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Aetna HealthFund October 2006 B. 1 $2,000 per individual $4,000 per family $4,000 per individual...

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Aetna HealthFund October 2006 B
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Page 1: Aetna HealthFund October 2006 B. 1 $2,000 per individual $4,000 per family $4,000 per individual $8,000 per family $2,000 per individual $4,000 per family.

Aetna HealthFund

October 2006

B

Page 2: Aetna HealthFund October 2006 B. 1 $2,000 per individual $4,000 per family $4,000 per individual $8,000 per family $2,000 per individual $4,000 per family.

2

$2,000 per individual$4,000 per family

$4,000 per individual$8,000 per family

$2,000 per individual$4,000 per family

$4,000 per individual$8,000 per family

Traditional Medical Coverage

In-Network Coinsurance Limit

Out-of-Network Coinsurance Limit

$2,000 per individual

$4,000 per individual

Hospital:80% Inova/70% non-Inova in-network/60% out-of-network

Other Services: 80% in-network/60% out-of-network

$3,000$2,500$1,500Annual Deductible**

$1,500*$1,125*$750*The Health Fund

FamilyEmployee + 1Employee

Pre

venti

ve C

are

covere

d a

t 1

00

%(i

n-n

etw

ork

only

)What is Aetna HealthFund?

Important: Read all details about this plan before you enroll as this is very different from our other plans.

Innovative approach to health benefits that gives you more control over who delivers your care and how your health care dollars are spent

You have the flexibility to decide how to spend your benefit dollars and the plan helps you manage your health care and its associated costs throughout the year

Depending on whether you are in an employee only, employee +1 or family plan, you are responsible for meeting the Annual Deductible outlined above. Any dollars you have in your Fund can be used towards meeting this deductible. Once this Annual Deductible has been met, your medical plan will reimburse benefits based on coinsurance (i.e., 80%). Regardless of whether you are in an employee only, employee + 1 or family plan, you are responsible for meeting the coinsurance limits outlined above. The most you will have to pay as an individual in coinsurance is $2,000 for in-network coverage/$4,000 for out-of network coverage. The most your family will have to pay in coinsurance is $4,000 for in-network coverage/$8,000 for out-of network coverage. Once your coinsurance limit is met, benefits will be paid at 100% for the remainder of the year. NOTES: * This amount will be added to your Fund each year. Your beginning Health Fund amount may be more if you have rollover dollars from the previous year. **This Annual Deductible can be satisfied by one member or any combination of family members.

Page 3: Aetna HealthFund October 2006 B. 1 $2,000 per individual $4,000 per family $4,000 per individual $8,000 per family $2,000 per individual $4,000 per family.

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1. An underlying deductible-based health insurance plan

2. A fund or account that you can use to help pay for qualified, out-of-pocket medical expenses

3. Interactive tools and information to help you make informed health care decisions

Aetna HealthFund is Made Up of Three Elements

Page 4: Aetna HealthFund October 2006 B. 1 $2,000 per individual $4,000 per family $4,000 per individual $8,000 per family $2,000 per individual $4,000 per family.

4

Traditional Medical Coverage

The Health Fund

EmployeeResponsibility

For out-of-pocket medical and drug expenses up to Health Fund amount. Unused portions roll over to next year.

Coverage for services and conditions defined by the plan design. Takes effect when the deductible (annual Inova Health Fund allocation plus the Employee Responsibility) is satisfied.

You pay medical expenses until you meet deductible. Can be offset by Health Fund rollover.

Pre

ven

tive

Ser

vice

s

In-Network Preventive Care Covered at 100 percent

How Does the Aetna HealthFund Work?

Underlying this basic plan design are a variety of on-line tools and other resources allowing members to take better care of themselves and find help when needed.

Page 5: Aetna HealthFund October 2006 B. 1 $2,000 per individual $4,000 per family $4,000 per individual $8,000 per family $2,000 per individual $4,000 per family.

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Traditional Medical

Coverage

The Health Fund

EmployeeResponsibility

How Does Aetna HealthFund Work forPrescription Drugs?

Employee does not payat the pharmacy

Employee pays discounted cost at the pharmacy

Employees pays copays at the pharmacy (same copays as the PPO plans)

Page 6: Aetna HealthFund October 2006 B. 1 $2,000 per individual $4,000 per family $4,000 per individual $8,000 per family $2,000 per individual $4,000 per family.

6

Aetna HealthFund Overview

Consumer

SeekCare

Health CareMarketplace

• Providers

• Hospitals

• Pharmacy

• Lab/Ancillary

Seek Information

• Health Management Tools

• Hospital Comparison Tool

• Provider Profiles & Information

• Prescription Drug Information

• Health Library & News

• Financial Tools• Price-a-medical

procedure• Price-a-drug

• DocFind• Price and quality

transparency

Online Health Tools

Seek

Help

Informed Health Line24/7 Nurse Advice and Proactive

Outreach, Education and Support for High Risk Individuals

Connect to www.aetna.com for access to Aetna Navigator, a personalized secure site allowing you to order ID cards, check the status of your

fund, deductible, and gather health information.

Page 7: Aetna HealthFund October 2006 B. 1 $2,000 per individual $4,000 per family $4,000 per individual $8,000 per family $2,000 per individual $4,000 per family.

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Aetna HealthFund ExampleThe Smiths are a family of four. Dwight (43) and Sherrie (38) have two children – Tiffany (12) and Tyler (7). In the past they have experienced relatively good health. Tiffany is managing diabetes, but her condition is under control.

• Annual OB/GYN visit in January

• Found out she was 3-weeks pregnant in April

• Pre-natal preventive care from April - December

• Normal labor and delivery in December

• Suffers mild heart attack in October

• Follow-up office visits and prescription drugs

• Managing diabetes since age 9

• 3 office visits and lab tests

• Monthly insulin prescription

• Preventive care doctors visit

• Prescription drugs for ear infection

Year 1 and Year 2 in the Aetna HealthFund plan were typical

Year 3 was marked by several serious health concerns including:

Sherrie Smith Dwight Smith Tiffany Smith Tyler Smith

Page 8: Aetna HealthFund October 2006 B. 1 $2,000 per individual $4,000 per family $4,000 per individual $8,000 per family $2,000 per individual $4,000 per family.

8

Yea

r 2

$1,500Annual Health Fund allocation from Inova

$700Amount paid from Inova’s annual Health Fund allocation (C1+D1)

$500Amount paid by Inova’s Preventive Care benefit (B1)

$800Fund Rollover to Year 2 (A1-E1)

$1,200B1. Preventive Care Services – $500

C1. Doctor’s Office Visits – $200

D1. Prescription Drugs – $500

Expenses:

Yea

r 1

Aetna HealthFund Example (cont’d)

$2,300Health Fund Balance Year 2: $800 from Year 1 (F1), plus $1,500 for Year 2

$1,000Amount paid from Inova’s annual Health Fund allocation (C2+D2)

$500Amount paid by Inova’s Preventive Care benefit (B2)

$1,300Fund Rollover to Year 3 (A2-E2)

$1,500B2. Preventive Care Services – $500

C2. Doctor’s Office Visits – $300

D2. Prescription Drugs – $700

Expenses:

A1

B1+C1+D1

E1

A2

B2+C2+D2

E2

F1

F2

Page 9: Aetna HealthFund October 2006 B. 1 $2,000 per individual $4,000 per family $4,000 per individual $8,000 per family $2,000 per individual $4,000 per family.

9

$18,700Amount paid by Inova in Traditional PPO Health Coverage

(80% of $22,700*) + ($4,540 -$4,000) = $18,160 + $540

$1,300Amount paid from Health Fund Carry-Over toward Employee Responsibility

$200Amount paid by You for remainder of your Employee Responsibility ($1,500-F2)

$4,000Amount paid by You in Traditional PPO Health Coverage

(20% of $22,700* = $4,540) but you pay only up to the $4,000 coinsurance limit

$2,800Health Fund Balance Year 3: $1,300 from Year 2 (F2), plus $1,500 for Year 3

$1,500Amount paid from Inova’s annual Health Fund allocation

$900Amount paid by Inova’s Preventive Care benefit

$0Fund Rollover to Year 4

$26,600B3. Cardiac Procedure – $15,000

C3. Pregnancy (Normal Delivery) – $8,500

D3. Preventive Care Services – $900

E3. Doctor’s Office Visits – $600

F3. Prescription drugs – $1,600

Expenses:

Yea

r 3

Aetna HealthFund Example (cont’d)

* $26,600 (G3) - $900 preventive benefit (D3) - $1,500 Inova fund allocation - $1,300 fund carryover (F2) - $200 employee responsibility (H3) = $22,700

A3

G3=B3+C3+D3+E3+F3

H3

This is the Traditional Medical Coverage portion of the Plan.

D3

F2

Page 10: Aetna HealthFund October 2006 B. 1 $2,000 per individual $4,000 per family $4,000 per individual $8,000 per family $2,000 per individual $4,000 per family.

10

How Does the Health Care Flexible Spending Account Work with Aetna HealthFund?

If you enroll in Aetna HealthFund you may also enroll in the Health Care Flexible Spending Account (FSA)

Contributions to a FSA could help you meet your out-of-pocket responsibility

If a service is covered by both the FSA and your HealthFund plan, benefits would first be paid by your HealthFund plan Any out-of-pocket amounts (i.e., amounts you are responsible for paying) covered by

but not paid by your HealthFund plan could be automatically paid from your FSA

Remember, contributions to a FSA are “use-it-or-lose-it” each year Rollovers are not currently permitted under IRS regulations

It is important to plan carefully and conservatively

Page 11: Aetna HealthFund October 2006 B. 1 $2,000 per individual $4,000 per family $4,000 per individual $8,000 per family $2,000 per individual $4,000 per family.

11

Is Aetna HealthFund for You?

Here are some ways to determine if this plan is right for you: Review your benefit usage for the past year, using Aetna Navigator or by

reviewing explanation of benefits statements from your previous plan Determine your medical and prescription drug expenses from last year Try to account for expected changes in your medical and drug usage in the

coming year Note the fund amount you will receive when you enroll in the plan Also note the payroll contribution amount Compare the fund amount to your expected expenses keeping in mind the

coinsurance amount you will pay if the fund is exhausted and the maximum amount of coinsurance you will ever have to pay in a given year

Consider enrolling in the Health Care Flexible Spending Account (FSA)

Note: If you or your spouse is enrolled in another plan, traditional coordination of benefit rules apply.

To learn more about our 2007 medical plans, estimate personal health care costs and model the impact under each plan, log on to Inova’s custom Aetna web site at http://custom.aetna.com/Inova

Page 12: Aetna HealthFund October 2006 B. 1 $2,000 per individual $4,000 per family $4,000 per individual $8,000 per family $2,000 per individual $4,000 per family.

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Post Enrollment Tools and Support

Self-S

ervice

Person

al Touch

Member Services Extended hours – 8 a.m. – 6 p.m. eastern time Toll-free (800) 862-5441

Telephone Self Service Aetna Voice AdvantageSM

24 x 7 availability Check claim status, eligibility and benefits, request ID card Option to connect to member services during business

hours

Secure, Personal Website Aetna Navigator™ Estimate the Cost of Care suite of tools Health information on conditions & alternative options Quality of participating providers 24 x 7 availability

Page 13: Aetna HealthFund October 2006 B. 1 $2,000 per individual $4,000 per family $4,000 per individual $8,000 per family $2,000 per individual $4,000 per family.

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Post Enrollment Tools and Support

Interactive Online Health and Wellness Program Simple Steps To A Healthier Life® Health Risk Assessment Tool Tailored Health Reports Personalized Action Plan Outreach programs

Self-S

ervice

Person

al Touch

Speak to a Registered Nurse Informed Health® Line*, 24 x 7 Availability Confidential Health and wellness information Promotes healthy lifestyles and disease prevention Promotes communication with physicians

*While only your doctor can diagnose, prescribe or give medical advice, the Informed Health nurses can provide information on more than 5,000 health topics. Contact your doctor first with any questions or concerns regarding your health care needs.


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