Aetna Medicare 2013 Benefits at a Glance

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1 Aetna Medicare 2013 Benefits at a Glance CVSP A Aetna Medicare Rx (PDP) Alabama, Arizona, California, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia, West Virginia, Wisconsin, Wyoming Aetna CVS/pharmacy Prescription Drug Plan (PDP) Aetna Medicare Rx Premier (PDP) Contact us for answers to your questions or to enroll: (TTY/TDD: 711) 8 a.m. to 8 p.m., 7 days a week Or visit our website: Compare our prescription drug plans in your area This is a partial list of covered services. For a complete description of benefits, exclusions, limitations and conditions of coverage, refer to the Summary of Benefits. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 of each year. S5810_D_PE_MM_20851 CMS Approved

2 Aetna Medicare Rx (PDP) Aetna CVS/pharmacy Prescription Drug Plan (PDP) Prescription Drug Coverage Monthly plan premium $ $32.50* Prescription deductible $325 Retail Prescription Drug Coverage Amount you pay for covered prescriptions until costs for you and the plan reach $2,970 (initial coverage limit) One-month supply from a retail network pharmacy Tier 1 Preferred generic (most generics are on this tier) CVS/pharmacy Other Network Pharmacies $2 copay $7 - $10 copay* Tier 2 Non-preferred generic $5 copay $10 - $33 copay* Tier 3 Preferred brand $40 - $45 copay* $40 - $45 copay* Tier 4 Non-preferred brand 34% - 50% coinsurance* 34% - 50% coinsurance* Tier 5 Specialty 25% coinsurance 25% coinsurance Amount you pay for covered prescriptions in the coverage gap (after your initial coverage limit and until your true out-of-pocket costs reach $4,750) One-month supply from a retail network pharmacy You receive a discount and 2.5% benefit on brand name drugs and pay only 79% of the costs of generic drugs. Amount you pay for covered prescriptions after your true out-of-pocket costs reach $4,750 (catastrophic coverage) Retail and prescription mail order Mail Order Drug Coverage Three-month supply from Aetna Rx Home Delivery The greater of $2.65 copay for generic drugs (including brand drugs treated as generic), $6.60 copay for all other covered drugs OR 5% coinsurance $5 copay for 90-day supply of Tier 1 drugs 3X copay for 90-day supply of Tier 2-5 drugs * Monthly plan premiums and copays/coinsurance may vary by region. Please refer to the Summary of Benefits for exact costs for your area. ** Longs Drugs, in Hawaii, is owned and operated by CVS/pharmacy. Contact us

3 With the Aetna CVS/pharmacy Prescription Drug Plan you can: Enjoy a low monthly plan premium Save even more with lower copays for generic drugs when you fill your prescription at a CVS/pharmacy or Longs Drugs** location. Your copays may be higher if you choose to use Aetna Medicare s more than 58,000 other network pharmacies. Have access to over 1,200 Tier 1 preferred generic drugs for a $2 copay at a CVS/pharmacy or $5 copay for a 90-day supply from a network mail order pharmacy Fill your prescriptions at any of the more than 7,200 CVS/pharmacy locations nationwide. Many offer 24-hour or extended-hours service and/or drive-thru pharmacies Receive a CVS ExtraCare Health Card upon enrollment at no extra cost to you for 20% off all CVS Brand health-related products regularly priced at more than $1 both in-store and online (excludes prescriptions) Take advantage of convenient mail order drug services from Aetna Rx Home Delivery and Aetna Specialty Pharmacy that deliver prescriptions to your door. Call (TTY/TDD ), Monday-Friday, 8 a.m. to 7 p.m. or see Summary of Benefits for details. Visit us

4 Aetna Medicare Rx (PDP) Aetna Medicare Rx Premier (PDP)** Prescription Drug Coverage Monthly plan premium $ $122.40* Prescription deductible $0 Retail Prescription Drug Coverage Amount you pay for covered prescriptions until costs for you and the plan reach $2,970 (initial coverage limit) One-month supply from a retail network pharmacy Tier 1 Preferred generic (most generics are on this tier) Tier 2 Non-preferred generic Tier 3 Preferred brand Tier 4 Non-preferred brand Tier 5 Specialty $5 copay $33 copay $45 copay 37% - 49% coinsurance* 33% coinsurance Amount you pay for covered prescriptions in the coverage gap (after your initial coverage limit and until your true out-of-pocket costs reach $4,750) One-month supply from a retail network pharmacy Continued plan coverage for Tier 1 and Tier 2 generic drugs. Partial plan coverage for Tier 3 and Tier 4 brand drugs. You receive a discount and 2.5% benefit on nonsupplemental brand gap coverage. You pay only 79% of the costs of generic drugs on non-supplemental generic gap coverage. Amount you pay for covered prescriptions after your true out-of-pocket costs reach $4,750 (catastrophic coverage) Retail and prescription mail order Mail Order Drug Coverage Three-month supply from Aetna Rx Home Delivery The greater of $2.65 copay for generic drugs (including brand drugs treated as generic), $6.60 copay for all other covered drugs OR 5% coinsurance $5 copay for 90-day supply of Tier 1 drugs 3X copay for 90-day supply of Tier 2-5 drugs * Monthly plan premiums and copays/coinsurance may vary by region. Please refer to the Summary of Benefits for exact costs for your area. ** Aetna Medicare Rx Premier (PDP) not offered in Hawaii. Contact us

5 Aetna Medicare Rx Premier (PDP) delivers more robust coverage and offers: $0 deductible first dollar coverage on all formulary generic and brand name drugs Coverage of all generic benzodiazepines and barbiturates, as well as coverage to over 1,300 Tier 1 generic drugs All Tier 1 and Tier 2 generic drugs and some Tier 3 and Tier 4 brand drugs are covered in the coverage gap, including popular diabetes and anti-hypertensive drugs The most commonly used brand name drugs covered by Medicare Part D Access to any of Aetna Medicare s more than 65,000 network pharmacies no need to use a preferred pharmacy to obtain lowest cost-sharing Convenient mail order drug services from Aetna Rx Home Delivery and Aetna Specialty Pharmacy deliver prescriptions to your door. To learn more call (TTY/TDD ), Monday-Friday, 8 a.m. to 7 p.m. or see Summary of Benefits for details. Variety. Innovation. Value. Here are just some of the added features and services you can take advantage of with all Aetna Medicare prescription drug plans: Two prescription drug plans in just about every state in the country ** we have you covered with an option designed with you in mind Online tools to help you manage your plan, your health and your budget. Visit Access to Aetna Navigator, our secure member website where you can get details on your specific plan benefits, look up the status of a claim, and check the price of a prescription drug Aetna Extras SM value-added services at no extra cost discounts on vision products and services (up to 40% off the retail prices of eyeglass frames and savings for all types of lenses), fitness and weight-loss programs (ediets, Jenny and Nutrisystem ) and other wellnessrelated products and services The discounted products and services described above are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the Aetna Medicare grievance process. Learn more about plan benefits, costs and covered drugs Call to learn more about Aetna Medicare prescription drug plans or to schedule an appointment with a sales representative. Call our toll-free number: (TTY/TDD: 711), 8 am to 8 pm, 7 days a week. Or visit our website at: Visit us

6 2013 Aetna Medicare Rx (PDP) Plan Offerings Aetna CVS/pharmacy Prescription Drug Plan (PDP) Initial Coverage 1,2,3 Monthly Annual Tier 1 Tier 2 Tier 3 Tier 4 Tier 5 Coverage STATE(S) Premium Deductible Gap ME, NH $30.30 $2 or $7 $5 or $10 $40 48% 25% CT, MA, $31.60 $2 or $7 $5 or $28 $45 38% 25% RI, VT NY $32.50 $2 or $7 $5 or $33 $45 44% 25% NJ $32.50 $2 or $7 $5 or $33 $45 44% 25% DE, DC, $32.50 $2 or $7 $5 or $33 $45 39% 25% MD PA, WV $32.50 $2 or $7 $5 or $30 $45 46% 25% VA $29.90 $2 or $7 $5 or $25 $45 43% 25% NC $30.90 $2 or $7 $5 or $21 $45 39% 25% SC $32.50 $2 or $7 $5 or $29 $45 38% 25% GA $31.40 $2 or $7 $5 or $16 $45 41% 25% FL $32.50 $2 or $7 $5 or $33 $45 50% 25% AL, TN $32.10 $2 or $7 $5 or $30 $40 44% 25% MI $32.50 $2 or $7 $5 or $16 $45 36% 25% OH $28.70 $2 or $7 $5 or $24 $45 34% 25% $325 IN, KY $32.50 $2 or $7 $5 or $22 $45 38% 25% for all WI $32.50 drugs $2 or $7 $5 or $28 $45 36% 25% IL $29.30 $2 or $7 $5 or $25 $45 39% 25% MO $32.10 $2 or $7 $5 or $28 $40 46% 25% MS $32.50 $2 or $7 $5 or $21 $45 40% 25% LA $32.50 $2 or $7 $5 or $22 $40 47% 25% TX $30.60 $2 or $7 $5 or $26 $45 43% 25% OK $31.30 $2 or $7 $5 or $24 $45 40% 25% KS $32.50 $2 or $7 $5 or $27 $45 35% 25% IA, MN, MT, NE, ND, SD, WY $32.50 $2 or $7 $5 or $25 $45 36% 25% NM $32.50 $2 or $7 $5 or $31 $40 49% 25% AZ $28.00 $2 or $7 $5 or $28 $40 50% 25% NV $32.50 $2 or $7 $5 or $33 $40 48% 25% CA $28.60 $2 or $10 $5 or $33 $45 47% 25% HI $30.60 $2 or $7 $5 or $18 $45 44% 25% After your yearly total drug costs 4 reach $2970, you receive a 50% discount and a 2.5% benefit on brand drugs and pay 79% of generic drug costs Catastrophic Coverage After your out-ofpocket drug costs reach $4750, you pay the greater of $2.65 for generic drugs, $6.60 for brand drugs, or 5% coinsurance 1 Amount you pay after the deductible for covered prescriptions until drug costs for you and the plan reach $ Copays and coinsurance are for a 30-day supply at any of the more than 65,000 pharmacies in the retail network. 3 Tier 1 and Tier 2 copay values are for copays at preferred pharmacies (CVS/pharmacy or Longs Drugs) OR copays at other network non-preferred pharmacies. Contact us

7 Aetna Medicare Rx Premier (PDP) Initial Coverage 1,2 Monthly Annual Tier 1 Tier 2 Tier 3 Tier 4 Tier 5 Coverage STATE(S) Premium Deductible Gap ME, NH $ $5 $33 $45 46% 33% CT, MA, $ $5 $33 $45 37% 33% RI, VT NY $ $5 $33 $45 38% 33% NJ $ $5 $33 $45 40% 33% DE, DC, $ $5 $33 $45 39% 33% MD PA, WV $ $5 $33 $45 44% 33% VA $ $5 $33 $45 45% 33% NC $ $5 $33 $45 43% 33% SC $ $5 $33 $45 42% 33% GA $97.10 $5 $33 $45 45% 33% FL $ $5 $33 $45 37% 33% AL, TN $ $5 $33 $45 42% 33% MI $86.20 $5 $33 $45 41% 33% OH $92.80 $5 $33 $45 39% 33% $0 IN, KY $ $5 $33 $45 42% 33% (None) WI $ $5 $33 $45 41% 33% IL $ $5 $33 $45 43% 33% MO $97.80 $5 $33 $45 47% 33% MS $ $5 $33 $45 44% 33% LA $ $5 $33 $45 46% 33% TX $96.20 $5 $33 $45 46% 33% OK $ $5 $33 $45 44% 33% KS $ $5 $33 $45 40% 33% IA, MN, MT, NE, ND, SD, WY $ $5 $33 $45 41% 33% NM $98.60 $5 $33 $45 42% 33% AZ $92.90 $5 $33 $45 48% 33% NV $ $5 $33 $45 48% 33% CA $ $5 $33 $45 49% 33% HI Plan not available in HI After your yearly total drug costs 4 reach $2970, your coverage continues for generic and some brand drugs and you receive a 50% discount and a 2.5% benefit on other brand drugs Catastrophic Coverage After your out-ofpocket drug costs reach $4750, you pay the greater of $2.65 for generic drugs, $6.60 for brand drugs, or 5% coinsurance 4 The amount you pay out-of-pocket or others pay on your behalf, plus the amount paid by the plan. Tier 1 = preferred generic, Tier 2 = non-preferred generic, Tier 3 = preferred brand, Tier 4 = non-preferred brand, Tier 5 = specialty drugs Visit us

8 Health insurance plans are offered by Aetna Life Insurance Company (Aetna). You must be entitled to Medicare Part A or B and continue to pay your Part B premium and Part A, if applicable. Medicare beneficiaries may enroll in a plan only during specific times of the year. To obtain additional information, please contact Aetna Medicare at (TTY/TDD: 711), from 8 a.m. to 8 p.m., 7 days a week. In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances. Pharmacy clinical programs such as prior authorization, step therapy, and quantity limits may apply to your prescription drug coverage. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. This information is available for free in other languages. For additional information, please contact our customer service number at (TTY/TDD: 711). Hours of operation: 7 days per week, 8 a.m. until 8 p.m. Esta información está disponible en otros idiomas de manera gratuita. Si desea más información, comuníquese con Servicios al Cliente al (TTY/TDD: 711). Horario de atención: los 7 días de la semana, de 8 a.m. a 8 p.m. A Medicare-approved Part D sponsor