Manage your health care and your budget

Transcription

1 Manage your health care and your budget Aetna HealthFund Health Reimbursement Arrangement (HRA) A new way to manage your family s health Integrated Rx D (8/07)

2 An easy-to-use th manage your hea Here s a health benefits and health insurance plan that lets you see any doctor you want, without a referral. Preventive care is generally covered at 100% and you get a fund to help cover your health expenses. The parts of your HRA plan There are three parts to your HRA plan the fund, the deductible and the health plan. 1. Y o u r F u n d At the start of each plan year, you get a fund, provided by your employer, to help you pay for eligible out-of-pocket health care costs. Any remaining balance not used during the year is rolled over into the next year s fund. 2. Y o u r D e d u c t i b l e Your deductible is an amount you must pay before your health plan begins to pay for most of your eligible expenses. 3. Y o u r h e a l t h P l a n When you meet your deductible, the health plan pays for most of your eligible expenses. You pay a smaller share of these costs from your own pocket. The Fund Health benefits and health insurance plans are underwritten or administered by Aetna Life Insurance Company.

3 ree-part plan to help you lth and expenses How these parts work The three parts of your HRA plan work together like this: 1. Your Fund When you have an eligible expense, your fund covers your share of the cost as long as there are funds available. 2. Your Deductible As you use the fund, the payments reduce your deductible. So, your fund helps you pay your deductible! Let s say your deductible is $2,000 and your fund is $1,000. After using all of your fund ($1,000), you pay the remaining $1,000 to meet your deductible. 3. Your Health Plan When you meet your deductible, you pay a smaller share of your eligible expenses and the plan pays the larger share. If you have been in the plan for over a year and your fund keeps growing, it may build up enough to pay your entire deductible and help you pay your share of your health care costs. Prescription drug benefits Your deductible also applies to your prescription drugs. Your fund pays for your prescription drugs, as long as there are funds available. When you meet your deductible, you then pay your share of the cost of the prescription, based on the charge we have negotiated with the pharmacy. You also have access to a network of retail pharmacies and a mail-order prescription service through our Aetna Rx Home Delivery program. Other important features You also get these important benefits: n Preventive care. From day one, your preventive care (such as routine physicals and immunizations) is typically covered at 100%. So you do not need to use your fund! n Out-of-pocket maximum. You are also protected by a limit on how much you pay in a year. If your expenses reach this limit, your remaining eligible expenses will be covered at 100% for the rest of the plan year (up to a lifetime benefit maximum). See your Plan Design and Benefits summary to learn more. 1

4 How it works Here is an example of how the HRA plan works over two years. In this example: n Preventive care was covered at 100 percent. n Prescription drug coverage from Aetna was included with the health plan. n All care was given by health care professionals in the Aetna network. Year One n You visit your doctor for a routine physical exam. The plan covers preventive care at 100 percent so you pay nothing, and you don t use your fund. n Later in the year, you sprain your ankle. During an office visit, your doctor asks for X-rays and prescribes an antibiotic to treat an infection. The total expense is $470: $175 for X-rays, $170 for the prescription and $125 for the office visit. Normally, you would pay $470 from your pocket. Under the HRA plan, this amount is paid in full by the fund you pay nothing out of pocket, and the amount paid from the fund is applied to your deductible. HERE IS THE PLAN (YOUR ACTUAL PLAN MAY DIFFER) Fund: $1,000 Deductible: $2,000 Health Plan Pays: 80% You Pay: 20% A LOOK AT YEAR ONE Total Expenses: $470 Your Fund: You start with: $1,000 You use: $470 Remaining fund: $530 Total Amount You Paid: $0 Total Amount Paid by Fund: $470 n At the end of Year One, you have $530 remaining in your fund. That amount is rolled over into your beginning fund balance for the next year. 2

5 Year Two n Early in the year, you need surgery. The total cost is $9,550. n You start the year with $1,530 in your fund: $1,000 from this year and $530 rolled over from last year. The entire fund is used to pay the first $1,530 of your bill. Your balance is $8,020. n The $1,530 paid from your fund is also applied to your $2,000 deductible. You pay the remaining $470 to meet your deductible. Your balance is $7,550. n With your deductible met, the health plan now begins. Because you visited network doctors and facilities, Aetna pays 80 percent of the balance ($6,040), and you pay 20 percent ($1,510). n At the end of Year Two, you paid $1,980: $470 to meet the deductible and $1,510 as your share of the cost of your care. The plan paid $7,570. There is nothing left in your fund, so you start Year Three with a new fund balance of $1,000. A LOOK AT YEAR TWO Total Expenses: $9,550 Your Fund: You start with: $1,000 Amount rolled over from Year One: $530 Total Year Two fund: $1,530 You use: $1,530 Remaining expenses: $8,020 Your Deductible: Starting deductible: $2,000 Amount paid from the fund: $1,530 Amount you paid to meet the deductible: $470 Remaining expenses: $7,550 Your Health Plan: Amount paid by plan (80%): $6,040 Amount paid by you (20%): $1,510 Remaining expenses: $0 Total Amount You Paid: $1,980 ($470 Deductible + $1,510 your share of the health costs) Total Amount Plan Paid: $7,570 ($1,530 Fund + $6,040 the plan s share of the health costs) 3

6 Your personal health and benefits source Visit your secure Aetna Navigator website for information about your health and benefits. n View your fund balance, summary and activity n Order ID cards n Check eligibility n Review the status of your claims n Download your claims history Information you can use Compare estimated in-network and outof-network costs for health care services in your area through the Estimate the Cost of Care tool, including: n Medical procedures such as arthroscopy or colonoscopy n Office visits including routine physicals and emergency room visits n Medical tests lab tests, X-rays, MRIs and more n Diseases & conditions for services related to specific diseases and conditions such as heart disease, high blood pressure and pregnancy Plan for expenses Predict how much your health care costs may be in the coming plan year. You can get estimated annual costs for many common conditions, such as asthma or diabetes, through Estimate the Cost of Care. Explore potential savings Could you save money on prescription drugs by using mail order? Compare the estimated cost of your prescription when filled at a local pharmacy versus ordering that prescription through our Aetna Rx Home Delivery program. Compare area hospitals Are you considering surgery? Expecting a baby? Use the Hospital Comparison Tool to compare area hospitals based on the criteria most important to you. Talk to a nurse, anytime Call our team of registered nurses 24 hours a day, 7 days a week for information on your health-related questions and issues. Get trusted health and wellness information You can also research thousands of health topics and medications, with our Aetna InteliHealth and Healthwise Knowledgebase resources. Find participating doctors Search for doctors based on important credentials like education, board certification and languages spoken, with our DocFind online directory. Identify your health and wellness needs Complete a brief online health survey. Take advantage of interactive programs for starting a healthier diet, getting in shape, handling stress and more, through our Simple Steps to a Healthier Life program. 4

7 Network notes Learn about your doctor and your medical costs. Keep your family and your budget healthy. You can see any doctor you want, without a referral. But, when you visit doctors in the network, your dollars last longer. That s because we ve negotiated special rates for you. The network has more than 774,000* health care professionals you can choose to see. And every one of them is up to our standards so you know you re in good hands. In fact, there s a very good chance that your doctor is already in the Aetna network. We have special rates with over 57,000* pharmacies across the country. One is sure to be near you. * Aetna s Enterprise Provider Database as of 1/1/

8 If you re already an Aetna member, you can log on to Aetna Navigator at Or click on Register Now and follow the prompts. If you are not yet a member, go to public information to take a tour. If you need this material translated into another language, please call Member Services at AETNA ( ). Si usted necesita este documento en otro idioma, por favor llame a Servicios al Miembro al AETNA ( ). Aetna HealthFund HRAs are subject to employer-defined use and forfeiture rules. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Health insurance plans contain exclusions and limitations. Aetna does not provide care or guarantee access to health services. 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. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Aetna receives rebates from drug manufacturers that may be taken into account in determining Aetna s Preferred Drug List. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. Information subject to change. For more information about Aetna plans, refer to Policy forms issued in Oklahoma include: GR-23 and/or GR-29. Integrated Rx Available in Spanish. Disponible en Español Aetna Inc D (8/07)