An Insider s Guide to 2012 Enrollment. Non-Medicare Eligible The Home Depot

Transcription

1 An Insider s Guide to 2012 Enrollment Non-Medicare Eligible The Home Depot

2 Why read this As a retiree not eligible for Medicare, The Home Depot has selected Retiree Health Access (RHA ) to bring you high quality health care benefits specially designed for you. The 2012 Enrollment Guide is here to help you understand your health benefit options. By reading it, you ll know what s right for you. You ll learn how RHA can help you live healthy and save money. So read this guide carefully. After all, there is nothing more important than your health. Happy reading! If you need help The Retiree Service Center can answer your questions about your plan, billing, eligibility and enrollment. Call us: TTY/TDD: Monday through Friday 8 a.m. 9 p.m., Eastern Time or Go online:

3 Where to find what Introduction How can I get the most from this Insider s Guide?... 3 What is Retiree Health Access (RHA)?... 5 Why Aetna?... 5 What can RHA do for me?... 7 Am I eligible for RHA?... 7 Health Plans What can I expect from my RHA plan? Health Plan Comparison Chart What can I expect from my Prescription Drug plan? Prescription Drug Chart What can I expect from my RHA dental? Retiree Dental Plan Comparison Chart Programs and Services Are there special programs and services offered? Enrollment What can I learn online before I enroll? How easy is it to use DocFind to locate providers nearby? What should I consider before enrolling? How can I enroll? What information is available online after I enroll? What do I do if I have questions? What will I get after enrolling? Common terms Disclaimers Learn More Important Disclosure Information

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5 Non-Medicare Eligible How can I get the most from this Insider s Guide? 1. Read Your guide 2. Write Write down the key benefits of your plan options Write down how much you currently pay for your health care needs; include premiums, copays and coinsurance Write down your current prescription drug needs and costs Write down any additional health insurance coverage you may have 3. Ask Call the Retiree Service Center at , TTY/TDD: , for answers to questions about eligibility and enrollment 4. Enroll Review your Personal Enrollment Worksheet Call Go online Be Sure you don t miss out. Know your enrollment deadline. This can be found in your Personal Enrollment Worksheet. 3

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7 Non-Medicare Eligible What is Retiree Health Access (RHA)? Retiree Health Access (RHA) offers you a unique health benefit resource. Created by the HR Policy Association, Retiree Health Access is a coalition of leaders in business and industry that has partnered with Aetna, an innovator in health benefit solutions. Working together, RHA and Aetna share a common goal to make high quality health care available and affordable for all retirees, including those not yet eligible for Medicare. Why Aetna? Quite simply, Aetna is a leader in health care benefits. Aetna s nationwide network of doctors, hospitals and pharmacies serves more than 18 million medical members and more than nine million pharmacy members. Aetna is committed to helping its members stay well, with generous preventive care benefits and discounts on health-related products and services. Most important, Aetna believes that the best care is the care that s right for you. So Aetna works to bring you what you need to help you live a healthy life. 5

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9 Non-Medicare Eligible What can RHA do for me? RHA strives to offer retirees health care benefits that are easy to access, understand and afford. Keep in mind, your specific benefits depend on your plan. Take a closer look: Accessibility You ll have access to coverage, regardless of your current health status. Receive both the coverage and premium that are right for you. From preventive exams to prescriptions, our extensive coverage will take care of your needs. Take advantage of our generous preventive care benefits, including recommended cancer screenings at no cost to you. Access a number of healthy living resources including weight management, tobacco cessation and more. Receive nationwide access to quality coverage and services. Support Get the support you need to make important decisions so you better understand and make the most out of your plan and benefits. Receive online and telephone support to get the answers you need. Keep track of all your medical information with the Personal Health Record, then easily share it with your doctor. Affordability Get the health plan that works for you and your budget. Receive discounts on dental and vision care as well as alternative health treatments. Take advantage of competitive premiums offered to you because you re part of a large pool of retirees eligible for group rates. Am I eligible for RHA? You are eligible to enroll in an RHA plan if you meet the following requirement: You are a retiree or a dependent of a retiree who is no longer a full-time or part-time employee. If your dependent(s) are not eligible for Medicare, they may be eligible to enroll in a coverage option specifically for those not eligible for Medicare. 7

10 8 What can I expect from my RHA plan?

11 Non-Medicare Eligible The Network Option Plan* What it is: This plan lets you choose health care professionals and facilities in or out of network. Your plan, available through RHA, is a Network Option Plan. How it works: You are required to meet an annual deductible each year. What s special: Preventive care is paid in full. No deductible for preventive care if certain in-network providers are used. There is an out-of-pocket cap on expenses. (Once you meet the out-ofpocket maximum, the plan pays the remaining covered expenses at 100% for the rest of the year.) The Network Option High (CDHP) plan is compatible with the requirements of the Health Savings Account (HSA). You can use the HSA to offset the higher out-of-pocket expenses of a high-deductible health plan. What you should know: If you choose in-network providers, you ll pay less out of pocket. To find a doctor in your network, visit DocFind at custom/rhagroup or call a representative to help you at For some benefits, once you meet the deductible, you may share in any remaining expenses. Under some plans, you may be required to pay a fixed fee or copay for a covered service. Some plans require you to pay a combination of copays and coinsurance. To understand how cost sharing for the Aetna Network Option Plans work, please review your plan documents. All Network Option Plans available to you will use the same provider network. * The Network Option Plan includes Aetna Open Access Managed Choice Network or Aetna Open Choice Network Option Plan or the Aetna Choice POS II Plan. 9

12 10 Aexcel : The High Performance Network Available through a Network Option Plan, Aexcel offers specialist services, whether it s an outpatient or inpatient situation. Selecting an Aexceldesignated specialist could mean you have a lower copay or coinsurance. You can be sure that an Aexcel specialist meets a variety of standards established by leading health organizations such as the American Heart Association, American College of Obstetricians and Gynecologists and Centers for Medicare & Medicaid Services.

13 Non-Medicare Eligible The Indemnity (Traditional Choice ) Plan* What it is: If you are offered a Network Option Plan but live outside the area it serves, you can enroll in the Indemnity Plan. How it works: After you meet the annual deductible, the plan pays a percentage of covered expenses (coinsurance) and you pay the rest. What s special: There is an out-of-pocket cap on expenses. Once you meet the out-ofpocket maximum, the plan pays the remaining covered expenses at 100% for the rest of the year. Preventive care is paid in full. There is no deductible for preventive care. What you should know: The Indemnity Plan lets you visit any licensed provider when you need care. *The Traditional Choice Plan is considered an out-of-area or indemnity plan. 11

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15 2012 Health Plan Comparison Chart 13

16 Access, Affordability, Choice Our retiree health plans are designed to help you stay well. We offer health benefits for retirees that make it easy as well as affordable to get the appropriate care. For most benefits, you will pay applicable fees or copays after you meet your deductible, if your plan has a deductible. With a strong commitment to help keep retirees healthy, preventive care is paid in full. This means you will have a $0 deductible or no copay or coinsurance for preventive care services. In-network preventive services include: Routine Physical Exams/Immunizations (One exam every 24 months/ Pneumonia, Flu, Hepatitis B) Routine Gynecological Care Exams (One routine ob/gyn visit and pap smear per calendar year) Routine Mammograms (One annual mammogram for members age 40 and over) Routine Prostate-Specific Antigen (PSA) Test and Digital Rectal Exam (DRE) (One annual test and exam for males age 40 and over) Routine Eye Exam (One exam every 24 months, subject to cost sharing) Routine Hearing Screening (One exam, every 24 months, subject to cost sharing) Please keep in mind this is not a complete listing of benefits; however, once you enroll you will receive an Evidence of Coverage that explains the full terms of your plan and how it works, including a complete description of benefits, exclusions, limitations and conditions of coverage; or you can visit the Aetna Navigator member website. Aetna Navigator is a secure website ( available to you 24 hours a day, 7 days a week. For more information, contact a representative at TTY/TDD: Note: You first need to register on the Aetna Navigator site to get your protected user name and password. Go to Use the First Time User box to register Follow the instructions If you are already registered, then go to and log in with your user name and password anytime! 14

17 How to get the most from these charts: The Home Depot has teamed with Retiree Health Access (RHA ) to help you stay healthy. But for that to happen, you need to know your options. The charts will help you find the plan that s right for you. 1. Scan q Take a quick look at the information. You ll see the name and the features of each plan. Similarly, look at the prescription drug plan chart to see how the information is grouped and displayed. 2. Look q Now take a closer look at the plan features. Look at, for example, the annual deductible, preventive care services and physician services. See what differentiates each plan. Be sure to match the health plan you choose to the corresponding prescription drug plan. 3. Write q Write down the type of plan(s) you want to investigate further. Write down any key features and their related expenses, per plan. Write down any questions you may have. 4. Refer q To find out more about your health plan, plan features and/or prescription drug plan, please refer to your enrollment guide for Helpful tip: Take a ruler or edge of a magazine and lay it horizontally across the chart to make it easier to distinguish how the features of each plan vary. If you prefer to view the information by plan, rather than by feature, place the ruler or magazine vertically. Not all of the plans in these charts may be available to you depending on where you live. Please refer to your Personal Enrollment Worksheet to see which plans you are eligible to enroll in. 15

18 Non-Medicare Eligible Plan Features The coinsurance percentage shown applies after you meet the annual deductible. Annual Deductible Coinsurance Out-of-Pocket Maximum (Includes deductible; excludes all copays and penalty amounts) Preventive Care Services Routine Eye and Hearing Screening (One exam every 24 months) Physician Services Primary Doctor Office Visit Network Option High (CDHP) SA High (CDHP) Indemnity SA In-Network Out-of-Network¹ Retirees not in Network Area $1,500 Individual 2 $3,000 Family 2 $1,500 Individual 2 $3,000 Family 2 $1,500 Individual 2 $3,000 Family 2 20% 40% 20% $3,600 Individual 3 $7,200 Family 3 (includes Rx expenses) $0; deductible waived $10,000 Individual 3 $30,000 Family 3 (includes Rx expenses) $3,600 Individual 3 $7,200 Family 3 (includes Rx expenses) 40% $0; deductible waived 20% 40% 20% Specialist Office Visits (Includes outpatient mental health and substance abuse) 20% for designated specialists; 30% for non-designated specialists 40% 20% Specialist Services (Other than office visit) X-ray and Lab Services (During office visit) 20% for designated 40% 20% specialists; 30% for non-designated specialists 20% 40% 20% Emergency Services Emergency Room (Copay waived if admitted) 20% 20% 20% Ambulance Hospital Services Hospital Admission (Includes mental health and substance abuse) Outpatient Hospital Alternatives to Hospital Care Skilled Nursing (Max. 60 days), Home Health (Max. 120 days) and Urgent Care Other Services X-ray and Lab (Outpatient) Outpatient Therapy DME/Prosthetics ($10,000 annual maximum) Chiropractic Care 16 20% 20% 20% 20% 40% 20% 20% 40% 20% 20% 40% 20% 20% 40% 20% 20% 40% 20% 20% 40% 20% 20% 40% 20%

19 Network Option Value SA Value Indemnity SA In-Network Out-of-Network¹ Retirees not in Network Area $7,500 Individual 2 $15,000 Family 2 $7,500 Individual 2 $15,000 Family 2 $7,500 Individual 2 $15,000 Family 2 20% 40% 20% $10,000 Individual 3 $20,000 Family 3 (includes Rx expenses) $15,000 Individual 3 $30,000 Family 3 (includes Rx expenses) $10,000 Individual 3 $20,000 Family 3 (includes Rx expenses) $0; deductible waived 40% after deductible $0; deductible waived 20%, deductible waived 20% for designated specialists; 30% for non-designated specialists 40% 20%, deductible waived 40% 20% 20% for designated specialists; 30% for non-designated specialists 20% (deductible waived if primary care office visit) 40% 20% 40% 20% (deductible waived if primary care office visit) 20% 20% 20% 20% 20% 20% 20% 40% 20% 20% 40% 20% 20% 40% 20% 20% 40% 20% 20% 40% 20% 20% 40% 20% 20% 40% 20% 17

20 Check your plan documents to find out whether the Retiree Health Access plan option(s) available to you feature the Aexcel network (designated specialists). Aexcel is a physician designation within Aetna s Performance Network that includes high performance specialists (cardiology, cardiothoracic surgery, gastroenterology, general surgery, neurology, neurosurgery, obstetrics/gynecology, orthopedic surgery, otolaryngology, plastic surgery, urology and vascular surgery). 1 Member coinsurance and deductible share for non-network plans are based on reasonable and customary fees. 2 Once the family deductible is met, all family members will be considered as having met their deductible for the remainder of the calendar year. There is no individual deductible to satisfy within the family deductible. 3 Once the family out-of-pocket maximum is met, all family members will be considered as having met their out-of-pocket maximum for the remainder of the calendar year. There is no individual out-of-pocket maximum to satisfy within the family out-of-pocket maximum. 18

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22 What can I expect from my Prescription Drug plan? 20

23 Non-Medicare Eligible Prescription Drug Plan What it is: This plan provides coverage that helps you pay the cost of prescription drugs. How it works: You can fill prescriptions at more than 60,000 network pharmacy locations. You simply pay your cost-sharing amount at the pharmacy. Virtually no paperwork. What s special: You pay a coinsurance or copay subject to a maximum for each prescription with no deductible required. Aetna Rx Home Delivery service You can order up to a 90-day supply of medications you use regularly delivered to your home or another location of your choice, with no cost for standard shipping. Aetna Specialty Pharmacy You can get: free, confidential delivery at home or any other location you choose safe, fast delivery refrigerated, insulated packaging of your prescriptions 24/7 phone support free, standard supplies for self-injectable medications educational materials medications not normally available through a retail pharmacy 21

24 Network Option High (CDHP) SA High (CDHP) Indemnity SA Network Option Value SA Value Indemnity SA Prescription Drug Plan In- Network Out-of- Network Retirees not in Network Area In- Network Out-of- Network 1 Retirees not in Network Area Retail Pharmacy (30-day supply) Generic $0 after annual medical deductible $20 copay after deductible 1 Preferred Brand 25% after annual medical deductible $40 copay after deductible 1 Non-Preferred Brand 50% after annual medical deductible $60 copay after deductible 1 Mail-Order Pharmacy (90-day supply) Generic $0 after deductible Not applicable $0 after deductible $40 copay after deductible 1 Not applicable $40 copay after deductible 1 Preferred Brand 25% after deductible Not applicable 25% after deductible $80 copay after deductible 1 Not applicable $80 copay after deductible 1 Non-Preferred Brand 50% after deductible Not applicable 50% after deductible $120 copay after deductible 1 Not applicable $120 copay after deductible 1 1 Deductible waived for certain chronic and preventive medicines. 22

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26 What can I expect from my RHA dental? 24

27 Non-Medicare Eligible Aetna Dental PPO* Plan Choose any dentist in or out of our network; you ll likely save more when your dentist is participating within our network. No referral required for covered services. Affordable coverage on dental cleanings, X-rays, restorative work and more. Participating dentists have agreed to offer services at a special rate so you generally pay less out of pocket for your care. Manage your dental benefits it s a snap! It s easy with your secure member website. Visit to: Find a network dentist through our DocFind online directory Get estimated average costs for cleanings, X-rays and more Check claims and statements Request replacement ID cards * In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). Dental PPO plans are underwritten and/or administered by Aetna Life Insurance Company (Aetna). Policy form numbers in Oklahoma include: GR-9 and/or GR-9N, GR-23, GR-29 and/or GR-29N. 25

28 2012 Retiree Dental Plan Comparison Chart Non-Medicare and Medicare Eligible Aetna Dental PPO Plan In-Network Out-of-Network Aetna Dental Plan Features Indemnity For Retirees not in Network Area Annual Deductible * Single $100 $100 $100 Annual Deductible * Family $200 $200 $200 Preventive Services No coinsurance 1 No coinsurance 2 No coinsurance 2 Basic Services Pay 50% 1 Pay 50% 2 Pay 50% 2 Major Services Pay 50% 1 Pay 50% 2 Pay 50% 2 Annual Benefit Maximum $1,000 $1,000 $1,000 1 Only participating dentists have agreed to negotiated rates for Aetna members. Costs may be higher when a member obtains services outside the Aetna network. 2 Members who visit a licensed dentist who does not participate in the Aetna network may be subject to balance billing (the difference between the amount covered by the plan and the amount charged by the dentist). *The deductible applies to: basic and major services. 26

29 Partial Listing of Services Preventive Services Basic Services Major Services -Oral examinations (a) - Cleanings, including scaling and polishing (a) adult/child Bitewing X-rays (a) Full mouth series X-rays (a) Space maintainers - Root canal therapy, with X-rays and cultures Anterior teeth/bicuspid teeth -Amalgam (silver) fillings - Composite fillings (anterior teeth only) -Stainless steel crowns -Scaling and root planing (a) -Gingivectomy (b) - Incision and drainage of abscess (b) -Uncomplicated extractions - Surgical removal of erupted tooth (b) - Surgical removal of impacted tooth (soft tissue) (b) - Root canal therapy, with X-rays and cultures (a) (b) -Osseous surgery - Surgical removal of impacted tooth (partial bony/full bony) (b) - General anesthesia/intravenous sedation (b) -Inlays -Onlays -Crowns -Full and partial dentures -Denture repairs -Pontics -Crown Lengthening -Crown Build-Ups (a) Frequency and/or age limitations may apply to these services. These limits are described in the booklet/certificate or evidence of coverage. (b) Certain services may be covered under the Medical Plan. Contact Member Services for more details. Eligibility rules apply for all plans. This material is for informational purposes only. Not all services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. In the event of a conflict or inconsistency between this material and plan documents, the terms of the plan documents shall govern. State mandates may apply. All products may not be available in all states. These benefit summaries are provided by Aetna Life Insurance Company. Under the Aetna Dental Preferred Provider Organization (PPO) plans, you may choose at the time of service to visit either a PPO network dentist or any out-of-network licensed dentist. With the PPO plan, savings are possible because the network dentists have agreed to provide care at a negotiated fee. Out-of-network benefits are subject to reasonable and customary charge limits. Under the Indemnity plan you may choose to visit any licensed dentist and benefits are subject to reasonable and customary charge limits. 27

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31 Non-Medicare Eligible Are there special programs and services offered? Yes! Your RHA plan includes a variety of programs and services that help you stay well. They include: Health and Wellness Discounts and Programs Availability may vary by plan. Aetna Vision SM discount program save on routine eye exams and select items and services, including LASIK surgery. Aetna Hearing SM discount program save on hearing aids, comprehensive hearing tests and hearing-aid services from licensed professionals, in certain areas. Aetna Natural Products and Services SM discount program offers reduced rates on acupuncture, chiropractic care, massage therapy and dietetic counseling through American Specialty Health Incorporated (ASH) and its subsidiaries. ASH also offers discounts on over-the-counter vitamins, herbal and nutritional supplements and natural products. Through Vital Health Network, members can receive a discount on online consultations and alternative remedies provided by medical doctors for a variety of conditions. 29

32 Aetna Fitness SM discount program access preferred rates on gym memberships and discounts on at-home weight-loss programs, home fitness options and one-on-one health coaching services; not available in all states. Aetna Weight Management SM discount program access for you and your eligible family members to discounts on ediets diet plans and products, Jenny Craig weight-loss programs and products and Nutrisystem weightloss meal plans.* Healthy Lifestyle Coaching speak to a licensed professional by phone to develop a specific program based on your health needs; learn how to manage weight and/or stress, quit smoking and maintain good health. Core Features Availability may vary by plan. Aetna Health Connections SM Disease Management Program offers educational materials and resources designed to help you live better with conditions such as diabetes, heart problems, asthma or arthritis. Health Risk-Assessment Tools evaluate your potential health care needs and get tips to manage your health conditions. Personal Health Record keep track of essential health information in a single, secure location online; get tips on alternative therapies; track important health numbers, like blood pressure, weight and other health markers in easy-to-understand graphs and charts. *Discounts do not apply to some plans, programs, food and/or products. 30

33 Non-Medicare Eligible Nurse Case Managers get personalized support for chronic and/or serious health conditions from specially trained medical professionals. Informed Health Line 1 speak with a registered nurse, 24/7, on healthrelated issues; access Aetna s Audio Health Library to learn about various health conditions in English or Spanish. National Medical Excellence Program offers access to our national Institutes of Excellence Transplant Network for transplants and transplantrelated services. It includes medical management through the recovery period. Case management is also provided for members with rare or complex conditions requiring specialized treatment. Patient Safety through Care Considerations get timely alerts and additional reminders that can help you stay healthy. These messages may warn you of potentially dangerous drug combinations, or remind you of important tests and screenings. DocFind If you have an Aetna Medicare Plan (PPO or HMO) or an Aetna Medicare Rx (PDP), you have access to this online provider directory, making it easier to find physicians, hospitals, pharmacies and other participating health care professionals; search by name, ZIP Code, city, state, specialty and/or hospital affiliation. 1 While only your doctor can diagnose, prescribe or give medical advice, the Informed Health Nurses can provide information on more than 5,000 health topics. Contact your doctor first with any questions or concerns regarding your health care needs. 31

34 What can I learn online before I enroll? You can learn how to be smart about your health and your health plan. Before you enroll, you can visit to learn about: personalized benefits information for which you re eligible your plan s description a link to DocFind, the online provider directory, so you can see if your doctor is in our network How easy is it to use DocFind to locate providers nearby? It s as easy as logging on to to find providers and hospitals who participate in your plan s network. Then, follow these simple steps: Step 1: Enter your geographic search information which includes your ZIP Code, city or county. Step 2: Select the provider category you are searching for. Step 3: Select the provider type you are searching for. Step 4: Select the plan name. (Please see the plan names listed on your Health Plan Comparison Chart included in this enrollment kit.) You can simply enter the required information listed above. Or, to be more specific, you can click on the More Options button. This option will allow you to find a provider by more detailed criteria, such as provider name, level of care, age range, type of service and number of results you want to view per page. Once you ve completed the information requested, click on the Start Search button to see the results of your search. If you do not have access to a computer, call a representative dedicated to finding a doctor at

35 Non-Medicare Eligible What should I consider before enrolling? To enroll in a health plan that s right for you, consider your needs, such as: Your health: Do you see a doctor often? Do you have a chronic condition that requires ongoing care, or do you visit the doctor for routine or preventive care reasons? Consider how frequently you see a health care provider. Your budget: Look at how the plan you re considering covers the expenses you may expect to incur. How will you pay for doctors office visits, hospital stays and emergency care? How much is your deductible? How much is your monthly premium? To find out what your monthly premium would be, please check your Personal Enrollment Worksheet. Your prescription drugs: Do you take prescription drugs on a regular basis? How much are you spending? Other coverage: If you re eligible for other coverage, compare that plan s benefits to your RHA plan. 33

36 How can I enroll? Call us: TTY/TDD: You ll follow a few simple instructions to enroll. You ll complete the process by speaking with a Retiree Service Center representative, who is available Monday through Friday, 8 a.m. 9 p.m., Eastern Time. or Go online: You ll follow the prompts and in a few minutes, you ll be enrolled. If you d like, you ll receive a confirmation in the mail. 34

37 Non-Medicare Eligible What information is available online after I enroll? Access Aetna s secure member website, Aetna Navigator, to learn about: benefits information so you can better understand your plan claims information, such as claim status and Explanation of Benefits statements cost-of-care tools that provide the estimated average cost of procedures, office visits, tests and more a hospital comparison tool self-service features such as requesting a replacement ID card reliable, current health information through links to Aetna InteliHealth, Aetna s award-winning health and wellness website What do I do if I have questions? What you need I have questions about my plan, billing, eligibility and/or enrollment information. I need help with claims, using my plan and/or locating a doctor. I need to print temporary ID cards, review coverage, search the formulary and/or locate a provider. I need a 24-hour toll-free nurse hotline. I need educational illustrations and interactive online features to help me learn about health care. I need mail-order prescription drug refills and status information. Where to get it Retiree Service Center Monday through Friday 8 a.m. 9 p.m., Eastern Time Member Services See your Member ID card for contact information Aetna Navigator Informed Health Line Aetna InteliHealth Aetna Rx Home Delivery* See your Member ID card for contact information * Applicable for Retiree Health Access prescription drug plans. 35

38 What will I get after enrolling? What to expect next Benefit Confirmation Statement Letter stating we have processed your enrollment; you also get an application to start automatic withdrawal of premium payments from a checking account. Premium Payments Payment options include automatic withdrawal, coupon book or monthly paper statement. If you ve recently enrolled in Automated Clearing House (ACH), contact the Aetna Retiree Service Center before sending your initial payment. Booklet Certificate and Summary of Coverage Provides a full explanation of how your plan works. Member ID Card Member ID card to share with providers. When you can expect it Approximately 1 to 2 weeks after your enrollment is received Premium payments due 1st of each month Approximately 90 to 120 days from effective date, you can view online at or request a print copy by calling the Member Services phone number on your ID card Approximately 1 to 2 weeks prior to your effective date 36

39 Non-Medicare Eligible Common Terms Aexcel: A provider designation within Aetna s network that includes specialists who have demonstrated effective delivery of care based on measures of clinical performance and efficiency. Benefit: The expenses and services a health plan covers. Coinsurance: The percent of covered expenses for which you are responsible. With some plans, you do not pay coinsurance until you have first paid a deductible. Copayment (Copay): The set amount you pay for select plan benefits such as a doctor s visit. Deductible: A set amount you may be required to pay before you receive coverage for your plan benefits. Dependent: Your spouse, domestic partner and/or eligible dependent child who meets the eligibility criteria and requirements set forth by your former employer. Health Savings Account: A tax-advantaged account that allows money to go in tax free, earn interest tax free and is not taxed when it s withdrawn to pay for qualified expenses. Network: A group of doctors, hospitals and other health care providers who contract with Aetna to offer care. Premium: The monthly cost for your plan coverage. PCP: A commonly used abbreviation for primary care physician. It is a doctor who provides primary care services to you and usually specializes in family practice or internal medicine. Rx: A commonly used abbreviation for a prescription or pharmacy. Traditional Choice Plan: A health plan that lets members receive care from any licensed provider. These plans often include deductible, coinsurance, benefit maximums and lifetime maximums. 37

40 Disclaimers Benefits coverage is provided by Aetna Health Inc., Aetna Health of California Inc. and/or Aetna Life Insurance Company. This material is for informational purposes only. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Aexcel designation is only a guide to choosing a physician. Members should confer with their existing physicians before making a decision. Designations have the risk of error and should not be the sole basis for selecting a doctor. Aetna receives rebates from drug manufacturers that may be taken into account in determining the Aetna Preferred Drug List. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. Pharmacy clinical programs such as precertification, step therapy and quantity limits may apply to your prescription drug coverage. Aetna Rx Home Delivery and Aetna Specialty Pharmacy refer to Aetna Rx Home Delivery, LLC and Aetna Specialty Pharmacy, LLC, respectively. Aetna Rx Home Delivery and Aetna Specialty Pharmacy are licensed pharmacy subsidiaries of Aetna Inc. that operate through mail order. The charges that Aetna negotiates with Aetna Rx Home Delivery and Aetna Specialty Pharmacy may be higher than the cost they pay for the drugs and the cost of the mailorder pharmacy services they provide. For these purposes, the pharmacies cost of purchasing drugs takes into account discounts, credits and other amounts that they may receive from wholesalers, manufacturers, suppliers and distributors. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Discount programs provide access to discounted prices and are not insured benefits. The Aetna Personal Health Record ( PHR ) should not be used as the sole source of information about the member s medical history. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to State mandates may apply. Product availability may vary by state. Retiree Health Access reserves the right to change or terminate benefit plans at any time. Retiree Health Access and RHA are registered trademarks of Health Care Policy Roundtable, LLC, used under license with Health Care Policy Roundtable. All rights reserved. 38