SAISD Health Insurance Plan2006-07

Aetna is the insurance carrier.Four plans are offered.Four plans are offered.

Aetna Health Fund 1000 ($500 up-front benefit, $1000 deductible, & no cost for the employee on “employee only” coverage)

PPO 500

PPO 250

HMO

Increase in District contribution

From $241 per employee per month to $251.35/employee/month

Overall increase in District expenditure = approx. $1 million

Total District expenditure for health insurance = approx. $24 million annually

Prescription drugs

$5 co-pay for Tier 1 drugs

$25 co-pay for Tier 2 drugs

$50 co-pay for Tier 3 drugs.

Mail order drugs – two co-pays for a three-month supply.

Mail order benefit

To use the mail order benefit, go to the Aetna web site, www.aetna.com and go to the Aetna Navigator to access the mail order form. (You will first need to register under Aetna Navigator if you have not already done so.)

Fourth quarter rollover

Any charges applied to an individual or family deductible that occurred in the fourth quarter (Oct.–Dec.) will carry over to the next year to help the individual/family meet the next year’s deductible.

Diagnostic lab and x-ray

Plan pays 100%.

Aetna Fund 1000 $500 health fund$500 health fund

Provides an upfront benefit of $500.

The fund can cover the first $500 of the deductible, reducing the effective deductible to only $500.

The family fund is $1000.

Accrues, without limit, if all or some of the $500/1000 is not expended in one year.

Aetna Fund 1000 NoNo co-pay for preventive care co-pay for preventive care

Preventive care includes physicals, flu shots, mammograms, and colonoscopy.

Any of the more expensive tests are covered when indicated by age or other risk factors.

Aetna Fund 1000Inpatient hospital coverageInpatient hospital coverage

Plan pays 100% after deductible.

Aetna Fund 1000Physician servicesPhysician services

Unused part of the $500 health fund will be used to cover doctor visits before the individual has to pay.

Preventive care by physician will be provided at no cost to the individual.

After deductible, for non-preventive care, plan pays 80% for both primary care physicians and specialists.

HMO Open AccessOpen Access

Individuals will be allowed to go to a specialist without referral from primary care physician.

Employee Assistance Program

Provided at no cost to covered District employees and their families.

Covered individuals are eligible for up to three confidential sessions with a professional counselor to discuss personal or family problems, such as divorce, drug or alcohol abuse financial problems, etc..

Call 1-888-238-6232.

Health Risk Assessment

Every quarter Aetna will draw for three $500 gift certificates to award to individuals who complete the electronic health risk assessment.

To access the assessment, go to www.aetna.com and click on the Aetna Navigator. (You will first need to register if you have not already done so.) Once you're in Navigator, click on Take Action on Your Health on the toolbar. Then click on Staying Healthy, then on Simple Steps to a Healthier Life. You will then need to register in order to take the health risk assessment.

The results of the assessment can provide you with information to help you be proactive with regard to your health.

Steps employees may want to take

Check your regular prescriptions to see what tier they are in.

If any of your regular prescriptions are in a higher tier than currently, talk with your physician about whether another medication could be prescribed.

On-site Aetna rep

In the request for proposals last year, the District included the requirement that the insurance company provide an on-site representative for the district.

SAISD on-site Aetna rep is Cynthia Navarro.

She can be reached at 299-5571 or via email at NavarroCY@aetna.com.

Steps employees may want to take, cont.

Check to see if your doctor(s) are in the Aetna network.

If any of your doctors are not in the network, ask them about whether they would be willing to become part of the network.

Review the plans to see which plan best meets your needs.

Committee’s review of scenarios indicates

Employees with modest to moderate medical needs will most likely benefit from selecting Aetna Fund 1000.

Most employees with high medical needs will most likely benefit from selecting the HMO or high option PPO ($250 deductible).

Some employees with high medical needs will benefit from selecting Aetna Fund 1000.

The low option PPO ($500 deductible) is least likely to be the best alternative for any employee.

How can you take best advantage of the new health insurance program?

Go to your doctor for an annual physical. FREE Go to your doctor for regular tests indicated by

your age. FREE Take the online Risk Assessment and follow the

recommendations. FREE Participate in the disease management program,

if indicated. FREE Use mail order for maintenance drugs.