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B. Aetna HealthFund. October 2006. What is Aetna HealthFund?. Innovative approach to health benefits that gives you more control over who delivers your care and how your health care dollars are spent
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B Aetna HealthFund October 2006
What is Aetna HealthFund? • 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 Employee Employee + 1 Family The Health Fund $750* $1,125* $1,500* Annual Deductible** $1,500 $2,500 $3,000 PreventiveCare covered at 100%(in-network only) Hospital:80% Inova/70% non-Inova in-network/60% out-of-network Other Services: 80% in-network/60% out-of-network Traditional Medical Coverage In-Network Coinsurance Limit Out-of-Network Coinsurance Limit $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 $2,000 per individual $4,000 per individual 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. Important: Read all details about this plan before you enroll as this is very different from our other plans.
Aetna HealthFund is Made Up of Three Elements • An underlying deductible-based health insurance plan • A fund or account that you can use to help pay for qualified, out-of-pocket medical expenses • Interactive tools and information to help you make informed health care decisions
How Does the Aetna HealthFund Work? The Health Fund Preventive Services • For out-of-pocket medical and drug expenses up to Health Fund amount. Unused portions roll over to next year. EmployeeResponsibility • In-Network Preventive Care Covered at 100 percent You pay medical expenses until you meet deductible. Can be offset by Health Fund rollover. Traditional Medical Coverage 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. 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.
How Does Aetna HealthFund Work forPrescription Drugs? The Health Fund Employee does not payat the pharmacy EmployeeResponsibility Employee pays discounted cost at the pharmacy Traditional MedicalCoverage Employees pays copays at the pharmacy (same copays as the PPO plans)
Consumer Online Health Tools Seek Information • Health Care • Marketplace • Providers • Hospitals • Pharmacy • Lab/Ancillary Seek Care • 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 Aetna HealthFund Overview Seek Help Informed Health Line 24/7 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.
Aetna HealthFund Example The 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. Sherrie Smith Tyler Smith Dwight Smith Tiffany Smith • Year 1 and Year 2 in the Aetna HealthFund plan were typical • Year 3 was marked by several serious health concerns including: • 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
Annual Health Fund allocation from Inova Health Fund Balance Year 2: $800 from Year 1 (F1), plus $1,500 for Year 2 $2,300 $1,500 Expenses: Expenses: B2. Preventive Care Services – $500C2. Doctor’s Office Visits – $300D2. Prescription Drugs – $700 B1. Preventive Care Services – $500C1. Doctor’s Office Visits – $200D1. Prescription Drugs – $500 $1,200 $1,500 Amount paid by Inova’s Preventive Care benefit (B1) Amount paid by Inova’s Preventive Care benefit (B2) $500 $500 Amount paid from Inova’s annual Health Fund allocation (C1+D1) Amount paid from Inova’s annual Health Fund allocation (C2+D2) $700 $1,000 Fund Rollover to Year 3 (A2-E2) Fund Rollover to Year 2 (A1-E1) $1,300 $800 Aetna HealthFund Example (cont’d) A1 Year 1 B1+C1+D1 E1 F1 A2 Year 2 B2+C2+D2 E2 F2
Health Fund Balance Year 3: $1,300 from Year 2 (F2), plus $1,500 for Year 3 $2,800 Expenses: B3. Cardiac Procedure – $15,000C3. Pregnancy (Normal Delivery) – $8,500D3. Preventive Care Services – $900E3. Doctor’s Office Visits – $600F3. Prescription drugs – $1,600 $26,600 Amount paid by Inova’s Preventive Care benefit $900 Amount paid from Inova’s annual Health Fund allocation $1,500 Amount paid from Health Fund Carry-Over toward Employee Responsibility $1,300 Amount paid by You for remainder of your Employee Responsibility ($1,500-F2) $200 Amount 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 $4,000 Amount paid by Inova in Traditional PPO Health Coverage (80% of $22,700*) + ($4,540 -$4,000) = $18,160 + $540 $18,700 Fund Rollover to Year 4 $0 Aetna HealthFund Example (cont’d) A3 G3=B3+C3+D3+E3+F3 Year 3 D3 F2 H3 This is the Traditional Medical Coverage portion of the Plan. * $26,600 (G3) - $900 preventive benefit (D3) - $1,500 Inova fund allocation - $1,300 fund carryover (F2) - $200 employee responsibility (H3) = $22,700
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
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
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 Self-Service Personal Touch Post Enrollment Tools and Support 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 Member Services • Extended hours – 8 a.m. – 6 p.m. eastern time • Toll-free (800) 862-5441
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-Service Personal Touch Post Enrollment Tools and Support 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.