5/$40/$60
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
Annual Deductible: Individual/Family
Total Annual Out-of-Pocket (OOP): Individual/Family
12
HMO OA 1903 compare to HNOnly 12-1000-80
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME HMO OA 1903 HNOnly 12-1000-80 HNOnly 12-1500-80
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance N/A 80% 80%
Annual Deductible: Individual/Family
N/A $1,000/$2,000 $1,500/$3,000
Type of Deductible N/A Embedded Embedded
Total Annual Out-of-Pocket (OOP): Individual/Family
$5,000/$10,000 $3,000/$6,000 $4,000/$8,000
PREVENTIVE CARE SERVICES
Preventive Care Services $0 $0, ded waived $0, ded waived
Vision Screening Services (1 time every 24 months)
Not Covered $50, ded waived $50, 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/OTHER SERVICES
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
PRESCRIPTION SERVICES
Retail Pharmacy Copay $20/$50/$75 $5/$40/$60 $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
Annual Deductible: Individual/Family
Total Annual Out-of-Pocket (OOP): Individual/Family
13
HMO OA 1911 compare to HNOnly 12-1000-80
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME HMO OA 1911 HNOnly 12-1000-80 HNOnly 12-2000-100
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 80% 80% 0%
Annual Deductible: Individual/Family
$500/$1,000 $1,000/$2,000 $2,000/$6,000
Type of Deductible Embedded Embedded 3X
Total Annual Out-of-Pocket (OOP): Individual/Family
$4,500/$9,000 $3,000/$6,000 $2,000/$6,000
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 $50, ded waived $50, ded waived
PHYSICIAN SERVICES
PCP Office Visit $20, ded waived $25, ded waived $25, ded waived
Specialist Office Visit $50, ded waived $50, ded waived $50, ded waived
INPATIENT SERVICES
Inpatient Hospital 80%, ded applies 80%, ded applies 100%, ded applies
OUTPATIENT/OTHER SERVICES
Outpatient Lab $0, ded waived $0, ded waived $0, ded waived
Outpatient X-ray $50, ded waived $50, ded waived $50, ded waived
Complex Imaging 80%, ded applies 80%, ded applies 100%, ded applies
Outpatient Surgery 80%, ded applies 80%, ded applies 100%, ded applies
Emergency Room $200, ded waived $300, ded waived $300, ded waived
Urgent Care $75, ded waived $75, ded waived $75, ded waived
PRESCRIPTION SERVICES
Retail Pharmacy Copay $5/$40/$60 $5/$40/$60 $10/$45/$65
Specialty Rx 25% 20% up to $180 80% up to $180
Preventive Rx Waiver Not applicable Not applicable Not applicable
OUT-OF-NETWORK SERVICES
Coinsurance Not applicable Not applicable Not applicable
Annual Deductible: Individual/Family
Total Annual Out-of-Pocket (OOP): Individual/Family
14
HMO OA 1912 compare to HNOnly 12-1000-80
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME HMO OA 1912 HNOnly 12-1000-80 HNOnly 12-1500-80
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 80% 80% 80%
Annual Deductible: Individual/Family
$1,000/$2,000 $1,000/$2,000 $1,500/$3,000
Type of Deductible Embedded Embedded Embedded
Total Annual Out-of-Pocket (OOP): Individual/Family
$4,000/$8,000 $3,000/$6,000 $4,000/$8,000
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 $50, ded waived $50, ded waived
PHYSICIAN SERVICES
PCP Office Visit $25, ded waived $25, ded waived $25, ded waived
Specialist Office Visit $50, ded waived $50, ded waived $50, ded waived
INPATIENT SERVICES
Inpatient Hospital 80%, ded applies 80%, ded applies 80%, ded applies
OUTPATIENT/OTHER SERVICES
Outpatient Lab $0, ded waived $0, ded waived $0, ded waived
Outpatient X-ray $50, ded waived $50, ded waived $50, ded waived
Complex Imaging 80%, ded applies 80%, ded applies 80%, ded applies
Outpatient Surgery 80%, ded applies 80%, ded applies 80%, ded applies
Emergency Room $200, ded waived $300, ded waived $300, ded waived
Urgent Care $75, ded waived $75, ded waived $75, ded waived
PRESCRIPTION SERVICES
Retail Pharmacy Copay $10/$45/$65 $5/$40/$60 $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
Annual Deductible: Individual/Family
Total Annual Out-of-Pocket (OOP): Individual/Family
15
HMO OA 1913 compare to HNOnly 12-1500-70
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME HMO OA 1913 HNOnly 12-1500-70 HNOnly 12-2000-70
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 70% 70% 70%
Annual Deductible: Individual/Family
$1,500/$3,000 $1,500/$3,000 $2,000/$4,000
Type of Deductible Embedded Embedded Embedded
Total Annual Out-of-Pocket (OOP): Individual/Family
$4,500/$9,000 $5,000/$10,000 $6,000/$12,000
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 $60, ded waived
PHYSICIAN SERVICES
PCP Office Visit $25, ded waived $30, ded waived $30, ded waived
Specialist Office Visit $50, ded waived $60, ded waived $60, ded waived
INPATIENT SERVICES
Inpatient Hospital 70%, ded applies 70%, ded applies 70%, 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 $60, ded waived
Complex Imaging 70%, ded applies 70%, ded applies 70%, ded applies
Outpatient Surgery 70%, ded applies 70%, ded applies 70%, ded applies
Emergency Room $250, ded waived $300, ded waived $350, 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
Annual Deductible: Individual/Family
Total Annual Out-of-Pocket (OOP): Individual/Family
16
HMO OA 1914 compare to HNOnly 12-2000-70
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME HMO OA 1914 HNOnly 12-2000-70 HNOnly 12-2000-50
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 70% 70% 50%
Annual Deductible: Individual/Family
$2,000/$4,000 $2,500/$5,000 $2,000/$4,000
Type of Deductible Embedded Embedded Embedded
Total Annual Out-of-Pocket (OOP): Individual/Family
$7,000/$14,000 $5,000/$10,000 $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 $100, 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
Annual Deductible: Individual/Family
Total Annual Out-of-Pocket (OOP): Individual/Family
17
HMO OA 1915 compare to HNOnly 12-2000-50
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME HMO OA 1915 HNOnly 12-2000-50 HNOnly 12-3000A-50
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 50% 50% 50%
Annual Deductible: Individual/Family
$2,000/$4,000 $2,000/$4,000 $3,000/$6,000
Type of Deductible Embedded Embedded Embedded
Total Annual Out-of-Pocket (OOP): Individual/Family
$7,000/$14,000 $7,000/$14,000 $9,000/$18,000
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 $50, ded waived $35, ded waived
PHYSICIAN SERVICES
PCP Office Visit $25, ded waived $25, ded waived $35, ded waived
Specialist Office Visit $50, ded waived $50, ded waived $70, ded waived
INPATIENT SERVICES
Inpatient Hospital 50%, ded applies 50%, 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 50%, ded waived 50%, ded applies
Complex Imaging 50%, ded applies 50%, ded applies 50%, ded applies
Outpatient Surgery 50%, ded applies 50%, ded applies 50%, ded applies
Emergency Room $250, ded waived $400, ded waived $400, ded waived
Urgent Care $75, ded waived $75, ded waived $100, ded waived
PRESCRIPTION SERVICES
Retail Pharmacy Copay $10/$45/$65 $10/$45/$65 $20/$50/$75
Specialty Rx 25% 20% up to $180 20% up to $225
Preventive Rx Waiver Not applicable Not applicable Not applicable
OUT-OF-NETWORK SERVICES
Coinsurance Not applicable Not applicable Not applicable
Annual Deductible: Individual/Family
Total Annual Out-of-Pocket (OOP): Individual/Family
18
HMO OA 1916 compare to HNOnly 12-3000A-50
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME HMO OA 1916 HNOnly 12-3000A-50 HNOnly 12-3000B-50
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 50% 50% 50%
Annual Deductible: Individual/Family
$3,000/$6,000 $3,000/$6,000 $3,000/$6,000
Type of Deductible Embedded Embedded Embedded
Total Annual Out-of-Pocket (OOP): Individual/Family
$9,000/$18,000 $9,000/$18,000 $9,000/$18,000
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 $35, ded waived $40, ded waived
PHYSICIAN SERVICES
PCP Office Visit $35, ded waived $35, ded waived $40, ded waived
Specialist Office Visit $70, ded waived $70, ded waived $80, ded waived
INPATIENT SERVICES
Inpatient Hospital 50%, ded applies 50%, 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 50%, ded applies 50%, ded applies
Complex Imaging 50%, ded applies 50%, ded applies 50%, ded applies
Outpatient Surgery 50%, ded applies 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
PRESCRIPTION SERVICES
Retail Pharmacy Copay $20/$50/$75 $20/$50/$75 $20/$50/$75
Specialty Rx 25% 20% up to $225 20% up to $225
Preventive Rx Waiver Not applicable Not applicable Not applicable
OUT-OF-NETWORK SERVICES
Coinsurance Not applicable Not applicable Not applicable
Annual Deductible: Individual/Family
Total Annual Out-of-Pocket (OOP): Individual/Family
19
HMO OA 1917 compare to HNOnly 12-10K-100
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME HMO OA 1917 HNOnly 12-10K-100 HNOnly 12-10K-80
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 100% 100% 80%
Annual Deductible: Individual/Family
$10,000/$10,000 $10,000/$10,000 $10,000/$10,000
Type of Deductible Embedded (1x) Embedded (1x) Embedded (1x)
Total Annual Out-of-Pocket (OOP): Individual/Family
$10,000/$10,000 $10,000/$10,000 $15,000/$15,000
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 $35, ded waived $35, ded waived
PHYSICIAN SERVICES
PCP Office Visit $35, ded waived $35, ded waived $35, ded waived
Specialist Office Visit 100%, ded applies 100%, ded applies 80%, ded applies
INPATIENT SERVICES
Inpatient Hospital 100%, ded applies 100%, ded applies 80%, ded applies
OUTPATIENT/OTHER SERVICES
Outpatient Lab 100%, ded applies 100%, ded applies 80%, ded applies
Outpatient X-ray 100%, ded applies 100%, ded applies 80%, ded applies
Complex Imaging 100%, ded applies 100%, ded applies 80%, ded applies
Outpatient Surgery 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
PRESCRIPTION SERVICES
Retail Pharmacy Copay $20/$50/$75 $20/$50/$75 $10 generic only
Specialty Rx 25% 20% up to $225 20% up to $225
Preventive Rx Waiver Not applicable Not applicable Not applicable
OUT-OF-NETWORK SERVICES
Coinsurance Not applicable Not applicable Not applicable
Annual Deductible: Individual/Family
Total Annual Out-of-Pocket (OOP): Individual/Family
20
HMO OA 1917S compare to HNOnly 12-10K-100S
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME HMO OA 1917S HNOnly 12-10K-100S HNOnly 12-10K-80S
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 100% 100% 80%
Annual Deductible: Individual/Family
$10,000/$10,000 $10,000/$10,000 $10,000/$10,000
Type of Deductible Embedded (1x) Embedded (1x) Embedded (1x)
Total Annual Out-of-Pocket (OOP): Individual/Family
$10,000/$10,000 $10,000/$10,000 $15,000/$15,000
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 $35, ded waived $35, ded waived
PHYSICIAN SERVICES
PCP Office Visit $35, ded waived $35, ded waived $35, ded waived
Specialist Office Visit $70, ded waived $70, ded waived $70, ded waived
INPATIENT SERVICES
Inpatient Hospital 100%, ded applies 100%, ded applies 80%, ded applies
OUTPATIENT/OTHER SERVICES
Outpatient Lab 100%, ded applies 100%, ded applies 80%, ded applies
Outpatient X-ray 100%, ded applies 100%, ded applies 80%, ded applies
Complex Imaging 100%, ded applies 100%, ded applies 80%, ded applies
Outpatient Surgery 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
PRESCRIPTION SERVICES
Retail Pharmacy Copay $20/$50/$75 $20/$50/$75 $10 generic only
Specialty Rx 25% 20% up to $225 20% up to $225
Preventive Rx Waiver Not applicable Not applicable Not applicable
OUT-OF-NETWORK SERVICES
Coinsurance Not applicable Not applicable Not applicable
Annual Deductible: Individual/Family
Total Annual Out-of-Pocket (OOP): Individual/Family
21
HMO OA 1922 compare to HNOnly 12-2000-100
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME HMO OA 1922 HNOnly 12-2000-100 HNOnly 12-3000-100
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 100% 100% 100%
Annual Deductible: Individual/Family
$2,000/$6,000 $2,000/$6,000 $3,000/$9,000
Type of Deductible 3X 3X 3X
Total Annual Out-of-Pocket (OOP): Individual/Family
$2,000/$6,000 $2,000/$6,000 $3,000/$9,000
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 $50, ded waived $60, ded waived
PHYSICIAN SERVICES
PCP Office Visit $25, ded waived $25, ded waived $30, ded waived
Specialist Office Visit $50, ded waived $50, ded waived $60, ded waived
INPATIENT SERVICES
Inpatient Hospital 100%, ded applies 100%, ded applies 100%, ded applies
OUTPATIENT/OTHER SERVICES
Outpatient Lab $0, ded waived $0, ded waived $0, ded waived
Outpatient X-ray $50, ded waived $50, ded waived $60, ded waived
Complex Imaging 100%, ded applies 100%, ded applies 100%, ded applies
Outpatient Surgery 100%, ded applies 100%, ded applies 100%, ded applies
Emergency Room $200, ded waived $300, ded waived $350, 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
Annual Deductible: Individual/Family
Total Annual Out-of-Pocket (OOP): Individual/Family
22
HMO OA 1923 compare to HNOnly 12-3000-100
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME HMO OA 1923 HNOnly 12-3000-100 HNOnly 12-5000-100
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 100% 100% 100%
Annual Deductible: Individual/Family
$3,000/$9,000 $3,000/$9,000 $5,000/$15,000
Type of Deductible 3X 3X 3X
Total Annual Out-of-Pocket (OOP): Individual/Family
$3,000/$9,000 $3,000/$9,000 $5,000/$15,000
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 $60, ded waived
PHYSICIAN SERVICES
PCP Office Visit $25, ded waived $30, ded waived $30, ded waived
Specialist Office Visit $50, ded waived $60, ded waived $60, ded waived
INPATIENT SERVICES
Inpatient Hospital 100%, ded applies 100%, ded applies 100%, 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 $60, ded waived
Complex Imaging 100%, ded applies 100%, ded applies 100%, ded applies
Outpatient Surgery 100%, ded applies 100%, ded applies 100%, ded applies
Emergency Room $250, ded waived $350, ded waived $400, ded waived
Urgent Care $100, ded waived $75, ded waived $75, ded waived
PRESCRIPTION SERVICES
Retail Pharmacy Copay $10/$45/$65 $10/$45/$65 $20/$50/$75
Specialty Rx 25% 20% up to $180 20% up to $225
Preventive Rx Waiver Not applicable Not applicable Not applicable
OUT-OF-NETWORK SERVICES
Coinsurance Not applicable Not applicable Not applicable
Annual Deductible: Individual/Family
Total Annual Out-of-Pocket (OOP): Individual/Family
23
HMO OA 1936 (HDHP) compare to HNOnly 12-10K-100
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME HMO OA 1936 (HDHP) HNOnly 12-10K-100 HNOnly 12-10K-80
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 100% 100% 80%
Annual Deductible: Individual/Family
$5,950/$11,900 $10,000/$10,000 $10,000/$10,000
Type of Deductible Non-Embedded Embedded (1x) Embedded (1x)
Total Annual Out-of-Pocket (OOP): Individual/Family
$5,950/$11,900 $10,000/$10,000 $15,000/$15,000
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 $35, ded waived $35, ded waived
PHYSICIAN SERVICES
PCP Office Visit 100%, ded applies $35, ded waived $35, ded waived
Specialist Office Visit 100%, ded applies 100%, ded applies 80%, ded applies
INPATIENT SERVICES
Inpatient Hospital 100%, ded applies 100%, ded applies 80%, ded applies
OUTPATIENT/OTHER SERVICES
Outpatient Lab 100%, ded applies 100%, ded applies 80%, ded applies
Outpatient X-ray 100%, ded applies 100%, ded applies 80%, ded applies
Complex Imaging 100%, ded applies 100%, ded applies 80%, ded applies
Outpatient Surgery 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
PRESCRIPTION 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
OUT-OF-NETWORK SERVICES
Coinsurance Not applicable Not applicable Not applicable
Annual Deductible: Individual/Family
Total Annual Out-of-Pocket (OOP): Individual/Family
24
POS OA 1902 compare to HNOnly 12-0-100
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME POS OA 1902 HNOnly 12-0-100 HNOption 12-2000-100
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance N/A N/A 100%
Annual Deductible: Individual/Family
N/A N/A $2,000/$6,000
Type of Deductible N/A Embedded 3X
Total Annual Out-of-Pocket (OOP): Individual/Family
$3,000/$6,000 $3,000/$6,000 $2,000/$6,000
PREVENTIVE CARE SERVICES
Preventive Care Services $0 $0 $0, ded waived
Vision Screening Services (1 time every 24 months)
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/OTHER SERVICES
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
PRESCRIPTION SERVICES
Retail Pharmacy Copay $5/$40/$60 $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 50% Not applicable 70%
Annual Deductible: Individual/Family
$2,000/$4,000 $3,000/$9,000
Total Annual Out-of-Pocket (OOP): Individual/Family
$8,000/$16,000 $6,000/$18,000
25
POS OA 1911 compare to HNOption 12-1000-80
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME POS OA 1911 HNOption 12-1000-80 HNOption 12-2000-100
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 80% 80% 100%
Annual Deductible: Individual/Family
$500/$1,000 $1,000/$2,000 $2,000/$6,000
Type of Deductible Embedded Embedded 3X
Total Annual Out-of-Pocket (OOP): Individual/Family
$4,500/$9,000 $3,000/$6,000 $2,000/$6,000
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 $50, ded waived $50, ded waived
PHYSICIAN SERVICES
PCP Office Visit $20, ded waived $25, ded waived $25, ded waived
Specialist Office Visit $50, ded waived $50, ded waived $50, ded waived
INPATIENT SERVICES
Inpatient Hospital 80%, ded applies 80%, ded applies 100%, ded applies
OUTPATIENT/OTHER SERVICES
Outpatient Lab $0, ded waived $0, ded waived $0, ded waived
Outpatient X-ray $50, ded waived $50, ded waived $50, ded waived
Complex Imaging 80%, ded applies 80%, ded applies 100%, ded applies
Outpatient Surgery 80%, ded applies 80%, ded applies 100%, ded applies
Emergency Room $200, ded waived $300, ded waived $300, ded waived
Urgent Care $75, ded waived $75, ded waived $75, ded waived
PRESCRIPTION SERVICES
Retail Pharmacy Copay $5/$40/$60 $5/$40/$60 $10/$45/$65
Specialty Rx 25% 20% up to $180 20% up to $180
Preventive Rx Waiver No Not applicable Not applicable
OUT-OF-NETWORK SERVICES
Coinsurance 50% 50% 70%
Annual Deductible: Individual/Family
$2,000/$4,000 $2,000/$4,000 $3,000/$9,000
Total Annual Out-of-Pocket (OOP): Individual/Family
$8,000/$16,000 $6,000/$12,000 $6,000/$18,000
26
POS OA 1912 compare to HNOption 12-1000-80
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME POS OA 1912 HNOption 12-1000-80 HNOption 12-1500-80
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 80% 80% 80%
Annual Deductible: Individual/Family
$1,000/$2,000 $1,000/$2,000 $1,500/$3,000
Type of Deductible Embedded Embedded Embedded
Total Annual Out-of-Pocket (OOP): Individual/Family
$4,000/$8,000 $3,000/$6,000 $4,000/$8,000
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 $50, ded waived $50, ded waived
PHYSICIAN SERVICES
PCP Office Visit $25, ded waived $25, ded waived $25, ded waived
Specialist Office Visit $50, ded waived $50, ded waived $50, ded waived
INPATIENT SERVICES
Inpatient Hospital 80%, ded applies 80%, ded applies 80%, ded applies
OUTPATIENT/OTHER SERVICES
Outpatient Lab $0, ded waived $0, ded waived $0, ded waived
Outpatient X-ray $50, ded waived $50, ded waived $50, ded waived
Complex Imaging 80%, ded applies 80%, ded applies 80%, ded applies
Outpatient Surgery 80%, ded applies 80%, ded applies 80%, ded applies
Emergency Room $200, ded waived $300, ded waived $300, ded waived
Urgent Care $75, ded waived $75, ded waived $75, ded waived
PRESCRIPTION SERVICES
Retail Pharmacy Copay $10/$45/$65 $5/$40/$60 $10/$45/$65
Specialty Rx 25% 20% up to $180 20% up to $180
Preventive Rx Waiver No Not applicable Not applicable
OUT-OF-NETWORK SERVICES
Coinsurance 50% 50% 50%
Annual Deductible: Individual/Family
$2,000/$4,000 $2,000/$4,000 $2,000/$4,000
Total Annual Out-of-Pocket (OOP): Individual/Family
$8,000/$16,000 $6,000/$12,000 $6,000/$12,000
27
POS OA 1913 compare to HNOption 12-1500-70
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME POS OA 1913 HNOption 12-1500-70 HNOption 12-2000-70
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 70% 70% 70%
Annual Deductible: Individual/Family
$1,500/$3,000 $1,500/$3,000 $2,000/$4,000
Type of Deductible Embedded Embedded Embedded
Total Annual Out-of-Pocket (OOP): Individual/Family
$4,500/$9,000 $5,000/$10,000 $6,000/$12,000
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 $60, ded waived
PHYSICIAN SERVICES
PCP Office Visit $25, ded waived $30, ded waived $30, ded waived
Specialist Office Visit $50, ded waived $60, ded waived $60, ded waived
INPATIENT SERVICES
Inpatient Hospital 70%, ded applies 70%, ded applies 70%, 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 $60, ded waived
Complex Imaging 70%, ded applies 70%, ded applies 70%, ded applies
Outpatient Surgery 70%, ded applies 70%, ded applies 70%, ded applies
Emergency Room $250, ded waived $300, ded waived $350, 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 No Not applicable Not applicable
OUT-OF-NETWORK SERVICES
Coinsurance 50% 50% 50%
Annual Deductible: Individual/Family
$2,000/$4,000 $2,000/$4,000 $3,000/$6,000
Total Annual Out-of-Pocket (OOP): Individual/Family
$8,000/$16,000 $8,000/$16,000 $10,000/$20,000
28
POS OA 1921 compare to HNOption 12-2000-100
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME POS OA 1921 HNOption 12-2000-100 HNOption 12-1500-80
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 100% 100% 80%
Annual Deductible: Individual/Family
$1,500/$4,500 $2,000/$6,000 $1,500/$3,000
Type of Deductible 3X 3X Embedded
Total Annual Out-of-Pocket (OOP): Individual/Family
$1,500/$4,500 $2,000/$6,000 $4,000/$8,000
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 $50, ded waived $50, ded waived
PHYSICIAN SERVICES
PCP Office Visit $20, ded waived $25, ded waived $25, ded waived
Specialist Office Visit $50, ded waived $50, ded waived $50, ded waived
INPATIENT SERVICES
Inpatient Hospital 100%, ded applies 100%, ded applies 80%, ded applies
OUTPATIENT/OTHER SERVICES
Outpatient Lab $0, ded waived $0, ded waived $0, ded waived
Outpatient X-ray $50, ded waived $50, ded waived $50, ded waived
Complex Imaging 100%, ded applies 100%, ded applies 80%, ded applies
Outpatient Surgery 100%, ded applies 100%, ded applies 80%, ded applies
Emergency Room $200, ded waived $300, ded waived $300, ded waived
Urgent Care $75, ded waived $75, ded waived $75, ded waived
PRESCRIPTION SERVICES
Retail Pharmacy Copay $5/$40/$60 $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 70% 70% 50%
Annual Deductible: Individual/Family
$2,000/$6,000 $3,000/$9,000 $2,000/$4,000
Total Annual Out-of-Pocket (OOP): Individual/Family
$5,000 /$15,000 $6,000/$18,000 $6,000/$12,000
29
POS OA 1922 compare to HNOption 12-2000-100
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME POS OA 1922 HNOption 12-2000-100 HNOption 12-3000-100
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 100% 100% 100%
Annual Deductible: Individual/Family
$2,000/$6,000 $2,000/$6,000 $3,000/$9,000
Type of Deductible 3X 3X 3X
Total Annual Out-of-Pocket (OOP): Individual/Family
$2,000/$6,000 $2,000/$6,000 $3,000/$9,000
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 Not Covered $60, ded waived
PHYSICIAN SERVICES
PCP Office Visit $25, ded waived $25, ded waived $30, ded waived
Specialist Office Visit $50, ded waived $50, ded waived $60, ded waived
INPATIENT SERVICES
Inpatient Hospital 100%, ded applies 100%, ded applies 100%, ded applies
OUTPATIENT/OTHER SERVICES
Outpatient Lab $0, ded waived $0, ded waived $0, ded waived
Outpatient X-ray $50, ded waived $50, ded waived $60, ded waived
Complex Imaging 100%, ded applies 100%, ded applies 100%, ded applies
Outpatient Surgery 100%, ded applies 100%, ded applies 100%, ded applies
Emergency Room $200, ded waived $300, ded waived $350, 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 70% 70% 70%
Annual Deductible: Individual/Family
$3,000/$9,000 $3,000/$9,000 $4,000/$12,000
Total Annual Out-of-Pocket (OOP): Individual/Family
$6,000/$18,000 $6,000/$18,000 $6,000/$18,000
30
POS OA 1935 (HDHP) compare to HNOption 12-2500-80HSA
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME POS OA 1935 (HDHP) HNOption 12-2500-80HSA HNOnly 12-3000-80HSA
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 80% 80% 80%
Annual Deductible: Individual/Family
$2,500/$5,000 $2,500/$5,000 $3,000/$6,000
Type of Deductible Non-Embedded Non-Embedded Non-Embedded
Total Annual Out-of-Pocket (OOP): Individual/Family
$5,000/$10,000 $5,000/$10,000 $6,000/$12,000
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 $0, ded waived $0, ded waived
PHYSICIAN SERVICES
PCP Office Visit 80%, ded applies 80%, ded applies 80%, ded applies
Specialist Office Visit 80%, ded applies 80%, ded applies 80%, ded applies
INPATIENT SERVICES
Inpatient Hospital 80%, ded applies 80%, ded applies 80%, ded applies
OUTPATIENT/OTHER SERVICES
Outpatient Lab 80%, ded applies 80%, ded applies 80%, ded applies
Outpatient X-ray 80%, ded applies 80%, ded applies 80%, ded applies
Complex Imaging 80%, ded applies 80%, ded applies 80%, ded applies
Outpatient Surgery 80%, ded applies 80%, ded applies 80%, ded applies
Emergency Room 80%, ded applies 80%, ded applies 80%, ded applies
Urgent Care 80%, ded applies 80%, ded applies 80%, ded applies
PRESCRIPTION SERVICES
Retail Pharmacy Copay $5/$40/$60 $20/$50/$75 ded applies $20/$50/$75 ded applies
Specialty Rx 25% 20% up to $225 20% up to $225
Preventive Rx Waiver Not applicable Ded waived for certain Preventive Rx Ded waived for certain Preventive Rx
OUT-OF-NETWORK SERVICES
Coinsurance 70% 50% Not applicable
Annual Deductible: Individual/Family
$3,000/$6,000 $3,000/$6,000
Total Annual Out-of-Pocket (OOP): Individual/Family
$6,000/$12,000 $6,000/$12,000
31
POS OA 1936 (HDHP) compare to HNOnly 12-10K-100
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME POS OA 1936 (HDHP) HNOnly 12-10K-100 HNOnly 12-10K-80
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 100% 100% 80%
Annual Deductible: Individual/Family
$5,950/$11,900 $10,000/$10,000 $10,000/$10,000
Type of Deductible Non-Embedded Embedded (1x) Embedded (1x)
Total Annual Out-of-Pocket (OOP): Individual/Family
$5,950/$11,900 $10,000/$10,000 $15,000/$15,000
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 $35, ded waived $35, ded waived
PHYSICIAN SERVICES
PCP Office Visit 100%, ded applies $35, ded waived $35, ded waived
Specialist Office Visit 100%, ded applies 100%, ded applies 80%, ded applies
INPATIENT SERVICES
Inpatient Hospital 100%, ded applies 100%, ded applies 80%, ded applies
OUTPATIENT/OTHER SERVICES
Outpatient Lab 100%, ded applies 100%, ded applies 80%, ded applies
Outpatient X-ray 100%, ded applies 100%, ded applies 80%, ded applies
Complex Imaging 100%, ded applies 100%, ded applies 80%, ded applies
Outpatient Surgery 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
PRESCRIPTION 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
Preventive Rx Waiver Not applicable Not applicable Not applicable
OUT-OF-NETWORK SERVICES
Coinsurance 70% Not applicable Not applicable
Annual Deductible: Individual/Family
$7,000/$14,000
Total Annual Out-of-Pocket (OOP): Individual/Family
$10,000 /$20,000
32
MC OA 1911 compare to MC OA 12-1000-80
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME MC OA 1911 MC OA 12-1000-80 MC OA 12-1500-80
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 80% 80% 80%
Annual Deductible: Individual/Family
$500/$1,000 $1,000/$2,000 $1,500/$3,000
Type of Deductible Embedded Embedded Embedded
Total Annual Out-of-Pocket (OOP): Individual/Family
$4,500/$9,000 $3,000/$6,000 $4,000/$8,000
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 $50, ded waived $50, ded waived
PHYSICIAN SERVICES
PCP Office Visit $20, ded waived $25, ded waived $25, ded waived
Specialist Office Visit $50, ded waived $50, ded waived $50, ded waived
INPATIENT SERVICES
Inpatient Hospital 80%, ded applies 80%, ded applies 80%, ded applies
OUTPATIENT/OTHER SERVICES
Outpatient Lab $0, ded waived $0, ded waived $0, ded waived
Outpatient X-ray $50, ded waived $50, ded waived $50, ded waived
Complex Imaging 80%, ded applies 80%, ded applies 80%, ded applies
Outpatient Surgery 80%, ded applies 80%, ded applies 80%, ded applies
Emergency Room $200, ded waived $300, ded waived $300, ded waived
Urgent Care $75, ded waived $75, ded waived $75, ded waived
PRESCRIPTION SERVICES
Retail Pharmacy Copay $5/$40/$60 $5/$40/$60 $10/$45/$65
Specialty Rx 25% 20% up to $180 20% up to $180
Preventive Rx Waiver No Not applicable Not applicable
OUT-OF-NETWORK SERVICES
Coinsurance 50% 50% 50%
Annual Deductible: Individual/Family
$2,000/$4,000 $2,000/$4,000 $2,000/$4,000
Total Annual Out-of-Pocket (OOP): Individual/Family
$8,000/$16,000 $6,000/$12,000 $6,000/$12,000
33
MC OA 1912 compare to MC OA 12-1000-80
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME MC OA 1912 MC OA 12-1000-80 MC OA 12-1500-80
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 80% 80% 80%
Annual Deductible: Individual/Family
$1,000/$2,000 $1,000/$2,000 $1,500/$3,000
Type of Deductible Embedded Embedded Embedded
Total Annual Out-of-Pocket (OOP): Individual/Family
$4,000/$8,000 $3,000/$6,000 $4,000/$8,000
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 $50, ded waived $50, ded waived
PHYSICIAN SERVICES
PCP Office Visit $25, ded waived $25, ded waived $25, ded waived
Specialist Office Visit $50, ded waived $50, ded waived $50, ded waived
INPATIENT SERVICES
Inpatient Hospital 80%, ded applies 80%, ded applies 80%, ded applies
OUTPATIENT/OTHER SERVICES
Outpatient Lab $0, ded waived $0, ded waived $0, ded waived
Outpatient X-ray $50, ded waived $50, ded waived $50, ded waived
Complex Imaging 80%, ded applies 80%, ded applies 80%, ded applies
Outpatient Surgery 80%, ded applies 80%, ded applies 80%, ded applies
Emergency Room $200, ded waived $300, ded waived $300, ded waived
Urgent Care $75, ded waived $75, ded waived $75, ded waived
PRESCRIPTION SERVICES
Retail Pharmacy Copay $10/$45/$65 $5/$40/$60 $10/$45/$65
Specialty Rx 25% 20% up to $180 20% up to $180
Preventive Rx Waiver No Not applicable Not applicable
OUT-OF-NETWORK SERVICES
Coinsurance 50% 50% 50%
Annual Deductible: Individual/Family
$2,000/$4,000 $2,000/$4,000 $2,000/$4,000
Total Annual Out-of-Pocket (OOP): Individual/Family
$8,000/$16,000 $6,000/$12,000 $6,000/$12,000
34
MC OA 1913 compare to MC OA 12-1500-70
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME MC OA 1913 MC OA 12-1500-70 MC OA 12-2000-70
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 70% 70% 70%
Annual Deductible: Individual/Family
$1,500/$3,000 $1,500/$3,000 $2,000/$4,000
Type of Deductible Embedded Embedded Embedded
Total Annual Out-of-Pocket (OOP): Individual/Family
$4,500/$9,000 $5,000/$10,000 $6,000/$12,000
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 $60, ded waived
PHYSICIAN SERVICES
PCP Office Visit $25, ded waived $30, ded waived $30, ded waived
Specialist Office Visit $50, ded waived $60, ded waived $60, ded waived
INPATIENT SERVICES
Inpatient Hospital 70%, ded applies 70%, ded applies 70%, 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 $60, ded waived
Complex Imaging 70%, ded applies 70%, ded applies 70%, ded applies
Outpatient Surgery 70%, ded applies 70%, ded applies 70%, ded applies
Emergency Room $250, ded waived $300, ded waived $350, 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 50% 50% 50%
Annual Deductible: Individual/Family
$2,000/$4,000 $2,000/$4,000 $3,000/$6,000
Total Annual Out-of-Pocket (OOP): Individual/Family
$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
Referral Required? No No No
Coinsurance 100% 100% 100%
Annual Deductible: Individual/Family
$10,000/$10,000 $10,000/$10,000 $10,000/$10,000
Type of Deductible Embedded (1x) Embedded (1x) Embedded (1x)
Total Annual Out-of-Pocket (OOP): Individual/Family
$10,000/$10,000 $10,000/$10,000 $10,000/$10,000
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 $35, ded waived $30, ded waived
PHYSICIAN SERVICES
PCP Office Visit $35, ded waived $35, ded waived $30, ded waived
Specialist Office Visit $70, ded waived $70, ded waived $60, ded waived
INPATIENT SERVICES
Inpatient Hospital 100%, ded applies 100%, ded applies 100%, ded applies
OUTPATIENT/OTHER 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
Outpatient Surgery 100%, ded applies 100%, ded applies 100%, ded applies
Emergency Room 100%, ded applies 100%, ded applies 100%, ded applies
Urgent Care 100%, ded applies 100%, ded applies $75, ded waived
PRESCRIPTION SERVICES
Retail Pharmacy Copay $20/$50/$75 $20/$50/$75 $20/$50/$75
Specialty Rx 25% 20% up to $225 20% up to $225
Preventive Rx Waiver Not applicable Not applicable Not applicable
OUT-OF-NETWORK SERVICES
Coinsurance 70% 70% 70%
Annual Deductible: Individual/Family
$10,000/$10,000 $10,000/$10,000 $10,000/$10,000
Total Annual Out-of-Pocket (OOP): Individual/Family
$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
MC OA 1922 compare to MC OA 12-3000-100
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME MC OA 1922 HNOption 12-3000-100 MC OA 12-1500-70
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 100% 100% 70%
Annual Deductible: Individual/Family
$2,000/$6,000 $3,000/$9,000 $1,500/$3,000
Type of Deductible 3X 3X Embedded
Total Annual Out-of-Pocket (OOP): Individual/Family
$2,000/$6,000 $3,000/$9,000 $5,000/$10,000
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 $60, ded waived
PHYSICIAN SERVICES
PCP Office Visit $25, ded waived $30, ded waived $30, ded waived
Specialist Office Visit $50, ded waived $60, ded waived $60, ded waived
INPATIENT SERVICES
Inpatient Hospital 100%, ded applies 100%, ded applies 70%, 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 $60, ded waived
Complex Imaging 100%, ded applies 100%, ded applies 70%, ded applies
Outpatient Surgery 100%, ded applies 100%, ded applies 70%, ded applies
Emergency Room $200, ded waived $350, ded waived $300, 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 70% 70% 50%
Annual Deductible: Individual/Family
$3,000/$9,000 $4,000/$12,000 $2,000/$4,000
Total Annual Out-of-Pocket (OOP): Individual/Family
$6,000/$18,000 $6,000/$18,000 $8,000/$16,000
37
MC OA 1935 (HDHP) compare to MC OA 12-2500-80HSA
Aetna Plan Options Current Plan Renewal Plan Suggested Alternate
PLAN NAME MC OA 1935 (HDHP) MC OA 12-2500-80HSA MC OA 12-3000-80HSA
IN-NETWORK SERVICES
Referral Required? No No No
Coinsurance 80% 80% 80%
Annual Deductible: Individual/Family
$2,500/$5,000 $2,500/$5,000 $3,000/$6,000
Type of Deductible Non-Embedded Non-Embedded Non-Embedded
Total Annual Out-of-Pocket (OOP): Individual/Family
$5,000/$10,000 $5,000/$10,000 $6,000/$12,000
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 $0, ded waived $0, ded waived
PHYSICIAN SERVICES
PCP Office Visit 80%, ded applies 80%, ded applies 80%, ded applies
Specialist Office Visit 80%, ded applies 80%, ded applies 80%, ded applies
INPATIENT SERVICES
Inpatient Hospital 80%, ded applies 80%, ded applies 80%, ded applies
OUTPATIENT/OTHER SERVICES
Outpatient Lab 80%, ded applies 80%, ded applies 80%, ded applies
Outpatient X-ray 80%, ded applies 80%, ded applies 80%, ded applies
Complex Imaging 80%, ded applies 80%, ded applies 80%, ded applies
Outpatient Surgery 80%, ded applies 80%, ded applies 80%, ded applies
Emergency Room 80%, ded applies 80%, ded applies 80%, ded applies
Urgent Care 80%, ded applies 80%, ded applies 80%, ded applies
PRESCRIPTION SERVICES
Retail Pharmacy Copay $5/$40/$60 $20/$50/$75 ded applies $20/$50/$75 ded applies
Specialty Rx 25% 20% up to $225 20% up to $225
Preventive Rx Waiver Not applicable Ded waived for certain Preventive Rx Ded waived for certain Preventive Rx
OUT-OF-NETWORK SERVICES
Coinsurance 70% 50% 50%
Annual Deductible: Individual/Family
$3,000/$6,000 $3,000/$6,000 $6,000/$12,000
Total Annual Out-of-Pocket (OOP): Individual/Family
$6,000/$12,000 $6,000/$12,000 $10,000/$20,000
38
New
Sta
ndar
d Pl
ans
FL 2
-100
Pla
ns
Ava
ilab
le
3/1/
2012
In N
etw
ork
Ser
vice
sIn
Net
wo
rkO
ut
of
Net
wo
rk S
ervi
ces
HN
On
ly
(HM
O
Op
en
Acc
ess)
HN
Op
tio
n
(PO
S O
pen
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cces
s)
MC
O
pen
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cces
sC
oins
Ded
uctib
leO
OP
(incl
udes
de
duct
ible
)PC
P O
VSp
ec
OV
I/P H
osp
ERU
CPh
arm
acy
Coi
nsD
educ
tible
OO
P (in
clud
es
dedu
ctib
le)
12-1
500
-Com
pass
90%
/70%
$1,5
00/$
3,00
0$4
,000
/$8,
000
$25
70%
90%
aft
er $
500
70%
70%
$5/$
40/$
60N
ot a
pplic
able
X
12-2
000
-100
100%
$2,0
00/$
6,00
0$2
,000
/$6,
000
$25
$50
100%
$300
$7
5 $1
0/$4
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%$3
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18,0
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XX
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$400
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ot a
pplic
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$1,0
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2,00
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16,0
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$2,0
00/$
4,00
0$5
,000
/$10
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$10,
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$75
$20/
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$10,
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$10,
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$35
$70
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100%
100%
$20/
$50/
$75
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$10,
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0%10
0%10
0%$2
0/$5
0/$7
5N
ot a
pplic
able
X
12-1
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%$1
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5 $7
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neric
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5 80
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neric
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12-0
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N/A
N/A
$3,0
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5 $5
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ay, d
ays
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$7
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ot a
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Aet
na S
peci
alty
Rx
– 20
% m
embe
r co
insu
ranc
e (m
axim
um c
opay
app
lies,
ref
er t
o pl
an d
ocum
ents
for
det
ails
).* D
educ
tible
mus
t be
met
bef
ore
Rx
copa
ys a
pply
on
HSA
Pla
ns, h
owev
er d
educ
tible
is w
aive
d fo
r ce
rtai
n pr
even
tive
med
icat
ions
. A
com
plet
e lis
t of
the
se m
edic
atio
ns is
ava
ilabl
e on
Aet
na N
avig
ator
.Th
is is
a p
artia
l des
crip
tion
of p
lans
and
ben
efits
ava
ilabl
e. F
or m
ore
info
rmat
ion,
ref
er t
o th
e sp
ecifi
c pl
an d
esig
n su
mm
ary.
The
dol
lar
amou
nt c
opay
men
ts in
dica
te w
hat
the
mem
ber
is r
equi
red
to p
ay a
nd t
he p
erce
ntag
e co
paym
ents
indi
cate
wha
t A
etna
is r
equi
red
to
pay
unle
ss o
ther
wis
e no
ted.
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 12-2500-80HSA
HNOnly 12-3000B-50
HNOption 12-2500-80HSA
HNOnly 12-3000A-50
MC OA 12-10K-100C
MC OA 12-3000-80HSA
HNOnly 12-2000-90HSA
MC OA 12-2500-80HSA
HNOnly 12-5000-100
HNOnly 12-2000-50
HNOnly 12-1500-80HSA
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
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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.
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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
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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.
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