Ready today for the future of consumer-directed health
plan solutions
Aetna HealthFund®
Health Reimbursement Arrangement (HRA)
32.25.102.1 (3/09)
2
3
4 ©2009 Aetna
Support member engagement
Help members become better health care consumers
Educate members on the process
Enable behavior change
Support doctor-patient relationships
Provide personalized information
Make connections for optimal health
5 ©2009 Aetna
Aetna HealthFund®
High deductible health plan, Health Reimbursement Arrangement( HRA)*, Health Savings Account (HSA)*, Aetna performance networks
Decision tools for value-based purchasing
Health incentives
Health care transparency
Integrated care management
Effective communications and education
*HRAs and HSAs are currently not available to HMO members in Illinois
6 ©2009 Aetna
Health benefits - current environment
Health care costs continue to rise
Employers looking for solutions and savings
New competitive options emerging
Legislative and political impact
Consumer’s role changing
Result – CDHP (Consumer-Directed Health Plans)
7 ©2009 Aetna
An industry transformation
Greater member responsibility
Promotes consumer engagement
Can improve employee satisfaction
Saves employers money
Drives cost down
8 ©2009 Aetna
The Aetna HealthFund®
Health Reimbursement Arrangement (HRA)*
Fully integrated systems, including Pharmacy
Full product and funding spectrum
Actuarial modeling capabilities
Plan design flexibility
Full medical management services
Personalized Aetna Navigator® consumer decision support tools
Favorable network discounts
Monthly member statements
*HRAs are currently not available to HMO members in Illinois
9 ©2009 Aetna
Aetna HealthFund HRA*
Fund integrated with deductible-based medical plan– Fund
• Established by employer• Notional account / unfunded liability • Pays eligible out-of-pocket expenses• Balances roll over, option to cap• Fund reduces deductible (standard model)
– Medical plan • Deductible• Coinsurance and/or copayments• 100% preventive care, not subject to fund or deductible• Out-of-pocket maximum
Consumer tools and information
*HRAs are currently not available to HMO members in Illinois
10*HRAs are currently not available to HMO members in Illinois.
*
Helps you pay for eligible out-of-pocket expenses……………………….
Employer funded each plan year
11 *HRAs are currently not available to HMO members in Illinois.
*
Helps you pay for eligible out-of-pocket expenses……………………….
Employer funded each plan year
You pay this amount before your health plan begins to pay for eligible
expenses
12 *HRAs are currently not available to HMO members in Illinois.
*
Helps you pay for eligible out-of-pocket expenses……………………….
Employer funded each plan year
You pay this amount before your health plan begins to pay for eligible
expenses
Once you meet your deductible, your health plan pays a larger % of eligible costs while you pay a smaller %
13 *HRAs are currently not available to HMO members in Illinois.
*
14 ©2009 Aetna
Employer-established fund
Various fund amounts available Generally half deductible amount Fund rollover options Fund typically forfeited at termination of employment or termination of plan Health fund can be limited to:
– Traditionally covered PPO expenses– IRS Section 213 deductible health expenses (ASC)
Rollover maximum One fund per family, not member Fund-tiering available
15 ©2009 Aetna
HRA* common plan designs
Underlying Plan deductible ranges– Individual range: $500 - $3,000 ($1,000 / $1,500 / $2,000)– Family range: $1,500 - $9,000 ($2,000 / $2,500 / $3,000)
Out-of-Pocket maximum– Individual range: $2,000 - $4,000– Family range: $4,000 - $8,000
Fund ranges– Individual range: $350 - $1,000 ($500 / $750 / $1,000)– Family range: $750 - $3,000 ($1,000 / $1,500 / $2,000)
Underlying plan coinsurance levels: 80/60, 90/70 or 100/70 100% preventive care Tiering
– Standard is 2-tier (Individual or Family)– Each tier has one deductible to meet for the entire group
Note: Effective member responsibility is a result of utilizing many of the plan design components as opposed to each component individually.
* HRAs are currently not available to HMO members in Illinois.
16 ©2009 Aetna
Preventive care coverage
Generally 100% covered for each individual– Does not apply to fund or deductible
Preventive care schedule on Aetna Navigator®
Covers medical services such as routine physicals, immunizations, screening, well-woman exams, well-child visits
Encourages employee to obtain preventive care
17 ©2009 Aetna
HRA* medical plan
Fund deductible coinsurance options– Fund pays member responsibility (deductible and member coinsurance)– Fund pays until exhausted (may or may not reduce deductible)– Before-fund deductible fund coinsurance (ASC only)– Deductible fund deductible coinsurance
Self-funded plans (ASC)– PPO, Aetna Choice® POS II, Open Access Aetna SelectSM
Fully insured plans– PPO, Open Access Managed Choice® (POS) and Aetna Choice POS (HMO)
Optional standalone or integrated pharmacy and dental Flexible plan designs
*HRAs are currently not available to HMO members in Illinois
18 ©2009 Aetna
Additional options & features
Dental integration
Long Term Care premium reimbursement
Chronic & preventive medications
Incentives
Hybrid funding arrangement (insured plan, ASC fund)
Simple Steps To A Healthier Life®
Informed Health® Line
Medical management programs
Aexcel®
19 ©2009 Aetna
Pharmacy integration
Real-time claim adjudication
Discounted cost of prescriptions applied to fund and/or deductible depending upon fund model
Once fund exhausted and deductible met, pharmacy plan can be:– Same or lower coinsurance level as medical, or– Copay plan
Participating pharmacy knows whether to collect anything from member – handled at point of sale with no balance billing
Price-A-DrugSM tool available to assist members
20
Comparing HRA*, HSA*, FSA
Note: HSAs can be purchased with a “limited purpose” HRA/FSA, post deductible HRA/FSA, suspended HRA, retirement HRA
Feature Health Reimbursement Arrangement (HRA* or RRA)
Health Savings Account (HSA*)
Flexible Spending Account (FSA)
Eligibility All eligible employees Individual covered by high deductible health plan (HDHP)
All eligible employees
Contributor Employer only Employer, individual or both
Employer, associate or both
Roll-Over Usually yes, but at employer discretion
Yes No
Tax Advantaged Yes Yes Yes
Portability No, forfeit upon termination Employer has option to roll to RRA on retirement
Yes No
Ability to Earn Investment Income
No Yes No
Rx Integrationfor HDHP
Available Required N/A
*HRAs and HSAs are currently not available to HMO members in Illinois
21
Aetna HealthFund® HRA* / HSA*
Health Reimbursement Arrangement819 customers
• 133 National• 123 Key• 290 Select• 68 Small Group
52 full replacement plans*
~ 882K members
High-Deductible Health Plan/HSA9,712 customers
• 131 National• 146 Key • 350 Select• 9,085 Small Group
51 full replacement plans*
~401K members HDHP/HSA
~75K members HDHP only
As of 12/2008
Aetna’s HRA/HSA growth1/02 – ~4821/03 – ~39K
1/04 – ~160K 1/05 – ~359K 1/06 – ~463K 1/07 – ~826K
1/08 – ~1.29M
* >1,000 lives
*HRAs and HSAs are currently not available to HMO members in Illinois
22 ©2009 Aetna
Plan sponsor tools
Cost modeling
Pricing tool
Reporting
23 ©2009 Aetna
Consumer tools
Aetna Navigator®
Plan Selection & Cost Estimator Tool
24 ©2009 Aetna
Consumer tools
DocFind®
Hospital Comparison Tool
Plan Selection & Cost Estimator
Transparency Suite of Tools – Price and Clinical Quality
Cost of Care Tool
Healthwise® Knowledgebase
Informed Health® Line
Aetna InteliHealth®
Simple Steps To A Healthier Life®
25 ©2009 Aetna
Keys to success
Set a strategy Appropriate benefit structure, information and tools A business culture actively communicating health care
engagement concepts
Member responsibility $750 - $1000 bridge between deductible and employer
fund/account contribution with appropriate coinsurance Update benefit offerings regularly to stay in-sync with the overall
strategy
Engagement Multi-year, cost controlling strategies that engage employees in
managing their health Provide information and tools for decisions about health,
spending and overall wellness
26 ©2009 Aetna
Keys to success
Wellness Preventive care covered at 100% In-depth education and communication including completion
of Health Assessments
Steerage to CDHP CDHP as the lowest cost option Lowering the required employee premium contribution
and/or offer higher fund/account contribution
27 ©2009 Aetna
Engaging your employees and enabling behavior
Four phases to an effective communications strategy
Enrollment
Contribution strategy
Educate
Emphasize accountability
2Post-Enrollment
Reinforce
Remind
Update
3 4Pre-Enrollment
Engage Management
Advantages/Features
Employee role
1Ongoing support
Motivate employees Keep them engaged Reintroduce resources
28 ©2009 Aetna
Why Aetna?
Experience
Innovation
Consumer communication and education
Integration
Plan design
Analysis and reporting
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Healthier employees
Higher levels of engagement
Innovative, client-centered solutions
Lifelong optimal healthLower medical costsHigher productivity
++=
Join the Change
Ready today for the future of health care
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This material is for information only. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Aetna HealthFund HRAs are subject to employer-defined use and forfeiture rules, and are unfunded liabilities of your employer. Fund balances are not vested benefits. Investment services are independently offered through JPMorgan Institutional Investors, Inc., a subsidiary of JPMorgan Chase Bank. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com. Policy forms issued in OK include: HMO OK COC-5 09/07, HMO/OK GA-3 11/01, HMO OK POS RIDER 08/07, GR-23 and/or GR-29/GR-29N.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Health Inc., Aetna Health of California Inc., Aetna Health of the Carolinas Inc., Aetna Health of Illinois Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 06156. Each insurer has sole financial responsibility for its own products.
©2009 Aetna Inc.
32.25.102.1 (3/09)
31 ©2009 Aetna
Appendix
32
HRA* Workflow (Medical HRA* pays first)
Member sees Provider
- presents ID card (no copay)
- Member pays $0
Provider bills
Aetna.
Aetna adjudicates claim and
determines what the Member
owes.
Is there enough money in the HRA Fund to cover the
Member responsibility?
Aetna pays Provider directly from the Fund.
Member owes $0.
Aetna pays Provider whatever it can, if anything, from the Fund and tells the Provider the exact
amount to bill the Member.
Provider bills Member.
Member pays Provider.
HRA$
Yes
No
*HRAs are currently not available to HMO members in Illinois.
33
HRA* – how it works
The Plan Pays
30%10%
*HRAs are currently not available to HMO members in Illinois.
34
HRA* – how it works
Member Responsibility
30%10%
*HRAs are currently not available to HMO members in Illinois.
35
HRA* – how it works
The Plan Pays
Member Responsibility
Fund
30%10%
*HRAs are currently not available to HMO members in Illinois.
36
HRA* – how it works
The Plan Pays
Member Responsibility
Fund
FundHelpsPay
30%10%
*HRAs are currently not available to HMO members in Illinois.
37
HRA* example year 1
30%10%*HRAs are currently not available to HMO members in Illinois.
** For illustrative purposes only. Does not reflect events experienced by an actual participant.
**
38
HRA* example year 1
30%10%*HRAs are currently not available to HMO members in Illinois.
** For illustrative purposes only. Does not reflect events experienced by an actual participant.
**
39
HRA* example year 1
30%10%*HRAs are currently not available to HMO members in Illinois.
** For illustrative purposes only. Does not reflect events experienced by an actual participant.
**
40
HRA* example year 2
30%10%*HRAs are currently not available to HMO members in Illinois.
** For illustrative purposes only. Does not reflect events experienced by an actual participant.
**