Aetna Advantage plans for individuals, families and the self-employed

All Managed Choice Open Access Plans, MC* Value Plans, MC* High Deductible Plans, and MC* First Dollar Plans include:

• You have access to Aetna’s nationwide network and your out-of-pocket costs may be lower if you choose from among the many participating physicians and hospitals within this nationwide network.
• Unlimited office visits to your primary care physician and specialists (copays, deductibles & coinsurance apply to MC* Value plans)
• No claim forms to fill out when you visit a network provider
  
• No referrals required to see a specialist n No waiting period to access preventive health (routine physicals)
• 100% annual routine GYN exam coverage — no waiting period, no dollar maximum, and no copay or deductible when you visit a network provider
• Coverage for prescription drugs
• Routine physicals include lab work and X-rays n 100% coverage on in-network childhood immunizations

About HSAs…

A Health Savings Account, or HSA, is a personal account that lets you pay for qualified medical expenses with tax-advantaged funds. You or an eligible family member make contributions to your HSA tax-free, and those dollars earn interest tax-free. Then, when you make withdrawals from your account to pay for qualified health care expenses, they’re tax-free, too.

Looking for a lower cost plan?

Add Dental PPO Max

With the Aetna Advantage Dental PPO Max insurance plan, you can obtain services from either a participating or non-participating dentist. Participating dentists have agreed to provide services at a negotiated rate for both covered services, as well as non-covered ser vices such as cosmetic tooth whitening and orthodontic care, so you generally pay less out-of-pocket. You also have the flexibility to visit a dentist who does not participate in Aetna’s network, though you will not benefit from negotiated fees. Dental is offered only if medical coverage is obtained.

Want to cover your children only?

All Aetna Advantage plans are available for children only, which means you can enroll your child even if no other family member enrolls. Coverage includes immunizations, well-child visits, emergency room and dental preventive services (if dental is selected). Note: when an HSA Compatible plan is selected for child only enrollment, an HSA account is not available for the child.

Your rates will depend on the area in which your county is located.

AREA 1

AETNA ADVANTAGE PLAN OPTION INDIVIDUAL DENTAL PPO MAX PLAN

MEMBER BENEFITS PREFERRED NONPREFERRED

Fluoride application — 100% deductible 50% deductible with cleaning waived waived

Access to negotiated discounts: members are eligible to receive non-covered services, including cosmetic services such as tooth whitening, at the PPO negotiated rate when visiting a participating PPO dentist at any time.

Nonpreferred (Out-of-Network) Coverage is limited to a maximum of the Plan’s payment, which is based on the contracted maximum fee for participating providers in the particular geographic area. Above list of covered services is representative. For a full list of benefit coverage and exclusions refer to the plan documents. All products not available in all counties. Please refer to the county list located on page 4.

Aetna Advantage Plans include special programs¹ with a wealth of features to complement our standard health insurance coverage. These programs include substantial savings on products and educational materials geared toward your special health needs. These programs are value added and are nOT insurance. Here are a few of the ways we can help you be well.

Fitness Program

With our Fitness program, eligible Aetna members and their families can enjoy preferred rates* on fitness club memberships at over 2,000 fitness clubs within the GlobalFit™ network. In addition, members can access other programs such as at-home weight loss programs, home fitness options and even one-on-one health coaching** services.

Aetna Weight Management^SM Program

The Weight Management Program can help you achieve your weight loss goals by providing you with a sensible weight loss plan and balanced nutrition guide to fit your lifestyle. This program provides Aetna members and their eligible family members access to discounts on Jenny Craig^® weight loss programs and products. Start with a FREE 30-day trial membership²; then choose either a 6-month² or 12-month² program³ that’s right for you. You also receive individual weight loss consultations, personalized menu planning, tailored activity planning, motivational materials and much more.

Eyecare Savings

Aetna VisionSM Discounts program offers special savings on eye exams, contact lenses, frames, lenses, LASIK eye surgery, and eye care accessories.

Hearing Discount Program

Aetna’s HearingSM Discounts help Aetna members and their families save on hearing exams, hearing services and hearing aids.

Aetna natural Products and Services^SM program

Eligible Aetna members and their families can access complementary health care products and services at reduced rates through the Aetna Natural Products and Services program. Members can save on acupuncture, chiropractic care, massage therapy and dietetic counseling as well as on over-the-counter vitamins, herbal and nutritional supplements and other health-related products.

Informed Health^® Line

Get answers 24/7 to your health questions via a toll-free hotline staffed by a team of registered nurses.

Want to save on dental expenses?

Vital Savings by Aetna^® is a discount program that provides you with dental savings. This is not insurance. Enrolling in the program will give you access to a network of providers who have agreed to accept discounted rates for services. To sign up today, visit www.vitalsavings.com or call 1-877-698-4825.

Aetna Rx Home Delivery^®

With this optional program, order prescription medications through our convenient and easy-to-use mail order pharmacy. To learn more or obtain order forms, visit www.AetnaRxHomeDelivery.com.

Aetna navigator^®

It’s easy and convenient for Aetna members to manage their health benefits. Anytime – day or night – wherever they have Internet access, members can log in to Aetna Navigator, Aetna’s secure member website. Members who register on the site can check the status of their claims, contact Aetna Member Services, estimate the costs of health care services, and much more!

Our new Aetna Navigator Health Information Guide provides you with a starting point to find answers about health care, types of treatment, cost of services and more. It provides links to some of the tools, programs and health content on Aetna Navigator that can help you make more informed decisions – before, during and after you receive medical care.

Members will also have access to their own Personal Health Record***, a single, secure place where they can view their medical history and add other health information that’s important to them.

For more information on any of these programs, please visit us online at www.aetna.com.

***The Aetna Personal Health Record should not be used as the sole source of information about your health conditions or medical treatment.

Things you need to know

To qualify for an Aetna Advantage Plan, you must be:

n Under age 64 3/4 (If applying as a couple, both

you and your spouse must be under 64 3/4.) n Under age 25 for dependent children n Legal residents in a state with products offered

by the Aetna Advantage Plans n Legal U.S. residents for at least 6 continuous months.

Your premium payments

Your premium payments are guaranteed not to increase for 12 months from your effective date once you’ve been accepted for coverage. After that, your premiums may change. Final rates are subject to underwriting review.

Your coverage

Your coverage remains in effect as long as you pay the required premium charges on time, and as long as you maintain membership eligibility. Coverage will be terminated if you become ineligible due to any of the following circumstances:

n Non-payment of premiums n Becoming a resident of a state or location in

which Aetna Advantage plans are not available. n Obtaining duplicate coverage n For other reasons permissible by law

Medical underwriting requirements

The Aetna Advantage Plans are not guaranteed issue plans and require medical underwriting. Some individuals may be federally eligible under the Health Insurance Portability Accountability Act (HIPAA) for a special guaranteed issue plan through CoverColorado under Colorado laws and regulations.

how to apply

All applicants, enrolling spouses and dependents are subject to medical underwriting to determine eligibility and appropriate premium rate level.

We offer various premium rate levels based on the known and predicted medical risk factors of each applicant.

Levels of coverage and enrollment

n You may be enrolled in your selected plan at the standard premium charge.

n You may be enrolled in your selected plan at a higher rate, based on medical findings.

n You may be declined coverage based on significant medical risk factors.

Duplicate coverage

If you are currently covered by another carrier, you must agree to discontinue the other coverage before or on the effective date of the Aetna Advantage Plan. Do not cancel your current insurance until you are notified that you have been accepted for coverage.

Pre-existing conditions

During the first 12 months following your effective date of coverage, no coverage will be provided for the treatment of a pre-existing condition unless you have creditable prior coverage.

A pre-existing condition is an illness or injury for which medical advice or treatment was recommended or received within 6 months preceding the effective date of coverage.

All You need to Know About Easy-Pay

Simple Automatic Payments via Electronic Funds Transfer (EFT)

Registration: Complete the payment section of the Aetna Advantage Plans application. Select the EFT option to approve the automatic withdrawal of your initial premium and all subsequent premium payments.

Invoices: You will not receive a paper invoice when you are enrolled in EFT. Payments will appear on your bank statement as “Aetna Autodebit Coverage.”

Terminating: To terminate EFT, you will need to provide Aetna with 10 days written notice prior to the date your next EFT payment will be deducted. Without this written notice, your bank account may be debited for the next month’s premium. You will then need to contact Aetna to have funds placed back in the checking account.

Refunds: To process an EFT refund (placing money back in member’s checking account), Aetna will require at least 5 days after the withdrawal was made to ensure valid payment.

Rejected transactions: If the EFT payment rejects for any reason, Aetna will automatically terminate the EFT and send you a letter saying you will receive paper invoices. Processing time to reinstate EFT will be 30–60 days. If an EFT payment is rejected, you will need to pay that payment by paper check or credit card.

Timing: Payments for Cycle 1 accounts (1st of the month effective date) will be taken from your bank account between the 3rd and the 10th of the month the premium is due. Payments for Cycle 2 accounts (15th of the month effective date) will be taken from your bank account between the 18th and 23rd of the month the premium is due.

Colorado limitations and exclusions

Medical

These medical plans do not cover all health care expenses and include exclusions and limitations. You should refer to your plan documents to determine which health care services are covered and to what extent.

The following is a partial list of services and supplies that are generally not covered. However, your plan documents may contain exceptions to this list based on state mandates or the plan design or rider(s). Services and supplies that are generally not covered include, but are not limited to:

n All medical and hospital services not specifically covered in, or which are limited or excluded by your plan documents, including costs of services before coverage begins and after coverage terminates

n Cosmetic surgery

n Custodial care

n Donor egg retrieval

n Weight control services including surgical procedures for the treatment of obesity, medical treatment, and weight control/loss programs

n Experimental and investigational procedures, (except for coverage for medically necessary routine patient care costs for Members participating in a cancer clinical trial)

n Charges in connection with pregnancy care other than for pregnancy complications

n Immunizations for travel or work

n Implantable drugs and certain injectable drugs including injectable infertility drugs

n Infertility services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI and other related services unless specifically listed as covered in your plan documents

n Medical expenses for a pre-existing condition are not covered for the first 12 months after the member’s effective date. Look back period for determining a pre-existing condition (conditions for which diagnosis, care or treatment was recommended or received) is 6 months prior to the effective date of coverage. If the applicant had prior creditable coverage within 90 days immediately before the signature on the application, then the pre-existing conditions exclusion of the plan will be waived.

n Orthotics n Over-the-counter medications and supplies n Radial keratotomy or related procedures n Reversal of sterilization n Services for the treatment of sexual dysfunction

or inadequacies including therapy, supplies or

counseling n Special or private duty nursing n Therapy or rehabilitation other than those listed as

covered in the plan documents

n Mental Health in-network services for Managed Choice Open Access plans not covered, except for severe biologically based mental or nervous disorders.

Dental

Listed below are some of the charges and services for which these dental plans do not provide coverage. For a complete list of exclusions and limitations, refer to plan documents.

n Dental Services or supplies that are primarily used to alter, improve or enhance appearance. Negotiated rates for cosmetic procedures available when a participating dentist is accessed.

n Experimental services, supplies or procedures n Treatment of any jaw joint disorder, such as temporomandibular joint disorder n Replacement of lost or stolen appliances and certain damaged appliances n Services that Aetna defines as not necessary for the diagnosis, care or treatment of a condition involved n All other limitations and exclusions in your plan documents

10-day right to review

Do not cancel your current insurance until you are notified that you have been accepted for coverage. We’ll review your application to determine if you meet underwriting requirements. If you’re denied, you’ll be notified by mail. If you’re approved, you’ll be sent an Aetna Advantage Plan contract and ID card.

If, after reviewing the contract, you find that you’re not satisfied for any reason, simply return the contract to us within 10 days. We will refund any premium you’ve paid (including any contract fees or other charges) less the cost of any services paid on behalf of you or any covered dependent.

This material is for information only and is not an offer or invitation to contract. Plan features and availability may vary by location. Plans may be subject to medical underwriting or other restrictions. Rates and benefits may vary by location. Health/dental insurance plans contain exclusions and limitations. Investment services are independently offered through JPMorgan Institutional Investors, Inc., a subsidiary of JPMorgan Chase Bank. 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. Not all health services are covered. See health insurance plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features are subject to change. Aetna receives rebates from drug makers 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. Aetna Rx Home Delivery refers to Aetna Rx Home Delivery, LLC, a licensed pharmacy subsidiary of Aetna Inc., that operates through mail order. Material subject to change.