Aetna medical plans€¦ · ©2016 Aetna Inc. 00.25.051.1 A (03/16) AETNA / MMC/ October 5, 2016 Aetna medical plans Marsh & McLennan Companies 2017 Benefits Overview - [PDF Document] (2024)

©2016AetnaInc.00.25.051.1A(03/16)

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AetnamedicalplansMarsh&McLennanCompanies2017BenefitsOverview

Presentedby:Gretta‐leeFlynn,AccountExecutive

Ourcorebelief

Whenemployeeshaveaccesstotheverybestcareavailable,

itwillcostyouless.

Anditgrowsyourcompany’sproductivity,onehealthier,happierpersonatatime.

Integrity

Inspiration

Excellence

Caring

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• Yourmedicalplanoptions– $400deductibleplan– $900deductibleplan– $1,500deductibleplan– $2,850deductibleplan

• TheAetnaprovidernetwork• Clinicalprograms• Preventivecare• Aetna’stoolsandresources

Today’sagenda:

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Medicalplanoptionsfor2017

ThemedicalplansavailableeffectiveJanuary1,2017:

• AetnaPPO(ChoicePOSII)• $400deductibleplan• $900deductibleplan

• AetnaHighDeductibleHealthPlan(HDHP)• $1,500deductibleplan• $2,850deductibleplan

MedicalplancomparisonPlanfeature $400deductible Plan $900deductible Plan

In‐network Out‐of‐network In‐network Out‐of‐network

Deductible(individual/family)

$400/$800(appliestomedicalonly)

$2,500/$5,000(appliestomedical

only)

$900/$1,800(appliestomedical only)

$3,000/$6,000(appliestomedical

only)

Officevisits $20PCPcopay /$40specialistcopay

40%afterdeductible 20%afterdeductible 40%afterdeductible

Coinsurance* 20%afterdeductible 40%afterdeductible 20%after deductible 40%afterdeductible

Out‐of‐pocketmaximum–includes deductible(individual/family)

$2,200/$4,400(includesmedical/prescriptioncopaysandcoinsurance)

$4,400/$8,800(includesmedical/

prescriptioncoinsurance)

$3,000/$6,000(includesmedicalandprescriptiondrugcoinsurance)

$6,000/$12,000(includesmedicalandprescriptiondrugcoinsurance)

Preventivecare Coveredat100% 40%afterdeductible Coveredat100% 40%afterdeductible

Emergencyroom $150copaythen20%afterdeductible

$150copaythen20%afterdeductible

20%after deductible

Teladoc® costshare $20PCPcopay 20%after deductible

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*Pleasenote:coinsurancepercentagesrepresenttheportionofthecostsyouareresponsiblefor.

Planfeature $1,500deductible plan $2,850deductible planIn‐network Out‐of‐network In‐network Out‐of‐network

Deductible(individual/family)

$1,500/$3,000(appliestomedicalandprescription

drug)

$3,000/$6,000(applies tomedicalandprescription

drug)

$2,850/$5,700(appliestomedicalandprescription

drug)

$5,700/$11,400(appliestomedicalandprescription

drug)

Coinsurance* 20%afterdeductible

40%afterdeductible 30%after deductible 50%afterdeductible

Out‐of‐pocketmaximum– includesdeductible(individual/family)

$3,000/$6,000(includesmedicalandprescriptiondrugcoinsurance)

$6,000/$12,000(includesmedicalandprescriptiondrugcoinsurance)

$5,500/$11,000(includesmedicalandprescriptiondrugcoinsurance)

$11,000/$22,000(includesmedicalandprescriptiondrugcoinsurance)

Preventivecare Coveredat 100% 40%afterdeductible Coveredat100% 50%afterdeductible

Teladoc costshare 20%afterdeductible 30% afterdeductible

Medicalplancomparison

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*Pleasenote:coinsurancepercentagesrepresenttheportionofthecostsyouareresponsiblefor.

[Customernameorlogo]

Medicalplan:what’scoveredAetna PPO(ChoicePOSII)Plan

$400deductible Plan $900deductible Plan

Innetwork Outofnetwork In network Outofnetwork

Preventivecare Planpays100% Planpays 60%afterdeductible Planpays100% Planpays 60%after

deductible

Maternitycare

Plan paysroutineprenatalcare100%.Deliverycoveredat80%afterdeductible. Thecopayappliestovisitsoutsideroutineprenatalcare.

Planpays60%afterdeductible

Plan paysroutineprenatalcare100%.Deliveryand allothermedicalservicescoveredat80%afterdeductible.

Planpays60%afterdeductible

EmergencyroomPlan pays80%after$150pervisitcopayandplandeductible

Plan pays80%after$150pervisitcopayandplandeductible

Plan pays80%afterdeductible

Plan pays80%afterdeductible

Inpatienthospital Plan pays80%afterdeductible

Planpays60% afterdeductible

Plan pays80%afterdeductible

Planpays60% afterdeductible

Durablemedicalequipment Plan pays80%afterdeductible

Planpays60% afterdeductible

Planpays80%afterdeductible

Planpays60% afterdeductible

Outpatientsurgeryfacility Plan pays80%afterdeductible

Planpays60% afterdeductible

Planpays80%afterdeductible

Planpays60% afterdeductible

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Medicalplan:what’scoveredAetna highdeductiblehealthplans

$1,500deductiblePlan $2,850 deductiblePlan

Innetwork Outofnetwork Innetwork Out of network

Preventivecare Plan pays100% Planpays60% afterdeductible Planpays100% Planpays50%after

deductible

Maternitycare

Plan paysroutineprenatalcareplan pays100%. Deliveryandallothermedicalservicescoveredat80%afterdeductible.

Plan pays60%afterdeductible

Plan paysroutineprenatalcareplan pays100%. Deliveryandallothermedicalservicescoveredat70%afterdeductible.

Planpays50% afterdeductible

Emergencyroom Plan pays80%afterdeductible

Plan pays80%afterdeductible

Plan pays70%afterdeductible

Planpays70%afterdeductible

InpatienthospitalPlan pays80%afterdeductible Planpays60%after

deductiblePlanpays70%afterdeductible

Planpays50% afterdeductible

Durablemedicalequipment

Plan pays80%afterdeductible Planpays60%after

deductiblePlanpays70%afterdeductible

Planpays50% afterdeductible

Outpatientsurgeryfacility

Plan pays80%afterdeductible Planpays60%after

deductiblePlanpays70%afterdeductible

Planpays50% afterdeductible

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HowadeductibleworksThedeductibleistheamountyoupayforcoveredservicesbeforeyourhealthplanbeginstopay.Remember

• Preventivecareiscovered100percentinnetworkunderyourmedicalplan,andyoudonotneedtomeetyourdeductiblefirst.

• The$1,500and$2,850deductibleplansincludesprescriptiondrugcostsinthedeductible.

Knowyourtypeofdeductible• The$400and$900deductibleplansincludesanindividualdeductiblethatis

embeddedintothefamilylimit.Noonepersonwouldhavetosatisfymorethantheindividualdeductibleamount.

• The$1,500DeductiblePlandoesnothaveanindividualdeductiblelimitforthefamilyplan.Thedeductibleforfamilycoverageisthedollaramountthatthefamily,intheaggregate,mustpayoutofpocketbeforetheplanpaysbenefitsforanyfamilymember. Thisfamilydeductiblecanbemetbyoneoranycombinationoffamilymembers.

• The$2,850DeductiblePlanwillhaveanindividualdeductiblethatisembeddedintothefamilylimit.Noonepersonwouldhavetosatisfymorethantheindividualdeductibleamount

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HowcoinsuranceworksThisisthepercentageyoupayformedicalservicesorprescriptionsafteryourdeductiblehasbeenmetifyouareenrolledinthe$900DeductiblePlan.

Forexample:Matthasalreadypaidhis$900yearlydeductible.Heseesthedoctorandischarged$80forthein‐networkvisit.Matt’scoinsuranceis20 percent.

Thismeans:1.Aetnapays80percentoftheremainingbill:$642. Mattwillgetabillfortheremaining20 percent:$16

IfMattwenttoadoctoroutofnetwork,hewouldberesponsibleforthehigherdeductibleand40percentofhisbill.Also,Matt'sbillwilllikelybehigheroutofnetwork.

Mattwouldalsoberesponsibleforanyamountsabovethereasonableandcustomarychargesforthisservice.

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Howanout‐of‐pocketmaximumworksThisisthelimitonthetotalcostsyoupayforcoveredservicesinayear.Includesprescriptiondrugs.Onceyouhavepaidthemaximumamount,yourplancovers100percentofallremainingeligibleexpenses*.

Knowyourtypeofout‐of‐pocketmaximum• The$400and$900deductibleplansincludesanindividualout‐of‐pocketlimit

thatisembeddedintothefamilylimit.Noonepersonwouldhavetosatisfymorethantheindividualoutofpocketlimit.

• The$1,500deductibleplandoesnothaveanindividualoutofpocketlimitforthefamilyplan.Theoutofpocketforfamilycoverageisthedollaramountthatthefamily,intheaggregate,mustpayoutofpocketbeforetheplanpaysbenefitsforanfamilymember.Thefamilyoutofpocketlimitcanbemetbyoneoranycombinationoffamilymembers.

• The$2,850deductibleplanwillincludeanindividualout‐of‐pocketlimitthatisembeddedintothefamilylimit.Noonepersonwouldhavetosatisfymorethantheindividualoutofpocketlimit.

*Outofnetwork– youarestillresponsiblefortheamountsabovethereasonableandcustomarycharges

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TheAetnaChoicePOSIINetwork• BothplansarebuiltonAetna’sChoicePOSIINetwork

• WhenyouuseDocFind® choosethisAetnanetwork

• TakeadvantageofthecustomMMCwebsiteatthefollowingURL:http://www.aetna.com/docfind/custom/mmc/

• Usingin‐networkdoctorssavesyoutimeandmoney

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CareManagement

Engagingcolleagueswithpersonalizedcare

• Offershigh‐touch/high‐techcaredeliveredthroughtheinnovativeCareManagementProgram

• Deliverscustomizedapproachtocaremanagement

• Providesexcellentservicewithourconcierge‐style,singlepointofcontactservicemodel

• Connectsmemberstonurseandorvendorpartnersasappropriate

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NeoCareSolutions℠

HowitworksStep1

• OutreachtothefamilybeginsonceAetnahearofaNICUadmission

Step2• Oncethefamilyenrollsintheprogram,theylogintotheNeoAppand

connectimmediatelywiththeirNeoCoach ℠• NeoCoachoffersinformationspecifictothebaby’sconditionandthe

family’ssituation• NeoCoachstaysconnectedwithregularcoachingsessionsmaking

assessments.Step3

• NeoCoachstaysconnectedwiththefamilythrougheverymilestonealongthewaytobaby’s1st birthday

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BeginningRight®maternitymanagementprogramcomponents• Pregnancyrisksurvey

• Casemanagement

• Membereducationalmaterials

• Postpartumoutreachcalls

• Programrewardsforearlyenrollmentandcompletingpostpartumassessment

• Activityreport,outcomesreport

• Physiciancommunication

• MaternityprogrameducationandinformationonAetnaNavigator® andwww.womenshealth.aetna.com

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WhencanIuseTeladoc?• Whenyouneedcarenow• Ifyourdoctorisunavailable• Ifyou’reconsideringtheemergencyroomorurgentcarecenterforanonemergency

issue• Onvacation,onabusinesstrip,orawayfromhome• Forshort‐termprescriptionrefills• Teladoc givesyou24/7/365accesstoadoctorthroughtheconvenienceofphoneor

videoconsults.• It'sanaffordableoptionforqualitymedicalcare.

Teladocdoctorscantreatmanymedicalconditions,including:• Cold&flusymptoms• Allergies• Bronchitis• Skinproblems• Respiratoryinfection

ContactTeladocvia:• 1‐855‐Teladoc(835‐2362)• Teladoc.com/aetna• Teladoc.com/mobile

Telemedicineprogram:Teladoc®

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How does Teladoc work?

Step 1 Complete

medical history

Step 2 Request consult

Step 3 Talk with a physician

Step 4 Resolve the issue

Step 5Continuity

of care

Step 6Reconcile account

Teladoc.com/aetna

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[Customernameorlogo]

TransitionofCare• Thisisaformoftemporarycoveragethatallowsforin‐networkbenefitstobepaidifyouarein

anactivecourseoftreatmentwithadoctorwhoisnotintheAetnanetwork.• Toqualifyyoumusthavebegunatreatmentprogramofplanedserviceswithyourdoctorto

correctortreatadiagnosedcondition.• Therequestfortransitionofcarebenefitsmustbereceivedwithin90daysfromthedateof

yourenrollment.• ContactanAetnaHealthConciergeat1‐866‐210‐7858 torequestaTransitionofCareRequest

Formthatcanberevieweduponenrollmentintheplan.

Examples:• Membersenrolledafter20weeksofpregnancy• Memberisinanongoingtreatmentplansuchaschemotherapyorradiationtherapy• Memberswhohaverecentlyhadsurgery• Memberswhoarereceivingoutpatienttreatmentformentalillnessorsubstanceabuse• Memberswhomayneedorhavehadanorganorbonemarrowtransplant

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TakeadvantageofInformedHealth®Line

• 1‐800‐556‐1555:24/7toll‐freeaccesstoregisterednursesforhealthinformation

• Accesstoonlinehealthinformationvia:www.aetnanavigator.com

• Personalfollow‐up

• Integration

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CoveredpreventiveservicesforadultsScreeningsfor:•Abdominalaorticaneurysm(one‐timescreeningformenofspecifiedageswhohaveeversmoked)•Alcoholmisuse•Bloodpressure•Cholesterol(foradultsofcertainagesorathigherrisk)•Colorectalcancer(foradultsoverage50)•Depression•Type2diabetes(foradultswithhighbloodpressure)•Humanimmunodeficiencyvirus(HIV)•Obesity•Tobaccouse•Lungcancer(foradultsage55andoverwithhistoryofsmoking),effectiveJanuary1,2015•Syphilis(foralladultsathigherrisk)

Counselingfor:•Alcoholmisuse•Diet(foradultswithhyperlipidemiaandotherknownriskfactorsforcardiovascularanddiet‐relatedchronicdisease)•Obesity•Sexuallytransmittedinfection(STI)prevention(foradultsathigherrisk)•Tobaccouse(includingprogramstohelpyoustopusingtobacco)

Immunizations:Doses,recommendedagesandrecommendedpopulationsvary•Diphtheria,pertussis,tetanus(DPT)•HepatitisAandB•Herpeszoster•Humanpapillomavirus(HPV)•Influenza•Measles,mumps,rubella(MMR)•Meningococcal(meningitis)•Pneumococcal(pneumonia)•Varicella(chickenpox)

Pleasenote:Coverageincludesregularcheckups,androutinegynecologicalandwell‐childexams. Aetnafollowstherecommendationsofnationalmedicalsocietiesabouthowoftenchildren,menandwomenneedtheseservices.Besuretotalkwithyourdoctoraboutwhichservicesarerightforyourage,genderandhealthstatus.

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[Customernameorlogo]

CoveredpreventiveservicesforwomenScreeningsandcounselingfor:•BRCA(counselingandgenetictestingforwomenofhighriskwithnopersonalhistoryofbreastand/orovariancancer)•Breastcancerchemoprevention(forwomenathigherrisk)•Breastcancer(mammographyevery1to2yearsforwomenover40)•Cervicalcancer(forsexuallyactivewomen)•Chlamydiainfection(foryoungerwomenandotherwomenathigherrisk)•Gonorrhea(forallwomenathigherrisk)•Interpersonalordomesticviolence•Osteoporosis(forwomenoverage60dependingonriskfactors)

Contraceptiveproductsandservices:•PrescribedFDA‐approvedfemaleover‐the‐counterorgenericcontraceptiveswhenfilledatanin‐networkpharmacy•TwovisitsayearforpatienteducationandcounselingoncontraceptivesisalsocoveredunderyourAetnamedicalplan

Coveredpreventiveservicesforpregnantwomen•Routineprenatalvisits(youpayyournormalcostsharefordelivery,postpartumcare,ultrasoundsorothermaternityprocedures,specialistvisitsandcertainlabtests)•Anemiascreenings•Diabetesscreenings•Bacteriuriaurinarytractorotherinfectionscreenings•Rhincompatibilityscreening,withfollow‐uptestingforwomenathigherrisk•HepatitisBcounseling(atthefirstprenatalvisit)•Expandedcounselingontobaccouse•Breastfeedinginterventionstosupportandpromotebreastfeedingafterdelivery,includinguptosixvisitswithalactationconsultant

Pleasenote:Coverageincludesregularcheckups,androutinegynecologicalandwell‐childexams. Aetnafollowstherecommendationsofnationalmedicalsocietiesabouthowoftenchildren,menandwomenneedtheseservices.Besuretotalkwithyourdoctoraboutwhichservicesarerightforyourage,genderandhealthstatus.

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[Customernameorlogo]

CoveredpreventiveservicesforchildrenScreeningsandassessmentsfor:•Alcoholanddruguse(foradolescents)•Autism(forchildrenat18and24months)•Behavioralissues•Cervicaldysplasia(forsexuallyactivefemales)•Congenitalhypothyroidism(fornewborns)•Developmentalscreening(forchildrenunderage3,andsurveillancethroughoutchildhood)•Hearing(forallnewborns)•Height,weightandbodymassindexmeasurements•Lipiddisorders(dyslipidemiascreeningforchildrenathigherrisk)•Hematocritorhemoglobin•Hemoglobinopathiesorsicklecell(fornewborns)•HIV(foradolescentsathigherrisk)•Lead(forchildrenatriskofexposure)•Medicalhistory•Obesity•Oralhealth(riskassessmentforyoungchildren)•Phenylketonuria(PKU)(fornewborns)•Tuberculintesting(forchildrenathigherriskoftuberculosis)•Vision

Counselingfor:•Obesity•Sexuallytransmittedinfection(STI)prevention(foradolescentsathigherrisk)

Immunizations:Frombirthtoage18— doses,recommendedagesandrecommendedpopulationsvary•Diphtheria,pertussis,tetanus(DPT)•Haemophilusinfluenzaetypeb•HepatitisAandB•Humanpapillomavirus•Inactivatedpoliovirus•Influenza•Measles,mumps,rubella(MMR)•Meningococcal(meningitis)•Pneumococcal(pneumonia)•Rotavirus•Varicella(chickenpox)

Pleasenote:Coverageincludesregularcheckups,androutinegynecologicalandwell‐childexams. Aetnafollowstherecommendationsofnationalmedicalsocietiesabouthowoftenchildren,menandwomenneedtheseservices.Besuretotalkwithyourdoctoraboutwhichservicesarerightforyourage,genderandhealthstatus.

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Aetna’stoolsandresourcesMakingconfidentdecisions• Ouronlineproviderdirectory• MemberPaymentEstimator• Costandquality‐of‐caredecision‐support

tools• iTriage®app

Takingcareofyourhealth• SimpleStepsToAHealthierLife®program• Healthhistoryreport• PersonalHealthRecord

Gettinghelpwhenyouneedit• Memberwebsite• 24‐hourphoneservice• MemberServices• InformedHealth®Line• AetnaMobileApp

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Knowbeforeyougo

Andwithourothercost‐of‐caretools,youcan:

• Lookupdoctors’ratesforcommonmedicalservices**

• Comparecostrangesforcommonmedicalproceduresdoneatahealthcarefacilitywithinthelocalarea***

• Checkoutwhatprescriptiondrugsmaycostatalocalpharmacyandestimatetheowedamount

• Getinformationonhospitals,likequalityandpatientsatisfaction,tohelpyoudecidewheretogetcare

OurMemberPaymentEstimator*Givesyoureal‐timeout‐of‐pocketcostestimates–basedonyourplan– forcommonin‐networkandout‐of‐networkhealthcareservices.

*Estimatedcostsnotavailableinallmarkets.Thetoolprovidesanestimateofwhatwouldbeowedforaparticularservicebasedontheplanatthatverypointintime.Actualcostsmaydifferfromanestimateif,forexample,claimsforotherservicesareprocessedaftertheestimateisprovidedbutbeforetheclaimforthisserviceissubmitted.Or,ifthedoctororfacilityperformsadifferentserviceatthetimeofthevisit.HMOmemberscanonlylookupestimatedcostsfordoctorandoutpatientfacilityservices.

**Memberscanonlyviewratesforparticipatingphysicians/physiciangroups.Adoctor’sraterepresentswhatadoctorwould receivefromAetnaasreimbursem*ntforaservice.

***Notallhospitalsorfacilitieswilldisplayforagivenareaduetodataand/orcontractuallimitations.Wedonotguaranteetheaccuracyofanyparticularcostamount.

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AllyouneedtomanageyourhealthAetnadiscountprograms:• Enjoydiscountsoneyeexamsand

eyewear,hearingaids,vitaminsandsupplements,weight‐lossprogramsandmore.

• SimplyshowyourAetnaIDcardtoparticipatingvendors.

• Thediscountsarenotinsurance—thememberisresponsiblefortheentirecostoftheservicetheyreceive.

• LearnmoreonyourAetnaNavigatorsecuremembersite.URL:www.aetnanavigator.com

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ConnectwithAetna—whenandhowit’sbestforyou

• Mobilewebisoptimizedforover5,000devices• Mobileapplicationsprovideamoreenhancedexperience

andareavailableforusewithiPad®,iPhone® andiPodtouch® mobiledigitaldevices,theAndroidTM mobiletechnologyplatformandtheBlackBerry® CurveTM*

smartphone

Weknowwhatyouneedonthego• DocFind®• Claimsearch• Urgentcarefinder• MemberIDcardinformation• PersonalHealthRecord• ContactUscapabilities• Usernameandpasswordrecovery• Registration

Byphone,byemail,online— evenonthego

Apple,theApplelogo,iPad®,iPod®,iPodtouch®andiPhone®aretrademarksofAppleInc.,registeredintheU.S.andothercountries.AndroidandGooglePlayaretrademarksofGoogleInc.BlackberryCurveisthetrademarkorregisteredtrademarkofBlackberryLimited,theexclusiverightstowhichareexpresslyreserved.Aetnaisnotaffiliatedwith,endorsed,sponsored,orotherwiseauthorizedbyBlackberryLimited.

Standardtextmessagingandotherratesfromyourwirelesscarriermayapply.

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Thankyou

Forself‐fundedplans,coverageisofferedbyyouremployerwithadministrativeservicesonlyprovidedbyAetnaLifeInsuranceCompany(Aetna). Notallhealthservicesarecovered.Seeplandocumentsforacompletedescriptionofbenefits,exclusions,limitationsandconditionsofcoverage.Planfeaturesandavailabilitymayvarybylocationandaresubjecttochange.Healthinformationprogramsprovidegeneralhealthinformationandarenotasubstitutefordiagnosisortreatmentbyaphysicianorotherhealthcareprofessional.Healthbenefitsandhealthinsuranceplanscontainexclusionsandlimitations.ProvidersareindependentcontractorsandarenotagentsofAetna. Providerparticipationmaychangewithoutnotice.Aetnadoesnotprovidecareorguaranteeaccesstohealthservices.DiscountprogramsprovideaccesstodiscountedpricesandareNOTinsuredbenefits.Thememberisresponsibleforthefullcostofthediscountedservices.Informationisbelievedtobeaccurateasoftheproductiondate;however,itissubjecttochange.For moreinformationaboutAetnaplans,refertowww.aetna.com.

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