Your 2015 Health Informational Meeting Health Care Focused on You

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1 Your 2015 Health Informational Meeting Health Care Focused on You Quality health plans & benefits Healthier living Financial well-being Intelligent solutions

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3 Agenda Introduction of Seton Health Alliance Plan Highlights and rates Tools and Resources Summary 3

4 Introducing Aetna Whole Health Seton Health Alliance It s a whole new way of looking at health care. Led by your primary care doctor, your care team's goal is to: Keep you healthy or improve your health, not just treat you when you re sick or injured Better coordinate your care by using health data supplied by Aetna Stay up to date on medical guidelines and clinical information Encourage you to play an active and informed role 4

5 The Seton Health Alliance Story Provider Support Staying Healthy Seaton Speaks Patient Information is Powerful Building Bridges

6 Choosing a Primary Care Physician* Why it matters: Every team needs a leader. And the primary care doctor you pick will lead your Aetna Whole Health Seton Health Alliance care team. Your doctor gets to know you and your medical history and sees you for your annual wellness exam and preventive screenings. So should you get sick, your primary care doctor can treat you and help guide you on important health decisions as well as direct your care across other specialties and facilities in your network. Be#er Care Be#er Cost Be#er Health *Not required 6

7 Aetna Whole Health Seton Health Alliance coverage area Williamson, Travis and Hays counties 700+ primary care physicians 3,000+ specialists 10 hospitals Dell Children s Medical Center of Central Texas Map is for illustrative purposes only. Please consult DocFind for the most up-to-date information on providers and facilities in the Aetna Whole Health Seton Health Alliance network. 7

8 Aetna Whole Health Seton Health Alliance For illustrative purposes only. Please consult DocFind for the most up-to-date information on providers and facilities in the Aetna Whole Health Seton Health Alliance network. 8

9 Section 1: Plan Details

10 Medical Plan Designs Gold Choice POS II In Network Gold Seton Select In Network Pla:num Choice POSII In Network HSA Seton Select In Network Deductible/family deductible $500 / $1,500 $300 / $900 $0 / $0 $1,500 / $3,000 Coinsurance (member pays) 20% 20% 20% 20% Out-of-pocket max/ family out-of-pocket max Preventive Care (frequency limits apply) $2,500 / $7,500 $2,300 / $6,900 $1,000 / $3,000 $4,500 / $9,000 Covered 100% Covered 100% Covered 100% Covered 100% Doctor visit (PCP) $25 copay; deductible waived $25 copay; deductible waived $20 copay 20% after deductible Specialist visit $25 copay; deductible waived $25 copay; deductible waived $20 copay 20%; after deductible Prenatal Maternity Covered 100%; deductible waived Covered 100%; deductible waived Covered 100%; Covered 100%; deductible waived In-patient Hospital 20% after $500 copay; after deductible 20% after $500 copay; after deductible 20% 20% after deductible Outpatient Hospital 20% after deductible 20% after deductible 20% 20% after deductible Emergency $100 copay; deductible waived $100 copay; deductible waived Urgent care $45 copay; deductible waived $45 copay; deductible waived 20% after $100 copay 20% after deductible $45 copay 20% after deductible Prescription coverage (Generic / Brand Formulary / Non Formulary) $10 / $25 / $45 $10 / $25 / $45 $10 / $25 / $40 20% after deductible 10

11 Monthly Medical Rates 12 Months Aetna Medical Plans District Contribution Employee Contribution Platinum Choice EE -- Employee $ $ EC -- Employee + Child(ren) $ $ ES -- Employee + Spouse $ $ EF -- Employee + Family $ $1, Gold Select (Seton Network) EE -- Employee $ $0.00 EC -- Employee + Child(ren) $ $ ES -- Employee + Spouse $ $ EF -- Employee + Family $ $ Gold Choice EE -- Employee $ $46.25 EC -- Employee + Child(ren) $ $ ES -- Employee + Spouse $ $ EF -- Employee + Family $ $ HSAPlan (Seton Network) EE -- Employee $ $ $0.00 EC -- Employee + Child(ren) $ $63.11 ES -- Employee + Spouse $ $ EF -- Employee + Family $ $

12 Monthly Medical Rates 9 Months Aetna Medical Plan District Contribution Employee Contribution Platinum Choice EE -- Employee $ $ EC -- Employee + Child(ren) $ $ ES -- Employee + Spouse $ $1, EF -- Employee + Family $ $1, Gold Select (Seton Network) EE -- Employee $ $0.00 EC -- Employee + Child(ren) $ $ ES -- Employee + Spouse $ $ EF -- Employee + Family $ $ Gold Choice EE -- Employee $ $61.67 EC -- Employee + Child(ren) $ $ ES -- Employee + Spouse $ $ EF -- Employee + Family $ $1, HSAPlan (Seton Network) EE -- Employee $ $ $0.00 EC -- Employee + Child(ren) $ $84.15 ES -- Employee + Spouse $ $ EF -- Employee + Family $ $

13 Section 2: Member Tools 13

14 Save on staying healthy Discount programs for Aetna Fitness SM, Aetna Vision SM, Aetna Natural Products and Services SM, Aetna Weight Management SM and Aetna Hearing SM Savings on dental products and more Navigator A one-stop member site to manage your plan and health needs Manage your Aetna plan, check on a claim and find forms, and contact Member Services View an Explanation of Benefits Get pharmacy information or a temporary ID card Reach your health goals Simple Steps To A Healthier Life Balance work and life Employee Assistance Program Find health information Aetna InteliHealth Healthwise KnowledgeBase Aetna SmartSource SM (personalized) Research prescription drugs and look up the costs of services Compare hospital outcomes Find in-network doctors Store and share your health history Personal Health Record (PHR) Virtual Assistant Ask Ann provides 24/7 access

15 Navigator 15

16 Building your care team Navigator First, choose a primary care doctor to lead your care team. To find one: Visit Type a name, specialty, procedure or condition in the Who or what are you looking for? box Enter your zip code in the Where? box Choose (TX) Aetna Whole Health Seton Health Alliance from the Select a Plan drop down menu (Seton Plans) Choose Aetna Choice POS II (Open Access) from the Select a Plan drop down menu (Platinum and Gold) Pick a doctor and take note of his or her name and seven-digit Provider ID 16

17 Mobile Search for in-network doctors, dentists or hospitals Use the Urgent Care Finder View your claims, coverage and benefits View your ID card information

18 Summary Aetna will be the new health care administrator for medical, pharmacy and disability. Choose a primary care physician if you select one of the Seton plans. Aetna Navigator is your one-stop shop for information regarding your health plan. Look out for dates and locations of the informational meetings. Questions about the new health plan? Call Aetna customer service at

19 Thank you! Health benefits and health insurance plans are offered, administered or underwritten by Aetna Health Inc., Aetna Health of California Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Florida, by Aetna Health Inc. and/or Aetna Life Insurance Company. In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT Each insurer has sole financial responsibility for its own products. This managed care plan may not cover all of your health care expenses. Read your contract carefully to determine which health care services are covered. To contact the plan if you are a member, call the number on your ID card; all others, call AETNA ( ). This material is for information only. Health benefits and health insurance plans contain exclusions and limitations. 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. If you are in a plan that requires the selection of a primary care physician and your primary care physician is part of an integrated delivery system or physician group, your primary care physician will generally refer you to specialists and hospitals that are affiliated with the delivery system or physician group. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. 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 care services. The Aetna Personal Health Record should not be used as the sole source of information about the member s medical history. Discount offers provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services. 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 Policy forms issued in OK include: HMO OK COC-5 09/07, HMO/OK GA-3 11/01, HMO OK POS RIDER 08/07, GR-23 and/or GR-29/GR-29N Aetna Inc. 9/14