2015 HSA Plan Quick Guide

Transcription

1 2015 HSA Plan Quick Guide The HSA Plan consists of two parts that work together to give you more control over how you receive and pay for medical care and services, both now and in the future: the Health Savings Account and the HSA Medical Plan. This guide provides you with details on both parts of the plan to assist you in making this plan work for you and your family. The HSA Plan enables you to: Set up and contribute pre-tax dollars to a Health Savings Account (HSA), and receive a contribution from Emory, to pay for eligible medical, dental and vision services. Participate in an Emory-sponsored medical plan with the lowest employee contributions. Seek and receive preventive care at no cost to you (EHN and In-Network). Receive incentives for your participation in healthy activities. Support your efforts to stay healthy with access to information, programs and health topics affecting you and your family. Have the flexibility to choose how you pay and from whom you receive medical care and services. Read more inside! 1

2 The HSA Plan provides a more non-traditional approach to managing your health care than Emory s POS Plan. The HSA Plan gives you more choice and flexibility while emphasizing and supporting you and your family s efforts to stay healthy. Like the POS Plan, you have financial protection for medical costs through a deductible, co-insurance and an out-of-pocket maximum. But unlike the POS Plan, this plan provides you with an account, which is funded in part by Emory, that gives you the flexibility to choose how to spend your health care dollars. The Health Savings Account Enrolling in the HSA Plan allows you to take advantage of the tax savings features of a Health Savings Account. Emory contributes tax-free funds to your HSA upon your enrollment. You and your covered spouse/same Sex Domestic Partner (SSDP) can complete incentive activities and receive an additional Emory contribution. You can also contribute on a pre-tax basis through payroll deduction. In order to qualify for Health Savings Account: 1. You must be enrolled in the HSA Plan. 2. You cannot be claimed as a dependent on someone else s tax return. 3. You cannot be covered by a spouse s Flexible Spending Account (FSA). 4. You cannot be covered by any other medical plan, including Medicare A and/or B. Withdrawals to pay for eligible expenses are not taxable. The IRS does impose penalties if you use the funds for ineligible expenses. Save your receipts and your Explanation of Benefits (EOB). What you do not spend stays in your account for you to use in the future. HSA contributions are owned by you and are portable in the event that you leave Emory. Compare It is important to note that employee contributions (bi-weekly premiums) for the HSA Plan are significantly lower than employee contributions for the POS Plan. To see how the HSA Plan compares with the POS Plan, use the Plan Selection & Cost Estimator Tool located online at 2

3 Opening your Account When you elect to establish a Health Savings Account, the Customer Identification Process (CIP) begins in order to open your account. Aetna/PayFlex, the administrator for the Health Savings Account, may contact you directly via or letter to request any additional information needed. Your timely response will facilitate the process. Until the account is open, no contributions will be applied to the account. Once the account is open, you will be mailed a welcome letter and debit card (PayFlex Card). Register your HSA following the directions in your welcome letter. Designate a beneficiary: If your spouse is the designated beneficiary, the HSA will be treated as your spouse s HSA after your death. If the designated beneficiary is not your spouse, the account stops being an HSA and the value of the HSA becomes taxable to the beneficiary. Emory s Annual Contribution If you are enrolled in the HSA Plan with individual coverage on January 1, Emory will make a $400 contribution to your Health Savings Account. If you cover any dependents (spouse/same sex domestic partner or children), you will receive an additional $400 for a total annual maximum contribution of $800. For employees who enter the plan at any time after January 1, Emory s contribution to the HSA will be prorated based on your enrollment date. Emory s contributions are made on the first payroll of the month following enrollment. Emory s Incentive Contribution You can earn incentives that are added to your HSA by participating in and completing various healthy activities (see the Incentives section on page 7 to learn more). The maximum incentive amount that can be earned and contributed to an HSA during the plan year is $800 (with a covered spouse/ssdp). To ensure that incentive funds are available to pay for your medical expenses, participate in and complete your incentives early in the year. Emory processes all incentives completed by the 15th of the month for incentive payment on the next pay period. Incentives must be completed between January 1, 2015 and November 15, 2015 to be eligible for 2015 incentives. 3

4 Your HSA Contributions The IRS establishes limits for the amount that can be contributed each year to an HSA by you and Emory: For 2015, the limits are $3,350 for individual coverage and $6,650 if you cover dependents. If you are over the age of 55, an additional $1,000 catch-up contribution is allowed. You can make pre-tax contributions through payroll deduction. The amount of your contribution can be changed by contacting the Employee Resource Center. THE HSA -- A TRIPLE TAX ADVANTAGE tax-free money in Emory contributes $400 (or $800). You can earn up to $400 (or $800) in incentives. You can contribute additional pre-tax money too! After-tax contributions can be made to your account by transferring funds from your bank account. If your total HSA contributions exceed annual maximums, you will be taxed on the excess. You can make changes to your method of contribution, as well as your contribution amount at any time during the year; payroll deduction changes are processed for the next available payroll. HSA Debit Card tax-free money out Use your HSA to pay for medical expenses or pay for them yourself and save your HSA funds for later. Contributions are allowed until you begin participating in Medicare or you no longer qualify for a Health Savings Account. tax-free savings Unused funds remain in your account and grow with tax-free interest. They roll over year-to-year. There is no use-it or lose-it rule. The HSA is All About Choice! If you have funds available in your HSA, you can use them to pay your eligible medical expenses. Or, you can choose to save your HSA dollars and pay eligible expenses yourself. HSA funds are not forfeited at the end of the plan year; your HSA dollars will continue to be available for you to use. 4

5 Managing your Account Register and log on to Aetna Navigator at Your HSA will be listed under Accounts and Funds. You can see the account activity including contributions and distributions. PayFlex Mobile allows you to receive notifications, submit claims and more. Complete incentive activities to receive additional funds to your account. Use your PayFlex card to pay your medical, dental or vision expenses, or pay out of pocket to save HSA funds for future use. Balances over $1,000 can be invested in BNY Mellon options. Investment earnings are tax-free. IRS Publication 969 provides information on Health Savings Accounts. Accessing Your HSA Funds Aetna/PayFlex MasterCard Debit Card You will receive a PayFlex MasterCard debit card in your welcome kit from Aetna. Once activated, you may use the debit card just as you would a debit card tied to a savings or checking account, as long as you use it to pay eligible expenses. You may make payments by phone, online or in person with the debit card. Make a Payment When you make a payment online using PayFlex, you can choose to have a check sent directly to your provider. Reimbursement When you pay eligible expenses, you may reimburse yourself from your HSA by transferring funds to your bank account. The linking process will require a one-time verification of your checking account. Details on this process are included in your welcome letter. Funds must be available in your account on the day you make payment or initiate reimbursement. HSA funds may not be used to pay or reimburse SSDP expenses or expenses for a child who is no longer a tax dependent, even if covered on your medical insurance plan. Be sure to keep your receipts and Explanation of Benefits (EOBs). 5

6 Eligible Expenses HSAs are to be used for eligible medical expenses, such as deductibles and co-insurance for doctor visits, hospitalization, and surgery for you and your eligible dependents. You may also use your HSA for prescription drugs, dental care and certain vision expenses. In general, you may not use your HSA to pay health care premiums while an active employee. However, there are exceptions for COBRA enrollees, and for those receiving unemployment benefits or who are age 65 and older. You may also use HSA funds for Medicare premiums and long-term care (LTC) premiums, if applicable. Any HSA funds used for ineligible expenses are subject to income tax and a 20% IRS tax penalty. IRS Publication 502 provides information on qualified medical expenses. While you may cover a child up to age 26 or a SSDP under the HSA Plan, qualified medical expenses are those incurred by you, your spouse, and all dependents you claim on your tax return. Refer to IRS Publication 969 for more details. Coordinating HSA with a Flexible Spending Account If you elect a Healthcare Flexible Spending Account (FSA), it will be a Limited FSA administered by Aetna/ PayFlex. You can receive reimbursement for dental and vision expenses. Once you have met the HSA annual deductible, medical expenses can be reimbursed from the FSA. Submit a claim for reimbursement; the limited FSA will not be on your PayFlex card. Remember, FSA funds do not roll over from year to year. FSA Balances and IRS Restrictions on HSAs In accordance with IRS regulations, if you are a new enrollee in the HSA Plan for 2015 (i.e. switching from the POS Plan) and you have a balance in a 2014 Healthcare Flexible Spending Account (as of December 31, 2014), you are not eligible to contribute funds to an HSA or receive any funds in your HSA until April 1, This includes Emory s annual contribution, incentives earned from wellness activities, or contributions you make to your HSA. The April 1, 2015 date still applies even if your Healthcare FSA account balance reaches $0 at an earlier point during Additionally, if you have a balance in your FSA as of December 31, any medical expenses incurred prior to April 1, 2015 are not eligible for reimbursement with HSA funds. Expenses must be incurred after April 1, 2015 in order to use HSA funds. You will need to consider whether or not you will have an FSA balance on December 31 when making your decisions about enrolling in the HSA Plan including making any contributions to an HSA through payroll deduction. If you have a $0 balance in your 2014 Healthcare FSA as of December 31, 2014, you are HSA eligible on January 1, 2015 and you (and Emory) can make contributions to the account and eligible medical expenses can be paid with your HSA funds. 6

7 Incentives Whether you select the HSA Plan or the POS Plan, you can lower your overall medical costs by participating in healthy activities. If you enroll in the HSA Plan, your incentives will be a contribution to your HSA. If you enroll in the POS Plan, your incentives will be a credit against your deductible. Refer to the chart below for incentive amounts. Each enrolled employee and spouse/same-sex domestic partner is eligible for the same incentive amounts. All incentive activities must be completed after January 1, 2015 to be eligible for 2015 incentive(s). Types of Incentives 2015 Incentive Amounts (Employee/Spouse/SSDP) Aetna s SimpleSteps Online Health Assessment $25.00 (gift card) Healthy Lifestyle Coaching $ Annual Check-up (preventive exam) $ Disease Management $ Maximum Incentive Total $ Aetna s Simple Steps Online Health Assessment Earn a $25 gift card for completing Aetna s Simple Steps online health assessment. The health assessment is a brief online questionnaire to help you assess your health habits and to provide you with next steps to a healthier you. Please note that this incentive activity must be completed before any other incentives can be received. For example, if you complete the Healthy Lifestyle Coaching and get your annual check-up, but don t complete the health assessment, you will not receive your incentives for the other two activities. Be sure to complete the health assessment early in 2015 so you can get credit for all of your incentive activities. Annual Check-up One of the most important things you can do for your health is to schedule an annual check-up (or wellness/ preventive exam visit). With a focus on preventive care, an annual check-up includes an age and gender appropriate history, an examination, a review of risk factors and plans to reduce them, and the ordering of appropriate immunizations, screenings, etc. For women, a well-adult (or well-woman) visit will count for this $100 incentive. If you have an annual check-up scheduled for late 2014, you may want to consider rescheduling it for early 2015 so it counts toward your 2015 incentives. Please note that free, onsite biometric screenings will not be offered at Emory in 2015, but you are encouraged to get your numbers at your annual check-up. If you don t have a primary care physician, you can find one by calling Emory Health Connection at: or EMORY, or going to: custom/emory. Aetna s Healthy Lifestyle Coaching You have access to your own personal, telephonic health coach to help you reach your health-related goals. Work on one or more of the following: weight management, tobacco cessation, stress management, nutrition, fitness and preventive health. By participating, you can receive $100 upon completion of the third coaching session. Disease Management Program If you have a chronic condition, the Disease Management Program can provide support and assistance and help you improve your overall health. Diseases can include diabetes, high blood pressure, high cholesterol and more. You can be referred to a disease management program by a physician, through another program, through Aetna, or you can refer yourself. The program involves a series of calls with a nurse who will work with you to effectively manage your condition. Upon four completed phone calls with your nurse, you will qualify for a $200 incentive. 7

8 The HSA Medical Plan The HSA Medical Plan features a deductible, co-insurance and an annual out of pocket maximum to provide financial security. Annual Deductible You are financially responsible for meeting the deductible before the plan pays for any eligible expenses. You can use the funds that accumulate in your HSA to pay eligible medical, dental and vision expenses incurred by you, your spouse, and dependents you claim on your tax return. The deductible depends on the coverage level you have elected. Employee Only Coverage: Annual Deductible - $1,350 (EHN or In-Network). You pay the first $1,350 in eligible expenses. You can fund these expenses by utilizing your HSA. The Out-of- Network deductible is $2,000. Employee + Spouse/SSDP, Employee + Child(ren) and Family level Coverage: Annual Deductible -$2,700 (EHN or In-Network). You pay the first $2,700 in eligible expenses. You can fund these expenses by utilizing your HSA. The Out-of- Network deductible is $4,000. Co-Insurance Once the deductible has been satisfied, the plan provides coverage for eligible expenses through co-insurance. The highest levels of coverage under the plan are by utilizing the Emory Healthcare Network (EHN) or by obtaining services from In-Network providers (Aetna National Network). EHN Plan pays 90% of eligible medical expense, you pay 10% In-Network Plan pays 80% of eligible medical expense, you pay 20% Out-of-Network Plan pays 60% of eligible medical expense, you pay 40% Annual Out-of-Pocket Maximum The HSA Plan also provides financial protection for you and your family in the event of a catastrophic illness or injury through the annual out-of-pocket maximum. If your share of expenses (deductible and co-insurance paid by you) during the year reaches the Out-of-Pocket Maximum all remaining eligible expenses are covered by the plan at 100%, including Emergency Room visits and prescription drugs. $3,000 for employee only coverage (EHN or In-Network); $6,000 Out-of-Network $6,000 for Employee + Spouse/SSDP, Employee + Child(ren) or Family level coverage (EHN or In-Network); $12,000 Out-of-Network. 8

9 Prescription Drug Coverage The pharmacy benefit manager for the HSA Plan is CVS/ caremark. You may fill prescriptions either at a retail pharmacy (30 day supply) or by using mail order service (90 day supply). You must pay all out-of-pocket costs for prescription drugs until you meet your annual deductible. After you meet the deductible, you will pay the applicable co-insurance amount under the HSA Plan, up to the 30-day Retail Maximum. Mail order is 2x the retail maximum. You can use your HSA to pay for prescription drugs. The table below shows what your responsibility is once your deductible is satisfied. For example, if the table shows co-insurance is 20%, the plan will pay 80% of the cost of the prescription drug and you are responsible for the other 20%. However, there is financial protection built into the prescription drug benefit in that you will never pay more than the 30-day Retail Maximum, outlined in the table below: Tier Co-insurance 30-Day Retail Maximum Zero 0% $0 1 10% $ % $35 Preventive medications are covered under Tier Zero and the deductible and co-insurance do not apply. One very important change to note is that if you take any maintenance prescription medications to treat certain ongoing medical conditions, you will need to fill your prescriptions in one of three ways: through CVS/caremark s mail order service, at a CVS retail pharmacy location (at the mail-service cost), or at an Emory pharmacy. Please be aware that if you attempt to fill a maintenance drug at a pharmacy other than CVS or Emory, you will be charged the full retail cost on your third attempt to refill. While this may cause some inconvenience, it is a necessary measure to help control the overall cost of the plan. 3 30% $ % $100 Mail-order maximum co-pays are 2½ x the retail amount Check up on Medications It s a good idea to occasionally check up on your medications coverage tiers. Sometimes drugs change tiers. To be certain which tier your medications are on, call CVS/caremark at

10 How the HSA Plan Works The HSA Plan encourages healthy living by providing 100% coverage for preventive care when you use Emory Healthcare providers (EHN) or In-Network providers (Aetna National Network). The plan also gives you more control over how you receive and pay for health care services. Like a traditional plan, the HSA Plan has a deductible, co-insurance and an outof-pocket maximum to provide financial protection in the event of a serious illness or injury. A distinct advantage when enrolling in the HSA Plan is the ability to set up a health savings account and contribute pre-tax to it each year. Emory Contributes $400 1 or $800 1 You Earn Incentives Up To $400 (or $800) You Contribute Any Amount Up To Plan Maximum Money in the HSA will be invested in a money market fund. Maximum Contributions All Sources: $3,350 2 or $6,650 2 Preventive Care Covered at 100% (EHN or In-Network) Health Savings Account (HSA) Emory Contribution + Your Earned Incentives + Your Contributions Deductible Co-Insurance Out-of-Pocket Maximum Remaining HSA Balance Use your HSA funds to pay for eligible medical expenses. Total Possible HSA Contributions 2 : $3,350 (Employee Only) $6,650 (Employee + Spouse/SSDP, Employee + Child(ren) or Family) You pay all eligible expenses until the deductible is satisfied. You may use funds in your HSA to meet your deductible. $1,350 (Employee Only In-Network); $2,000 (Out-of-Network) $2,700 (Employee + Spouse/SSDP, Employee + Child(ren) or Family In-Network); $4,000 (Out-of-Network) Once the deductible is satisfied, for services you pay: 10% in the Emory Healthcare Network (EHN) 20% in the Aetna National Network (In-Network) 40% Out-of-Network If your expenses paid annually exceed: $3,000 (Employee Only In-Network); $6,000 (Out-of-Network) $6,000 (Employee + Spouse/SSDP, Employee + Child(ren) or Family); $12,000 (Out-of-Network). Then the plan pays 100% 3 Unused HSA funds will continue to be available for future use on eligible medical, dental and vision expenses Emory contributes $400 if you are enrolled in employee only coverage; $800 if you cover any dependents (spouse/ssdp or children). Employees 55 years of age and over can add up to an additional $1,000 contribution to the HSA maximums for catch-up contributions. Once the annual out-of-pocket maximum is satisfied, the plan pays 100% of all remaining eligible expenses during the plan year, including Emergency Room visits and prescription drugs. 10

11 HSA Plan Examples Donna Single Coverage Employee Only Meet Donna! Her health expenses throughout the year are usually low. Other than getting her annual check-up, she typically has few medical expenses. Since she does not usually spend much on health care, Donna likes the idea of receiving funding from Emory to meet her other health care needs during the year. Donna takes advantage of 100% In-Network covered preventive care by getting her well-woman check-up. Because an annual check-up now counts as an incentive activity, she receives $100. She also receives a $25 gift card for completing her Aetna SimpleSteps online health assessment. (Completion of the health assessment is required in order to get the other incentive). Additionally, she has one other office visit and fills one prescription each month from Tier 2 at a retail pharmacy. Year One Donna s HSA Contributions Emory s contribution...$ 400 Received incentive (annual check-up)... $100 Donna s Contribution ($100 per month x 12 months)...$1,200 Total HSA funds available...$1,700 Donna s Medical Expenses Tier 2 prescription...$ 420 In-Network office visit.... $125 Annual check-up (preventive care is paid by the plan at 100%)... $0 Total expenses..... $ 545 Year two Donna s HSA Contributions HSA balance carried over from previous year....$1,155 Emory s contribution... $400 Received incentive (annual check-up)... $100 Total HSA funds available in year two...$1,655 Donna s Medical Expenses Tier 2 prescription... $420 In-Network office visit.... $125 Annual check-up (preventive care).... $0 Total Expenses in year 2....$ 545 Donna s Totals HSA funds available....$1,655 Annual deductible satisfied... $545 Annual out-of-pocket maximum satisfied.... $545 With the HSA Plan, Donna again used her HSA to cover her $545 of medical expenses during the plan year. The $1,110 remaining in her HSA at the end of year two will be available for future use. Year Three Donna s HSA Contributions HSA balance from previous year... $1,110 Emory s contribution...$400 Received incentive (annual check-up)...$100 Total HSA funds available in year three... $1,610 Annual deductible to meet.... $1,350 For year three, Donna has accumulated enough funds in her HSA to cover her annual deductible should she incur a large health expense. Donna s Totals HSA funds available....$1,700 Annual deductible satisfied... $545 Annual out-of-pocket maximum satisfied.... $545 With the HSA Plan, Donna can pay for her $545 in expenses by using her HSA. The $1,155 remaining in her HSA after her expenses paid will be available for future eligible medical expenses. 11

12 HSA Plan Examples The Smith Family Family Coverage 2 Adults, 1 Child Meet the Smiths! Andrew and Cindy and their three-year old son, Joe, have a variety of planned and unplanned health expenses throughout the year. Each year they all normally get an annual physical exam. The family estimates at least five office visits per year two well-child and two well-adult visits, plus an office visit for Cindy s chronic asthma condition. Cindy and Andrew both get $100 each in incentive money for completing their annual check-ups. Cindy, because she has an asthma condition, referred herself to Aetna and completed the disease management program to earn an additional incentive of $200. Plus, both Cindy and Andrew each received $25 gift cards for completing their Aetna SimpleSteps online health assessment. (Completion of the health assessment is required in order to get the other incentives). Year One Smith Family HSA Contributions Emory s contribution...$800 Cindy completed an incentive (annual check-up)...$100 Andrew completed an incentive (annual check-up)...$100 Cindy completed an incentive (disease management program)....$200 Smith Family Payroll Contribution....$1,800 Total HSA funds available...$3,000 Smith Family Medical Expenses Smiths Paid Plan Paid HSA Funds Used Joe has an emergency room visit that results in eligible charges totaling $750. $750 $0 $0 One office visit for Cindy s Asthma Condition. $150 $0 $0 Asthma Prescriptions $1,200 $0 $0 Two In-Network Well-Adult and two Well-Child visits at $125 each totaling $500. The Smiths responsibility is $0 because preventive care is covered at 100%. $0 $500 $0 Total Expenses $2,100 $500 $0 The Smiths have HSA available funds totaling $3,000. They have decided to save their HSA funds for future eligible medical expenses. Alternatively, the Smiths could have decided to pay all of their expenses incurred using their HSA, and paid $0 out of their own pocket. Then, they would start year two with an HSA balance of $900 ($3,000 - $2,100 = $900) from year one s balance rolling forward. 12

13 Frequently Asked Questions How do I deposit funds into my HSA? Funds to your HSA can come from (1) Emory s annual contribution, (2) incentives you and/or your spouse/ssdp earn and (3) contributions you and/or your spouse make. Your contributions to the HSA, including contributions from your spouse, can be made through pre-tax payroll deductions, or may be made after-tax by transferring funds from your bank account. SSDPs cannot make cash contributions to your HSA, but can contribute to HSAs they establish on their own. NOTE: If you enroll in the HSA Plan for 2015 and have a balance in a 2014 Healthcare Flexible Spending Account (as of December 31, 2014), you are not eligible to contribute funds to an HSA or receive any funds in your HSA until April 1, This includes Emory s annual contribution, incentives earned from wellness activities, or contributions you make to your HSA. The April 1, 2015 date still applies even if your Healthcare FSA account balance reaches $0 at an earlier point during Can I use the funds in my HSA to pay medical expenses for my SSDP and/or my SSDP s dependent child(ren)? No. The IRS defines dependent eligibility for filing eligible expenses through accounts such as HSAs and FSAs (flexible spending accounts). While Emory allows employees to cover SSDPs (and their dependent children) through Emory-sponsored medical plans, HSAs and FSAs must adhere to federally-established guidelines. SSDPs and their children currently do not meet IRS guidelines for eligible dependents. However, SSDPs may establish their own HSAs (independent of the employee s HSA), and may use their own HSAs to cover eligible expenses for themselves and their children. However, eligible expenses for SSDPs and their children will be covered under the HSA medical plan once the deductible has been satisfied. Emory will monitor IRS updates and make changes in accordance with IRS regulations. How do I get a new or additional debit card for myself or my dependents? If you need a replacement card or an additional card for yourself or your dependent, you should request one through Aetna/PayFlex by calling I am a new employee and want to enroll in the HSA Plan. Will I receive the entire annual Emory contribution? No. The contributions you receive from Emory to your HSA will be prorated based on when you activated your HSA. For example, if you are hired on February 10 and enroll in employee only coverage, you receive the annual contribution for the March December timeframe that s 10 out of 12 months or 83% of the year ($400 x.83 = $332). I am over 55 years of age. Can I contribute more to my HSA? Yes, if you are an Emory employee and are over the age of 55, you can make an additional $1,000 in catch-up contributions to your HSA. When including catch-up contributions, the annual contribution maximums are increased to $4,350 for individual coverage and $7,650 for family coverage. How do I access the beneficiary form for the HSA? Beneficiary designation forms are available on the Aetna Navigator website ( After you log in to your account, click the Tools & Resources tab at the top of the page. Can I still have an FSA if I am enrolled in the HSA Plan? Yes. You can enroll in a limited Healthcare Flexible Spending Account (FSA) even if you are enrolled in the HSA Plan. You may use the limited FSA to pay for dental and vision expenses and for medical expenses once your deductible has been met. Remember: with an FSA, the funds must be used by the end of the grace period (March 15 or the following year) or they are forfeited. When will I see my incentive in my HSA account? Emory processes all incentives completed by the 15th of the month for incentive payment on the next pay period. For more information, contact: Employee Resource Center ehc.hr/benefits@emoryhealthcare.org Aetna