an enrollment package including all forms and required information

PO Box 321101 • Fairfield, Connecticut 06825 Telephone: 203-367-4070 • Facsimile: 203-367-4078

Open Enrollment for the Orthodox HealthPlan Begins Soon

Open enrollment runs from December 1st thru December 30th. Coverage begins January 1, 2014. The Orthodox HealthPlan is the official health plan for the clergy of the Greek Orthodox Archdiocese of America, The Antiochian Orthodox Christian Archdiocese, The Orthodox Church in America, The Diocese of The Armenian Church, The Serbian Orthodox Church and The Russian Orthodox Church Outside Russia. The Orthodox HealthPlan (OHP) is a PPO Plan which offers our participants the broadest and most flexible medical coverage available, and also includes prescription (pharmacy and mail order), dental, and vision benefits. The insurance carrier is Aetna, one of the single largest healthcare providers in the nation. Some of your advantages when you join OHP are: extensive medical and dental coverage, prescription drug benefits, parish transfers without interruption of coverage -- just to name a few. You can find a full description of the plan, participating physicians and hospitals, on the OHP website -- www.orthodoxhealthplans.com. With the enactment of the Affordable Care Act (ACA), many people are suddenly losing their individual coverage or are receiving notices that require them to change plans to comply with the ACA. Small group plans are facing the prospect of major plan changes or premium increases as insurers now restructure their plans to comply with the new regulations of the law. The Orthodox HealthPlan, through the work of the Orthodox HealthPlan Committee, its experienced advisors and Aetna, has worked diligently over the years to provide our members with coverage that meets or exceeds the requirements of the new ACA, all done years before the ACA mandated these minimum standards. NOW IS THE TIME TO JOIN OHP! If you apply for OHP coverage, you should not terminate any coverage you presently have until you have received confirmation that your participation has been approved. In order to be accepted, your completed enrollment form with your first month's premium needs to be received by the Plan Administrator no later than the 30th of December. If your parish will be paying the monthly premiums, we also need a dated and signed letter on parish letterhead stating that invoices should be sent to the parish. All completed enrollment forms need to be returned to the following address (and received by 12/30):

The Orthodox HealthPlan 929 Kings Highway East, 1st Floor

Fairfield CT 06825 The completed forms require a binder check for the first month’s premium, made payable to “Orthodox HealthPlan”. The monthly premium for single coverage is $1,043, while family coverage is $2,188. The Orthodox HealthPlan Committee strives to provide the broadest medical/dental plans for you and your family’s wellness and peace of mind. For additional information on the plan, enrollment forms, or other questions, please call our Plan Administrator, The GDC Financial Group at (203) 367-4070, or visit the OHP website at www.orthodoxhealthplans.com. Yours in Christ, Rev. Father Constantine L. Sitaras, Chairman Joint Orthodox HealthPlan Committee

PLAN DESIGN AND BENEFITS EFFECTIVE 05-01-2013 OPEN CHOICE® PPO

Effective date:05-01-2013 Page 1

PLAN FEATURES IN-NETWORK OUT-OF-NETWORK Deductible (per calendar year) $1,000 Individual $1,500 Individual $2,000 Family $3,000 Family All covered expenses, accumulate separately toward the preferred or non-preferred Deductible. Unless otherwise indicated, the deductible must be met prior to benefits being payable. Member costs sharing for certain services, as indicated in the plan, are excluded from charges to meet the Deductible. Pharmacy expenses do not apply towards the Deductible. The family Deductible is a cumulative Deductible for all family members. The family Deductible can be met by a combination of family members; however no single individual within the family will be subject to more than the individual Deductible amount. Member Coinsurance 10% 30% Applies to all expenses unless otherwise stated. Payment Limit (per calendar year) $3,000 Individual $4,000 Individual $6,000 Family $8,000 Family All covered expenses accumulate separately toward the preferred or non-preferred Payment Limit. Certain member cost sharing elements may not apply toward the Payment Limit. Only those out-of-pocket expenses resulting from the application of coinsurance percentage (except any deductibles, and penalty amounts) may be used to satisfy the Payment Limit. Pharmacy expenses do not apply towards the Payment Limit. The family Payment Limit is a cumulative Payment Limit for all family members. The family Payment Limit can be met by a combination of family members; however no single individual within the family will be subject to more than the individual Payment Limit amount. Lifetime Maximum Unlimited except where otherwise indicated. Payment for Non-Preferred Care** Not Applicable Professional: 300% of Medicare Facility: 300% of Medicare *We cover the cost of care differently based on whether health care providers, such as doctors and hospitals, are "in network" or "out of network." We want to help you understand how much Aetna pays for your out-of-network care. At the same time, we want to make it clear how much more you will need to pay for this out-of-network care. As an example, you may choose a doctor in our network. You may choose to visit an out-of-network doctor. If you choose a doctor who is out of network, your Aetna health plan may pay some of that doctor's bill. Most of the time, you will pay a lot more money out of your own pocket if you choose to use an out-of-network doctor or hospital. When you choose out-of-network care, Aetna limits the amount it will pay. This limit is called the "recognized" or "allowed" amount. This amount is based on "reasonable" or "prevailing" charges. We get this data from an external database. Exactly how much Aetna "recognizes" depends on the plan you or your employer picks. Your out-of-network doctor sets the rate to charge you. It may be higher -- sometimes much higher -- than what your Aetna plan "recognizes" or "allows." Your doctor may bill you for the dollar amount that Aetna doesn't recognize. You must also pay any co-payments, coinsurance and deductibles under your plan. No dollar amount above the recognized charge counts toward your deductible or maximum out-of-pocket. To learn more about how we pay out-of-network benefits visit Aetna.com. Type "how Aetna pays" in the search box. You can avoid these extra costs by getting your care from Aetna's broad network of health care providers. Go to www.aetna.com and click on "Find a Doctor" on the left side of the page. If you are already a member, sign on to your Aetna Navigator member site. This way of paying out-of-network doctors and hospitals applies when you choose to get care out of network. When you have no choice (for example: emergency room visit after a car accident), we will pay the bill as if you got care in network. You pay your plan's co-payments, coinsurance and deductibles for your in-network level of benefits. Contact Aetna if your provider asks you to pay more. You are not responsible for any outstanding balance billed by your providers for emergency services beyond your co-payments, coinsurance and deductibles. Primary Care Physician Selection Not Applicable Not Applicable Certification Requirements -



Certification for certain types of Non-Preferred care must be obtained to avoid a reduction in benefits paid for that care. Certification for Hospital Admissions, Treatment Facility Admissions, Convalescent Facility Admissions, Home Health Care, Hospice Care and Private Duty Nursing is required - excluded amount applied separately to each type of expense is $400 per occurrence. Referral Requirement None None PREVENTIVE CARE IN-NETWORK OUT-OF-NETWORK Routine Adult Physical Exams/ Immunizations

Covered 100%; deductible waived 30%; after deductible

1 routine physical exam per calendar year age 22 and older Routine Well Child Exams/Immunizations

Covered 100%; deductible waived Covered 100%; deductible waived

7 exams in the first 12 months of life, 3 exams in the second 12 months of life, 3 exams in the third 12 months of life, 1 exam per 12 months thereafter to age 22 Routine Gynecological Care Exams

Covered 100%; deductible waived 30%; after deductible

2 exams per calendar year. Includes routine tests and related lab fees. Routine Mammograms Covered 100%; deductible waived 30%; after deductible Women's Health Covered 100%; deductible waived Member cost sharing is based on

the type of service performed and the place of service where it is rendered

Includes: Screening for gestational diabetes, HPV (Human- Papillomavirus) DNA testing, counseling for sexually transmitted infections, counseling and screening for human immunodeficiency virus, screening and counseling for interpersonal and domestic violence, breastfeeding support, supplies and counseling. Contraceptive methods, sterilization procedures, patient education and counseling. Limitations may apply. Routine Digital Rectal Exam Covered 100%; deductible waived 30%; after deductible Prostate-specific Antigen Test Covered 100%; deductible waived 30%; after deductible Colorectal Cancer Screening Member cost sharing is based on the

type of service performed and the place of service where it is rendered

30%; after deductible

For all members age 50 and over. Routine Eye Exams Not Covered Not Covered Routine Hearing Exams Not Covered Not Covered PHYSICIAN SERVICES IN-NETWORK OUT-OF-NETWORK Office Visits to non-Specialist $30 office visit co-pay; deductible

waived 30%; after deductible

Includes services of an internist, general physician, family practitioner or pediatrician. Specialist Office Visits $45 office visit co-pay; deductible


Pre-Natal Maternity Covered 100%; deductible waived 30%; after deductible E-visit to non-Specialist $30 office visit co-pay; deductible


An E-visit is an online internet consultation between a physician and an established patient about a non-emergency healthcare matter. This visit must be conducted through an Aetna authorized internet E-visit service vendor. E-visit to Specialist $45 office visit co-pay; deductible


An E-visit is an online internet consultation between a physician and an established patient about a non-emergency healthcare matter. This visit must be conducted through an Aetna authorized internet E-visit service vendor.



Walk-in Clinics $30 office visit co-pay; deductible waived

30%; after deductible

Walk-in Clinics are network, free-standing health care facilities. They are an alternative to a physician's office visit for treatment of unscheduled, non-emergency illnesses and injuries and the administration of certain immunizations. It is not an alternative for emergency room services or the ongoing care provided by a physician. Neither an emergency room, nor the outpatient department of a hospital, shall be considered a Walk-in Clinic. Allergy Testing Member cost sharing is based on the

type of service performed and the place of service where it is rendered; deductible waived

Member cost sharing is based on the type of service performed and the place of service where it is rendered

Allergy Injections Member cost sharing is based on the type of service performed and the place of service where it is rendered; after deductible


DIAGNOSTIC PROCEDURES IN-NETWORK OUT-OF-NETWORK Diagnostic X-ray 10%; deductible waived 30%; after deductible If performed as a part of a physician office visit and billed by the physician, expenses are covered subject to the applicable physician's office visit member cost sharing. Diagnostic Laboratory 10%; deductible waived 30%; after deductible If performed as a part of a physician office visit and billed by the physician, expenses are covered subject to the applicable physician's office visit member cost sharing. Diagnostic Outpatient Complex Imaging

10%; deductible waived 30%; after deductible

EMERGENCY MEDICAL CARE IN-NETWORK OUT-OF-NETWORK Urgent Care Provider $45 co-pay; deductible waived 30%; after deductible Non-Urgent Use of Urgent Care Provider

Not Covered Not Covered

Emergency Room 10% after $150 co-pay; deductible waived

Same as preferred care.

Non-Emergency Care in an Emergency Room

50% after deductible 50% after deductible

Emergency Use of Ambulance 20% after deductible Covered 100%; after deductible Non-Emergency Use of Ambulance Not Covered Not Covered HOSPITAL CARE IN-NETWORK OUT-OF-NETWORK Inpatient Coverage 10% after $250 per admission co-

pay; after deductible 30% after $250 per admission co-pay

The member cost sharing applies to all covered benefits incurred during a member's inpatient stay. Inpatient Maternity Coverage (includes delivery and postpartum care)

10% after $250 per admission co-pay; after deductible

30% after $250 per admission co-pay

The member cost sharing applies to all covered benefits incurred during a member's inpatient stay. Outpatient Hospital Expenses 10%; after deductible 30%; after deductible The member cost sharing applies to all covered benefits incurred during a member's outpatient visit. Outpatient Surgery 10%; after deductible 30%; after deductible The member cost sharing applies to all covered benefits incurred during a member's outpatient visit. MENTAL HEALTH SERVICES IN-NETWORK OUT-OF-NETWORK Inpatient Biologically Based 10% after $250 per admission co-

pay; after deductible 30% after $250 per admission deductible

The member cost sharing applies to all covered benefits incurred during a member's inpatient stay.



Inpatient Non-Biologically Based 10% after $250 per admission co-pay; after deductible

30% after $250 per admission deductible

The member cost sharing applies to all covered benefits incurred during a member's inpatient stay. Outpatient Biologically Based $45 co-pay; deductible waived 30%; after deductible The member cost sharing applies to all covered benefits incurred during a member's outpatient visit. Outpatient Non-Biologically Based $45 co-pay; deductible waived 30%; after deductible The member cost sharing applies to all covered benefits incurred during a member's outpatient visit. Crisis Intervention Services $45 co-pay; deductible waived 30%; after deductible ALCOHOL/DRUG ABUSE SERVICES

IN-NETWORK OUT-OF-NETWORK

Inpatient 10% after $250 per admission co-pay; after deductible

30% after $250 per admission co-pay

The member cost sharing applies to all covered benefits incurred during a member's inpatient stay. Residential Treatment Facility 10% after $250 co-pay; after

deductible 30% after $250 co-pay

Outpatient $45 co-pay; deductible waived 30%; after deductible The member cost sharing applies to all covered benefits incurred during a member's outpatient visit. OTHER SERVICES IN-NETWORK OUT-OF-NETWORK Convalescent Facility 10% after $250 per admission co-

pay; after deductible 30% after $250 per admission deductible

Limited to 60 days per calendar year. The member cost sharing applies to all covered benefits incurred during a member's inpatient stay. Home Health Care 20%; deductible waived 25%; deductible waived Includes Private Duty Nursing Each visit by a nurse or therapist is one visit. Each visit up to 4 hours by a home health care aide is one visit. Hospice Care - Inpatient 10%; after deductible 30%; after deductible The member cost sharing applies to all covered benefits incurred during a member's inpatient stay. Hospice Care - Outpatient 10%; after deductible 30%; after deductible The member cost sharing applies to all covered benefits incurred during a member's outpatient visit. Private Duty Nursing - Outpatient Not Covered Not Covered Outpatient Physical, Speech, and Occupational Therapy

20% after deductible 20%; after deductible

Spinal Manipulation Therapy $45 co-pay; deductible waived 20%; after deductible Autism Behavioral Therapy $45 co-pay; deductible waived 30%; after deductible Covered same as any other outpatient mental health benefit. Autism Applied Behavior Analysis covered the same as any other

expense based on the type of service performed and place of service where rendered

covered the same as any other expense based on the type of service performed and place of service where rendered

covered no age or visit restrictions - ny Autism Physical, Occupational and Speech Therapy

$45 co-pay; deductible waived 10%; after deductible

Covered same as any other physical and occupational combined therapy expense. no age or visit limit restrictions. Durable Medical Equipment 20% after deductible 50%; after deductible Diabetic Supplies Covered same as PCP office visit

cost sharing Covered same as any other medical expense.

Generic FDA-approved Women's Contraceptives

Covered 100%; deductible waived Not Covered

Contraceptive drugs and devices not obtainable at a pharmacy

Covered 100%; deductible waived Covered same as any other medical expense.

Fertility Drugs (oral and injectable) 10% 30%; after deductible



Transplants 10% after $250 co-pay; after deductible

30% after $250 co-pay; after deductible Non-Preferred coverage is provided at a Non-IOE facility.

Preferred coverage is provided at an IOE contracted facility only.

Non-Preferred coverage is provided at a Non-IOE facility.

Bariatric Surgery 10% after $250 per admission co-pay; after deductible

30% after $250 per admission deductible

The member cost sharing applies to all covered benefits incurred during a member's inpatient stay. "Other" Health Care -- 20% member coinsurance after the preferred (per calendar year) deductible for services that are neither "preferred" nor "non-preferred". FAMILY PLANNING IN-NETWORK OUT-OF-NETWORK Infertility Treatment Member cost sharing is based on the


Member cost sharing is based on the type of service performed and the place of service where it is rendered; after deductible

Diagnosis and treatment of the underlying medical condition. Comprehensive Infertility Services Member cost sharing is based on the



Coverage includes Artificial Insemination and Ovulation Induction. Advanced Reproductive Technology (ART)

Not Covered Not Covered

Vasectomy Member cost sharing is based on the type of service performed and the place of service where it is rendered; after deductible

Member cost sharing is based on the type of service performed and the place of service where it is rendered; after deductible.

Tubal Ligation Covered 100%; deductible waived Member cost sharing is based on the type of service performed and the place of service where it is rendered; after deductible.

PHARMACY IN-NETWORK OUT-OF-NETWORK Retail $15 co-pay for generic drugs, $25 co-

pay for formulary brand-name drugs, and $40 co-pay for non-formulary brand-name drugs up to a 30 day supply at participating pharmacies.

20% of submitted cost after the applicable preferred co-pay

Mail Order $30 co-pay for generic drugs, $50 co-pay for formulary brand-name drugs, and $80 co-pay for non-formulary brand-name drugs up to a 31-90 day supply from Aetna Rx Home Delivery®.

Not Applicable

No Mandatory Generic (NO MG) - Member is responsible to pay the applicable co-pay only. Oral and injectable fertility drugs included (physician charges for injections are not covered under RX, medical coverage is limited). Precert for growth hormones included. Expanded Precert included Formulary generic FDA - approved Women's Contraceptives covered 100% in network.

GENERAL PROVISIONS Dependents Eligibility Spouse, children from birth to age 26 regardless of student status. Pre-existing Conditions Exclusion On effective date: Waived After effective date: Waived



For members age 19 or over this plan imposes a pre-existing condition exclusion, which may be waived in some circumstances and may not be applicable to you. A pre-existing condition exclusion means that if you have a medical condition before coming to this plan, you may have to wait a certain period of time before the plan will provide coverage for that condition. This exclusion applies only to conditions for which medical advice, diagnosis, care, or treatment was recommended or received or for which the individual took prescribed drugs within 90 days. Generally, this period ends the day before your coverage becomes effective. However, if you were in a waiting period for coverage, 90 days ends on the day before the waiting period begins. The exclusion period, if applicable, may last up to 365 days from your first day of coverage, or, if you were in a waiting period, from the first day of your waiting period. If you had prior creditable coverage within 90 days immediately before the date you enrolled under this plan, then the pre-existing conditions exclusion in your plan, if any, will be waived. If you had no prior creditable coverage within the 90 days prior to your enrollment date (either because you had no prior coverage or because there was more than a 90 day gap from the date your prior coverage terminated to your enrollment date), we will apply your plan's pre-existing conditions exclusion. In order to reduce or possibly eliminate your exclusion period based on your creditable coverage, you should provide us a copy of any certificates of creditable coverage you have. Please contact Aetna Member Services at 1-888-982-3862 if you need assistance in obtaining a certificate of creditable coverage from your prior carrier or if you have any questions on the information noted above. The pre-existing condition exclusion does not apply to pregnancy nor to a child who is enrolled in the plan within 31 days of birth, adoption, or placement for adoption. Note: For late enrollees, coverage will be delayed until the plan's next open enrollment, and the pre-existing condition exclusion will be applied from the individual's effective date of coverage.

Plans are provided by: Aetna Life Insurance Company. While this material is believed to be accurate as of the production date, it is subject to change. Health benefits and health insurance plans contain exclusions and limitations. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. You may be responsible for the health care provider's full charges for any non-covered services, including circumstances where you have exceeded a benefit limit contained in the plan. 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. If you are in a plan that requires the selection of a primary care physician and your primary care physician is part of an integrated delivery system or physician group, your primary care physician will generally refer you to specialists and hospitals that are affiliated with the delivery system or physician group.



The following is a 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) purchased by your employer. • All medical and hospital services not specifically covered in, or which are limited or excluded by your plan documents. • Cosmetic surgery, including breast reduction. • Custodial care. • Dental care and dental X-rays. • Donor egg retrieval. • Durable medical Equipment • Experimental and investigational procedures, except for coverage for medically necessary routine patient care costs for members participating in a cancer clinical trial. • Hearing aids • Home births • Immunizations for travel or work, except where medically necessary or indicated. • Implantable drugs and certain injectable drugs including injectable infertility drugs. • 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. • Long-term rehabilitation therapy. • Non-medically necessary services or supplies. • Orthotics except diabetic orthotics. • Outpatient prescription drugs (except for treatment of diabetes), unless covered by a prescription plan rider and over-the-counter medications (except as provided in a hospital) and supplies. • Radial keratotomy or related procedures. • Reversal of sterilization. • Services for the treatment of sexual dysfunction or inadequacies, including therapy, supplies or counseling or prescription drugs. • Special duty nursing. • Therapy or rehabilitation other than those listed as covered. • Treatment of behavioral disorders. • Weight control services including surgical procedures, medical treatments, weight control/loss programs, dietary regimens and supplements, appetite suppressants and other medications; food or food supplements, exercise programs, exercise or other equipment; and other services and supplies that are primarily intended to control weight or treat obesity, including Morbid Obesity, or for the purpose of weight reduction, regardless of the existence of comorbid conditions. Aetna receives rebates from drug manufacturers 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. The charges that Aetna negotiates with Aetna Rx Home Delivery may be higher than the cost they pay for the drugs and the cost of the mail order pharmacy services they provide. For these purposes, the pharmacy's cost of purchasing drugs takes into account discounts, credits and other amounts that they may receive from wholesalers, manufacturers, suppliers and distributors. In case of emergency, call 911 or your local emergency hotline, or go directly to an emergency care facility. ©2013 Aetna, Inc.

OOrrtthhooddooxx HHeeaalltthhPPllaannss SSuummmmaarryy ooff BBeenneeffiittss PPPPOO DDeennttaall PPllaann

Aetna, Inc.

Plan Features In-Network Out-of-Network PPllaann DDeedduuccttiibbllee (per calendar year; $50 Individual $50 Individual Applies to all covered services) $150 Family $150 Family Routine Oral Exams, Prophylaxis, 100% 100% Diagnostic X-Rays (Deductible waived) (Deductible waived) Fluoride Treatment (for dependent children to age 15)

General Dental Expenses* 90% after deductible 80% after deductible Crown, Inlays, Gold Fillings 60% after deductible 50% after deductible Fixed Bridgework and Orthodontia Calendar year maximum $1,500 per person Orthodontia Lifetime Maximum $1,500 per person Orthodontia Eligibility Dependent children to age 19

only *General Dental Expenses-Includes non-surgical extractions; fillings; general anesthetics; non-surgical endodontic treatment; non-surgical periodontal treatment; initial installation of dentures; space maintainers (dependent children only); repair or recementing of crowns, inlays, bridgework or dentures; relining of dentures; and administration of drugs for prevention, alleviation or cure of disease or pain. This is a Summary of Plan Benefits Only. The Master Policy Contract holds more detailed information on coverage. In the event of any discrepancies, the Master Contract shall be binding, subject to State Mandates.

Saveonglasses,contacts,LASiKandmore.

00.03.301.1 H (8/07)

See better for less! AetnavisionSMdiscounts

The eye-opening choice for healthy vision thousandsoflocationstochoosefrom

It’s easy to find a provider, with a broad range** of participating independent locations as well as national chains like LensCrafters®, Target Optical®, and select Sears® Optical and Pearle Vision® locations.

Want to find a spot in your hometown? Visit our DocFind® directory at www.aetna.com and follow the standard search prompts to “Places/Eyecare” to find a participating professional in seconds. Or check your paper directory. If you don’t have one, you can call the number on your ID card, or give EyeMed customer service a ring at 1-800-793-8616.

Getgreatratesoneyeexams

For such a short and sweet procedure, a routine eye exam does the eyes — and the body — good. It’s the #1 way to detect eye problems like glaucoma or astigmatism. And it can also spot symptoms of diabetes, hypertension and other medical problems early … before they become a bigger problem.1

That’s why most of the participating locations have doctors of optometry practicing right on the premises or at a nearby location. Now, even if you don’t have eye exam coverage through your medical benefits plan, you can still get a great rate on eye exams for eyeglasses or contact lenses through Aetna Vision Discounts. Check the price list on the back of this flyer for details.

If you already have eye exam coverage, Aetna Vision Discounts is a great way to supplement your insurance coverage. Covered eye exams are available from most participating locations. But remember — check your plan documents first, since your out-of-pocket expenses could be lower if you follow your plan requirements.

SaveBiGonseeingbetter

It’s easy, with Aetna Vision Discounts.* You receive special discounts on eyeglasses, contact lenses and solutions, LASIK and other eye-care services and accessories. And since it’s automatically included with your Aetna health benefits or health insurance plan, you don’t pay anything extra for program access.

And that’s not all: your discount covers specialty vision care items not typically covered by insurance, like snazzy eyeglass chains, designer frames, sunglasses — even colored contacts. Now, you’ve got everything you need to keep you, and your vision, super-sharp!

there’snostoppingthesavings

That’s right — there’s no limits to how often you can use the discount. So grab a pair of summer shades. Then stop back another time for more-serious spectacles. You’ll get on-the-spot savings each and every time you purchase a product or service from our wide selection of participating locations.

*Formerly known as the Vision One® discount program. **EyeMed Select Network and Provider List, 1/07. 1 Eyes show it: System diseases revealed in routine eye exams. Employee Benefits News.

April 15, 2004. Accessed at www.benefitnews.com.

Needeyeexamsoreyewear?1-800-793-8616 Monday – Saturday 8 a.m. to 11 p.m. Sundays 11 a.m. to 8 p.m. Eastern Time

LostaLens?1-800-391-LENS (5367)

readyforLASiK?1-800-422-6600 Weekdays 8 a.m to 9 p.m. Saturdays 9 a.m. to 6 p.m. Eastern Time

Save on everything you need to see better.

The eye-opening choice for healthy vision 2. The doctor’s office will contact

you directly to schedule your free consultation.

3. Still ready to proceed? Schedule the surgery and call the U.S. Laser Network for instructions on submitting your $100 deposit. It’s completely refundable if you don’t have the surgery.

4. Check with your surgeon’s office for convenient payment arrangements or pay the discounted price before your surgery date.

here’showtostartsaving

Purchasing eyewear and vision services is as easy as book, browse and save!

Book!Schedule an eye exam, or visit any participating location.

Browse!Choose from hundreds of fashionable frames and the latest in lens technology.

Save!Present your Aetna ID card for on-the-spot savings. No claims, no waiting for reimbursement, no fuss!

replacecontactsinablink

Lost a lens? Get additional pairs delivered right to your door! Just purchase your first pair of prescription contact lenses — then call our mail-order center at 1-800-391-LENS (5367) for a brand-new pair.

GetLASiKforless

LASIK surgery just got more affordable. Not only do you save on the procedure, you also receive education, an initial screening and follow-up care — all wrapped into the discounted price. Best of all, the initial consultation is always free, even if you choose not to have the surgery.

here’showtogetstarted:1. Call the U.S. Laser Network at

1-800-422-6600 to schedule your FREE consultation. Our LASIK information specialists can help you find and choose a nearby doctor.

00.03.301.1 H (8/07) Available in Spanish. Disponible en Español. ©2007 Aetna Inc.

Health benefits and health insurance plans are offered, underwritten or administered by: Aetna Health Inc., Aetna Health of the Carolinas Inc., Aetna Health of Illinois Inc., Aetna Health Insurance Company of New York, Corporate Health Insurance Company and/or Aetna Life Insurance Company.

If you need this material translated into another language, please call Member Services at 1-888-98-AETNA (1-888-982-3862). Si usted necesita este documento en otro idioma, por favor llame a Servicios al Miembro al 1-888-98-AETNA (1-888-982-3862).

Discount programs provide access to discounted prices and are not insured benefits. 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. Information subject to change. Health benefits and health insurance plans contain exclusions and limitations. For more information about Aetna plans, refer to www.aetna.com.

Policy forms issued in Oklahoma include: HMO/OK COC-4 09/02, HMO/OK GA-3 11/01, CHI/OK GP-3 02/02, CHI/OK INSCT-4 01/02, GR-23 and/or GR-29.

*EyeMed Services and Compensation Schedule, 1/07. Prices are subject to change.

ProductorService eyeexamsforPlans thatcovereyeexams

eyeexamsforPlansthatdoNotcovereyeexams n Comprehensive eye exam n Standard contact lenses fit & follow up n Specialty contact lenses fit & follow up

(e.g. Toric, Bifocal, Gas Permeable)

LensesperPair(uncoatedplastic) n Single Vision n Bifocal n Trifocal n Standard Progressive (no-line bifocal)

eyeglassFrames(retailprices)

LensoptionsperPair(addtolenspriceabove) n Standard polycarbonate (includes UV coating and scratch-resistant coating) n Scratch-resistant coating n Ultraviolet (UV) coating n Solid or gradient tint n Standard antireflective coating n Glass n Photochromic Glass

contactLenses Get a 15% discount (5% on disposables) off retail prices.

Mail-ordercontactLensreplacementProgram Call 1-800-391-LENS (5367) to order replacement contact lenses. (Mail-order contact pricing

is not subject to the discounts received at participating locations.)

Additionalvision-relateditems Visit any participating location to receive a 20% discount off retail prices.

LASiKProcedure Save up to 15% off the surgeon’s fee through the U.S. Laser Network.

WhAtYou’LLPAYRefer to your health benefits plan documents for coverage details

$42 $40 (plus $42 exam fee) $10 off retail (plus $42 exam fee)

$40 $60 $80 $120

40% off retail prices

$40 $15 $15 $15 $45 20% off retail 20% off retail

visionsavingssnapshotKeepthischart*handy—itliststhesavingsavailablethroughAetnavisiondiscounts.

AetnavisiondiscountsisfreewithyourAetnamedicalplan.Sotakecareofyoureyes,forless,today!

Documents

an enrollment package including all forms and required information