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This disclosure contains importantinformation regarding:■ the operation of Aetna Health Inc. (Aetna*);

■ the relationship between members, providers andAetna; and

■ disclosure information required by State of Washingtonlaws and regulations.

Please review all of this information carefully.

Disclosure Information Required byWashington State LawWashington law requires Aetna to provide, upon request,the following information:

(a) a listing of covered benefits, including prescriptiondrug benefits, if any;

(b) a copy of the current formulary, if any is used;

(c) definitions of terms such as generic versus brandname;

(d) policies regarding coverage of drugs, such as howthey become approved or taken off the formulary;

(e) how consumers may be involved in decisions aboutbenefits;

(f) a listing of exclusions, reductions, and limitations tocovered benefits;

(g) definition of medical necessity or other coveragecriteria;

(h) a statement of Aetna's policies for protecting theconfidentiality of health information;

(i) a statement of the cost of premiums and anymember cost-sharing requirements;

(j) a summary explanation of Aetna's grievance processClaim Procedures/Complaints, Appeals and ExternalReview;

(k) a statement regarding the availability of a point ofservice option, if any, and how the option operates;

(l) a convenient means of obtaining lists ofparticipatingprimary care and specialty care providers,including disclosure of network arrangements thatrestrict access to providers within any plan network.

Aetna Health Inc. provides health care coverage throughemployer groups who purchase health care plans from us.This disclosure is intended to provide disclosureinformation to employer groups who are consideringpurchasing a health care plan and to their employees whoare considering enrolling in the Aetna health plan (orplans) offered by their employer. This disclosure is part ofthe pre-enrollment information provided to eachprospective member. Specific details of the Aetna plan(s)offered by your employer are also provided in thepreenrollment information.

Your coverage will be provided by Aetna Health Inc.licensed in the State of Washington as a Health CareServices Contractor. Aetna Health Inc. is a subsidiary ofAetna Inc. and is referred to throughout this disclosure as"Aetna".

Plan of BenefitsYour plan of benefits is determined by the plan designchosen by your employer. Generally, covered servicesinclude most types of treatment by primary care providers,specialists and hospitals. However, your health plan alsoexcludes or limits coverage for some services. In addition,in order to be covered, all services, including the location(type of facility), duration and costs of services, must bemedically necessary as defined in the plan documents andas determined by Aetna. The information that followsprovides general information regarding Aetna health plans.

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Important Disclosure Information -WashingtonFor Primary ChoiceSM, Aetna Open Access®, Aetna Choice® POS and QPOS® Plans.

State mandates do not apply to self-funded plans governed by ERISA. If you are unsure if yourplan is self-funded and/or governed by ERISA, please confer with your benefits administrator.Specific plan documents supersede general disclosures contained within, as applicable.

* Aetna is the brand name used for products and services provided by oneor more of the Aetna group of subsidiary companies.

01.28.302.1-WA E (3-07)

Exclusions, Limitations and Reductions toCoverage Under Your Health PlanAetna plans do not cover all health care expenses. Eachplan has limitations and exclusions, which are detailed inthe Certificate of Coverage (part of your plan documents).Limitations and exclusions may vary by plan because somebenefits are available to employers on an optional basisand are only covered when purchased in addition to thebase medical plan.

Consult your pre-enrollment materials or plan documentsfor your plan's list of exclusions and limitations. In general,services and supplies that are not covered include, but arenot limited to:

■ Cosmetic surgery, including breast reduction, (exceptas part of a staged reconstruction procedurefollowing a mastectomy);

■ Special duty nursing unless medically necessary andpreauthorized by Aetna;

■ Custodial care;

■ Blood and blood byproducts;

■ Dental care and dental x-rays;

■ Experimental and investigational procedures;

■ Immunizations for travel or work;

■ Hearing aids;

■ Orthotics;

■ Long-term rehabilitation therapy;

■ Prescription drugs and over-the-counter medicationsand supplies;

■ Services for the treatment of sexual dysfunction orinadequacies including therapy, supplies, counselingor prescription drugs;

■ Home births, unless preauthorized by Aetna for lowrisk members;

■ Durable medical equipment, except as provided inconjunction with alternative care that is provided inorder to allow the member to remain at home;

■ Implantable drugs and certain injectable drugsincluding injectable infertility drugs;

■ Reversal of voluntary sterilization;

■ Infertility treatment including artificial inseminationand advanced reproductive technologies such as IVF;ZIFT, GIFT, ICSI and other related services unlessspecifically listed as covered in your plan documents;

■ Donor egg retrieval;

■ Vision care and supplies, including radial keratotomyor related procedures;

■ Treatment of behavioral disorders;

Member Cost SharingMembers are responsible for any copayments, coinsuranceand deductibles for covered services. Copayments are paiddirectly to the provider or facility at the time the service isrendered. Copayment, coinsurance and deductibleamounts are listed in your benefits summary and plandocuments.

Role of Primary Care Providers ("PCPs")For Primary Choice plans, members are required to select aPCP who participates in the Aetna network. The PCP canprovide primary care as well as coordinate your overallcare. Members should consult their PCP when they are sickor injured to help determine the care that is needed. YourPCP should issue referrals to participating specialists andfacilities for certain services. For some services, your PCP isrequired to obtain prior authorization from Aetna. Exceptfor those benefits described in our plan documents as"direct access benefits", our plans with self-referral toparticipating providers that include benefits fornonparticipating provider services (our QPOS plan), or in anemergency or urgent care situation, members will need toobtain a referral authorization ("referral") from their PCPbefore seeking covered nonemergency specialty or hospitalcare. Check your plan documents for details.

Referral PolicyThe following points are important to remember regardingreferrals:

■ The referral is how the member's PCP arranges for amember to be covered for necessary, appropriatespecialty care and follow-up treatment.

■ The member should discuss the referral with theirPCP to understand what specialist services are beingrecommended and why.

■ If the specialist recommends any additionaltreatments or tests that are covered benefits, themember may need to get another referral from theirPCP prior to receiving the services. If the memberdoes not get another referral for these services, themember may be responsible for payment.

■ Except in emergencies, all hospital admissions andoutpatient surgery require a prior referral from themember's PCP and prior authorization by Aetna.

■ If it is not an emergency and the member goes to adoctor or facility without a referral, the membermust pay the bill.

■ Referrals are valid for 30 days as long as you remainan eligible member of the plan.

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■ Coverage for services from non-participatingproviders requires prior authorization by Aetna inaddition to a special nonparticipating referral fromthe PCP. When properly authorized, these servicesare fully covered, less the applicable cost-sharing.

■ The referral provides that, except for applicable costsharing, the member will not have to pay thecharges for covered benefits, as long as theindividual is a member at the time the services areprovided.

Self-referral Under Primary Choice PlansExcept for direct access benefits as explained below, if yougo directly to a specialist or hospital for non-emergency ornon-urgent care without a referral, you must pay the billyourself unless the service is specifically identified as adirect access benefit in your plan documents.

Direct Access to Women's Health Care Specialists

Under State of Washington law, female members may selfrefer to participating "Women 's Health Care Specialists",including physicians who specialize in women 's healthcare, ARNP's nurse midwives, licensed midwives, and PA'swho specialize in women 's health care for women 'shealth care services including maternity.

Direct Access to Chiropractors

Under Washington law, members may self-refer toparticipating chiropractors for medically necessary care.This self-referral benefit may be subject to annual visitmaximums. Refer to your plan documents for informationabout your plan limits.

Direct AccessUnder our QPOS plan, you may choose to obtain care fromyour PCP or upon referral from your PCP to a specialist orother provider ("referred" care) or you may go directly to aspecialist or hospital without a PCP referral for certaincovered benefits ("nonreferred" or "self-referred" care).When you self-refer for covered services without a PCPreferral under our QPOS plan you will generally beresponsible for a deductible and copayment orcoinsurance, which will be a higher out-of-pocket costthan if you received PCP referred care. You may be able toreduce your out-of-pocket expenses by using theparticipating providers listed in the Provider Directory. Yourspecific plan documents will provide plan specificinformation on the non-referred benefits included in ourQPOS plan.

The terms precertification and preauthorization refer to therequirement that certain health care services, such ashospitalization or outpatient surgery, receive authorizationfrom Aetna to verify coverage for those services.Participating providers will precertify those services prior totreatment. Certain benefits such as comprehensiveinfertility and advanced reproductive technology (ART)services, if covered under your plan, are subject to a selectnetwork of participating providers, from which you will berequired to seek care to receive covered benefits.

If you choose to seek care from a nonparticipatingprovider, you will be responsible for obtainingprecertification from Aetna by calling the toll free memberservices number listed on your ID card. Your plandocuments identify those services and supplies whichrequire precertification.

Health Care Provider NetworkIn addition to the Provider Directory listing of participatingproviders, members can also conduct an online search forparticipating physicians, hospitals, dentists, pharmacies andother providers in their area through our DocFind® onlineprovider directory, Aetna's electronic provider directory(updated three times a week) on our website. To use ourDocFind online provider directory go to: www.aetna.com.

Members can then select a PCP based on geographiclocation, group practice, medical specialty and/or hospitalaffiliation. Our DocFind online provider directory alsoallows members to obtain other useful information notfound in the directory, such as the providers' credentials.

All the providers in the directory are independentpracticing providers that are neither employed norexclusively contracted with Aetna. Individual providers arein the network by either directly contracting with Aetnaand/or affiliating with a group or organization whichcontracts with us. Information regarding each provider'slicense, education and work history is reviewed by Aetnaor in some cases the provider's affiliated group ororganization. A committee of participating providers ineach geographical area reviews information beforeproviders can participate in the network. Participatingproviders also periodically undergo a recredentialingprocess. Members are encouraged to ask their providersabout their education, training, work experience andhospital privileges.

In our DocFind online provider directory some primary careoffice listings contain a hospital, provider group, integrateddelivery system, or group designation, such as anIndependent Practice Association ("IPA") or a ProviderMedical Group ("PMG"). If you choose one of theseprimary care offices, you generally will be referred tospecialists and hospitals affiliated with the designated

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hospital, integrated delivery system or group for care,unless your medical needs extend beyond the capability ofthese providers.

To find out if a particular specialist or facility is affiliatedwith a particular PCP, call the PCP's office. Members mayalso call Member Services at the toll free number on theirID card to find out which PCP a particular specialist orfacility is affiliated with.

Advance DirectivesAn advance directive is a legal document that states yourwishes for medical care. It can help doctors and familymembers determine your medical treatment if, for somereason, you can't make decisions about it yourself.

There are three types of advance directives:

■ Living will - spells out the type and extent of care youwant to receive.

■ Durable power of attorney - appoints someone youtrust to make medical decisions for you.

■ Do-not-resuscitate order - states that you don't wantto be given CPR if your heart stops or if you stopbreathing.

You can create an advance directive in several ways:

■ Get an advance medical directive form from a healthcare professional. Certain laws require health carefacilities that receive Medicare and Medicaid funds toask all patients at the time they are admitted if theyhave an advance directive. You don't need anadvance directive to receive care. But we are requiredby law to give you the chance to create one.

■ Ask for an advance directive form at state or localoffices on aging, bar associations, legal serviceprograms, or your local health department.

■ Work with a lawyer to write an advance directive.

■ Create an advance directive using computer softwaredesigned for this purpose.

Advanced Directives and Do Not Resuscitate Orders.American Academy of Family Physicians, March 2005.

(Available at http://familydoctor.org/003.xml?printxml)

How to Change Your PCPYou may change your primary care provider at any time byvisiting our DocFind online provider directory at:www.aetna.com. You may also call the toll free memberservices number on your Aetna ID card. Your PCP changewill be effective as soon as Member Services enters it intothe Aetna system, but no later than the first day of themonth after the change request was received.

Emergency CareIf you need emergency care, you are covered 24 hours aday, 7 days a week, anywhere in the world. An emergencymedical condition is one manifesting itself by acutesymptoms of sufficient severity such that a prudentlayperson, who possesses average knowledge of healthand medicine, could reasonably expect the absence ofimmediate medical attention to result in serious jeopardyto the person 's health, or with respect to a pregnantwoman, the health of the woman and her unborn child.

Whether you are in or out of an Aetna service area, followthe guidelines below when you believe you needemergency care.

■ Call the local emergency hotline (ex. 911) or go tothe nearest emergency facility. If a delay would notbe detrimental to your health, call your PCP . Notifyyour PCP as soon as possible after receivingtreatment.

■ If you are admitted to an inpatient facility, you or afamily member or friend on your behalf should notifyyour PCP or Aetna as soon as possible.

Emergency or Urgent Care, Outside YourAetna Service AreaMembers who are traveling outside their service area orstudents who are away at school are covered foremergency and urgently needed care. Urgent care may beobtained from a private practice provider, a walk-in clinic,an urgent care center or an emergency facility. Certainconditions, such as severe vomiting, earaches, sore throatsor fever, are considered "urgent care" outside your Aetnaservice area and are covered in any of the above settings.

If, after reviewing information submitted to us by theprovider that supplied care, the nature of the urgent oremergency problem does not qualify for coverage, it maybe necessary to provide us with additional information. Wewill send you an Emergency Room Notification Report tocomplete, or a member services representative can takethis information by telephone.

Follow Up Care After EmergenciesAll follow up care should be coordinated by your PCPwhether you are inside or outside your service area. UnderPrimary Choice Plans follow-up care with nonparticipatingproviders is only covered with a referral from your PCP andprior authorization from Aetna. Under our QPOS plan,follow up care is only covered at the referred level of costsharing with a referral from your PCP and priorauthorization from Aetna. Suture removal, cast removal, X-rays and clinic and emergency room revisits are someexamples of follow-up care.

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After-Hours CareYou may call your doctor's office 24 hours a day, 7 days aweek if you have medical questions or concerns. You mayalso consider visiting participating Urgent Care facilities.

Prescription Drug CoverageGenerally, outpatient prescription drugs are covered only ifyour health plan includes a rider for such coverage. If yourplan covers outpatient prescription drugs, your plan mayinclude a preferred drug list (also known as a "drugformulary"). The preferred drug list is a list of prescriptiondrugs that, depending upon your prescription drugbenefits plan, are covered on a preferred basis. Manydrugs, including many of those listed on the preferred druglist are subject to rebate arrangements between Aetna andthe manufacturer of the drugs. Such rebates are notreflected in and do not reduce the amount a member paysfor a prescription drug. In addition, in circumstances whereyour prescription plan utilizes copayments or coinsurancecalculated on a percentage basis or a deductible, yourcosts may be higher for a preferred drug than they wouldbe for a non-preferred drug. The medications listed on theDrug Formulary are subject to change. A printed copy ofthe Formulary Guide will be provided, upon request or ifapplicable, annually for current members and uponenrollment for new members. Additional copies can beobtained by calling Member Services at the toll freenumber listed on your member ID card. Current formularyguide information is available on our website atwww.aetna.com. The medications listed on the preferreddrug list are subject to change in accordance withapplicable state law.

Aetna Uses the Following Definitions in Prescription DrugRiders

■ Brand Name Prescription Drug(s). Prescription drugsand insulin with a proprietary name assigned to it bythe manufacturer or distributor and so indicated byMediSpan or any other similar publication designatedby Aetna or an affiliate. Brand Name PrescriptionDrugs do not include those drugs classified asGeneric Prescription Drugs as defined below.

■ Drug Formulary. A list of prescription drugs andinsulin established by Aetna or an affiliate, whichincludes both Brand Name Prescription Drugs, andGeneric Prescription Drugs. This list is subject toperiodic review and modification by Aetna or anaffiliate. The Pharmacy and Therapeutics Committeereviews the Drug Formulary at least annually.Throughout the year the Pharmacy and TherapeuticsCommittee may evaluate new drugs once they areapproved by the FDA, and may re-evaluate the drugson the current formulary in light of new FDA,manufacturer and peer reviewed information.

■ A copy of the Drug Formulary will be available uponrequest by the Member or may be accessed at thepharmacy website, at www.aetna.com.

■ Drug Formulary Exclusions List. A list of prescriptiondrugs excluded from the Drug Formulary, subject tochange from time to time at the sole discretion ofAetna.

■ Generic Prescription Drug(s). Prescription drugs andinsulin, whether identified by its chemical,proprietary, or non-proprietary name, that isaccepted by the U.S. Food and Drug Administrationas therapeutically equivalent and interchangeablewith drugs having an identical amount of the sameactive ingredient and so indicated by MediSpan orany other similar publication designated by Aetna oran affiliate.

■ Non-Formulary Prescription Drug(s). A product ordrug not listed on the Drug Formulary which includesdrugs listed on the Drug Formulary Exclusions List.

■ Precertification Program. For certain outpatientprescription drugs, prescribing Physicians mustcontact Aetna or an affiliate to request and obtaincoverage for such drugs. The list of drugs requiringprecertification is subject to change by Aetna or anaffiliate. An updated copy of the list of drugsrequiring precertification shall be available uponrequest by the Member or may be accessed at thepharmacy website, at www.aetna.com.

■ Step Therapy Program. A form of precertificationunder which certain prescription drugs will beexcluded from coverage, unless a first-line therapydrug is used first by the Member. The list of steptherapy drugs is subject to change by Aetna or anaffiliate. An updated copy of the list of drugs subjectto step therapy shall be available upon request by theMember or may be accessed at the pharmacywebsite, at www.aetna.com.

How much do I have to pay to get a prescription filled?

Your out-of-pocket costs for prescription drugs, referred tothroughout this section as "copayments" will varydepending upon the type of plan your employer choosesto offer. Copayments may be a specific dollar amount, orbe a percentage of the cost of the prescription drug(coinsurance). Copayment information for the plan(s)offered by your employer is included in your preenrollmentinformation. Covered nonformulary prescription drugs maybe subject to higher copayments or coinsurance undersome benefit plans.

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Formulary ManagementAetna has created a formulary to give you access toquality, affordable medications. The drugs chosen for ourformulary have been approved by the FDA as safe andeffective. Many drugs on our formulary are subject tomanufacturer rebate arrangements between Aetna andthe drug manufacturer for the benefit of Aetna.

Drugs that are considered for our formulary are extensivelyreviewed. Aetna's Pharmacy Quality Advisory Committee(PQAC) and Pharmacy and Therapeutics (P&T) Committeeeach meet regularly to review drugs that have beenapproved by the FDA.

Practicing pharmacists and physicians, who areparticipating providers in our network, serve on the PQAC.This committee reviews available clinical information on thedrugs being considered for our formulary. The PQAC thenprovides its qualitative comments to the P&T Committee.

After evaluating information from a variety of sourcesincluding FDA guidelines, manufacturer labeling, peerreview journals and other independently developedmaterials, the P&T Committee places the drugs into one ofthree categories:

■ Category I: The drug represents an importanttherapeutic advance. (These drugs are alwaysincluded on the formulary.)

■ Category II. The drug is clinically and therapeuticallysimilar to other available products. (These drugs arereviewed by Aetna for overall value, including theircost and manufacturer rebate arrangements beforebeing placed on the formulary.)

■ Category III: the drug has significant disadvantages insafety or effectiveness when compared with othersimilar products. (These drugs are always excludedfrom the formulary.)

When can my plan change the approved drug list(formulary)? If a change occurs, will I have to pay more touse a drug I had been using?

Since we are regularly evaluating both new and existingtherapies, our Formulary is subject to change. Aetnaencourages the use of generic drugs when appropriate.The Food and Drug Administration (FDA) has deemed thatgeneric drugs are therapeutically equivalent to brand namedrugs. Generic drugs must contain the same activeingredients in the same amounts as their brand-namecounterparts. Additionally, the same FDA quality and safetystandards apply to generic drugs and brand name drugs.Furthermore, generic drugs may help lower your healthcare expenses. Under some Aetna prescription drug benefitplans, members pay a lower copayment if they choosegeneric drugs over brand-name medications. Until a newbrand name FDA approved drug has been reviewed by theAetna P&T Committee and a formulary determination is

made by Aetna, it may not be listed on the Formulary.Until these drugs are reviewed by the Aetna P&TCommittee these drugs will be available at the highestcopay in your prescription drug plan.

During the calendar year, deletions to the formulary mayoccur either by a drug being removed from themarketplace by a Federal directive or if an FDA approvedgeneric formulation of a brand name formulary drugbecomes commercially available.

When a new generic drug becomes commercially availableAetna may remove the brand name formulary drug fromthe Formulary and place the generic drug on the Formularyinstead.

For most prescription plan options this change wouldmean that you would receive the generic drug at a lowercopay than you previously paid for the brand name drug.Under some plan options, you would be required to pay ahigher copay to continue using the brand name drug,and/or your provider might have to obtain a medicalexception for coverage for your continued use of thebrand name drug.

Limitations to the Prescription Drug Plans (Does this plan,limit or exclude certain drugs my health care provider mayprescribe, or encourage substitutions for some drugs?)

All prescription drug plans contain limitations andexclusions on the type of drugs that are covered.Depending upon the plan design, the following areexamples of some of the types of limitations, which mayapply.

■ Prescription drug plans may have an open or closedformulary, and differential copays for brand nameand generic drugs and or formulary andnonformulary prescription drugs.

■ Under closed formulary plans, drugs on the DrugFormulary Exclusions List are not covered unless yourprovider obtains a medical exception.

■ Prescription drug plans may have precertificationprogram and/or step therapy program requirements.

■ In addition to your copayment, some prescriptiondrug benefit plans may require you to pay thedifference in cost between a brand name drug andits generic drug equivalent if the brand name drug isdispensed.

Updates to the Drug FormularyYou can obtain formulary information from the Internet atwww.aetna.com/formulary/, or by calling your MemberServices toll-free number.

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Excluded drugsCertain categories of drugs, listed in the Exclusions andLimitations section of the Prescription Drug Rider, areexcluded from coverage. Refer to your prescription drugrider for a complete list of exclusions and limitations toyour prescription drug coverage. The following categoriesof drugs are excluded from coverage under both closedand open formulary plans, unless specifically listed ascovered in your plan documents.

■ Drugs that do not require a prescription (exceptinsulin).

■ Drugs not medically necessary as determined byAetna.

■ Drugs dispensed more than one year from the datethe prescription was written.

■ Drugs which are consumed or administered at theplace where they are dispensed, including take homeprescriptions dispensed from a hospital pharmacyupon discharge.

■ Drugs used for cosmetic purposes, for example drugsto promote hair growth.

■ Drugs used for purposes of weight suppression.

■ Drugs used to treat sexual dysfunction.

■ Drugs listed as experimental or investigative except asspecifically specified in the plan documents.

■ Drugs, including Injectable drugs, used to treatinfertility.

■ Performance, athletic performance or lifestyleenhancement drugs and supplies.

■ Nutritional supplements.

■ Smoking cessation aids or drugs.

■ Growth hormones.

Drug Formulary Exclusions ListA drug formulary exclusions list is a specific list of drugsthat are excluded from coverage in closed formularybenefit plans unless a medical exception is obtained. Drugson the Drug Formulary Exclusions List are covered formembers enrolled in open formulary plans; however, thenonformulary prescription drug copayment will apply. Mostmembers in a "tiered" open formulary benefits plan willpay a higher copayment for nonformulary prescriptiondrugs (which include drugs on the Drug FormularyExclusions List).

If it is medically necessary for a member in a closedformulary benefit plan to use a drug on the DrugFormulary Exclusions List, the member's physician maycontact the Aetna Pharmacy Management PrecertificationUnit to request coverage as a medical exception.

For every drug listed on our Drug Formulary Exclusions List,there is a therapeutically equivalent formulary alternativeavailable. The Drug Formulary Exclusions List is subject tochange.

Precertification ProgramYour pharmacy benefits plan may include ourPrecertification Program. Precertification helps encouragethe appropriate and cost-effective use of certain drugs.These drugs must be preauthorized by our PharmacyManagement Precertification Unit before they will becovered. Only your physician can request priorauthorization for a drug.

Your doctor must contact the Pharmacy ManagementPrecertification Unit via fax at 1-800-408-2386 or bycalling the unit at 1-800-414-2386 to request coverage formedications on the Precertification List. If the request isapproved, the medication will be covered; however specialmaximum duration of therapy or quantity limitations mayapply.

The Aetna Pharmacy Management Precertification Unit willrespond to complete exception requests within 24 hours ofreceipt. In urgent or emergent situations your provider mayrequest a same day response. Coverage granted as a resultof a medical exception is based on an individual case bycase medical necessity determination and coverage will notapply or extend to other plan members.

The Precertification Program is based upon current medicalfindings, manufacturer labeling, FDA guidelines and costinformation. For these purposes, cost information includesany rebate arrangements between Aetna andmanufacturers for the benefit of Aetna.

The drugs requiring precertification are subject to change.Visit our website at www.aetna.com for the currentPrecertification List. Please refer to your Prescription DrugRider for additional information on whether precertificationapplies to your plan.

Generally, pharmacists may not request precertification.However, for antibiotics or analgesics requiring priorauthorization, the dispensing pharmacist may submit aprecertification request for these medications to thePharmacy Management Precertification Unit via fax at 1-800-408-2386 or by calling the unit at 1-800-414-2386.In the event the precertification unit is closed, thepharmacist is allowed to dispense one filling of anantibiotic or analgesic that requires precertification.

To be covered, drugs that require precertification must beauthorized by Aetna before they are dispensed. Coveragewill not be authorized if you pay your pharmacist for aprescription and then request precertification for the drug.If your physician or pharmacist did not receive advanceapproval, and you pay the full cost of the medication, youwill not be reimbursed for the cost of the drug.

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The Step Therapy Program is a different form ofprecertification. Under the Step Therapy Program, certaindrugs are not covered unless you have tried one or more"prerequisite therapy" medication(s) first. However, if it ismedically necessary for you to use a step therapymedication as initial therapy without trying a "prerequisitetherapy" drug, your doctor can request coverage of theStep Therapy medication as a medical exception bycontacting the Pharmacy Management PrecertificationUnit.

Medical Exceptions (What should I do if I want a change from limitations,exclusions, substitutions or cost increases for drug specifiedin this plan?)

If you have a pharmacy benefit plan with a closedformulary and it is medically necessary for you to use adrug that is on the Drug Formulary Exclusion List, yourprovider or pharmacist (in the case of antibiotics andanalgesics,) may contact the Pharmacy ManagementPrecertification Unit via fax at 1-800-408-2386 or bycalling the unit at 1-800-414-2386 to request coverage ofa drug on the Drug Formulary Exclusions List as a medicalexception. If your pharmacy benefit plan includes thePrecertification or Step Therapy Program and it is medicallynecessary for you to use a drug on the Precertification orStep Therapy Lists, your provider should contact theprecertification unit to request a medical exception.

The precertification unit will respond to completeexception requests within 24 hours of receipt. In urgent oremergent situations providers may request same dayresponse. Coverage granted as a result of a medicalexception shall be based on an individual case by-casemedical necessity determination and coverage will notapply or extend to other members.

Clinical Policy Bulletins ("CPBs"), which detail generalcriteria used in determining medical exceptions for manydrugs, are available on our website www.aetna.com. Youmay also contact Member Services at the number on yourID card to request the CPB for a specific drug, if one isavailable. If Aetna denies your provider's precertificationrequest or medical exception request, you or your provideracting on your behalf may file a complaint (oral or written)according to the Aetna's Complaints, Appeals and ExternalReview procedures outlined in your plan documents, andbriefly described in this disclosure.

You may contact Member Services at the toll free numbershown on your ID card to file a complaint. See Aetna'sComplaints, Appeals and External Review section of thisdisclosure or your Certificate of Coverage for additionalinformation regarding the complaints process.

Filling Prescriptions (Do I have to use certain pharmacies to pay the least out ofmy own pocket under this health plan? How many days'supply of most medications can I get without payinganother copay or other repeating charge?)

Participating Retail PharmaciesExcept in the case of a medical emergency or an urgentcare situation that occurs outside your plan service area,you must obtain covered prescription medications from aparticipating pharmacy. There are approximately 994participating pharmacies in the State of Washington andover 50,000 participating pharmacies nationally, includingthe District of Columbia, Puerto Rico, and the U.S. VirginIslands. Participating pharmacies in the State ofWashington are listed in the Provider Directory, or may befound on our DocFind online provider directory atwww.aetna.com.

The maximum supply available from a participating retailpharmacy per copay is a 30 day supply. The maximumsupply available per copayment from a participating mailorder pharmacy is a 90 day supply. Your prescription willindicate the number of refills your provider has authorized.Any refill in excess of the amount indicated on theprescription will not be covered. If you need a supplygreater than the maximum due to travel, your providermay contact the Pharmacy Management Unit to requestan exception to the supply limitations. Additionalcopayments may apply to exceptions approved. Supplyexception requests will be considered on an individual casebasis.

Before filling prescriptions Aetna may require a newprescription of evidence as to need if a prescription or refillappears excessive under accepted medical practicestandards. Prescription orders filled prior to the effectivedate or after the termination date of your eligibility will notbe covered. Replacement for lost or stolen prescriptionswill not be covered.

Always present your Aetna ID card at a participatingpharmacy. This will help ensure that you will only berequired to pay the appropriate amount under yourbenefits plan. Please keep in mind that if you get yourprescription filled at a participating pharmacy and don'tpresent your ID card, but rather pay for the prescriptionand submit a claim for reimbursement, you may not bereimbursed the full amount you paid. For instance, we willdeduct from your reimbursement your copay amount, anddepending on your plan design, we may reimburse you atthe pharmacy's contracted rate, which may be less thanthe amount you paid out of pocket, or we may deny yourclaim altogether.

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In an emergency or in an urgent care situation outsideyour plan service area, you can fill your prescription at anonparticipating pharmacy. In this case, you will need topay the pharmacy directly and submit a claim to Aetna forreimbursement under the terms of your plan. You maycontact Member Services to order prescription drug claimforms or to submit emergency claims from anonparticipating pharmacy.

Mail Order PrescriptionsYour prescription drug benefit may include mail orderdelivery. You can order up to a 90 day supply of coveredmedications (if authorized by your physician) from aparticipating mail order pharmacy.

Medications most appropriate for mail order are those youtake continuously, such as for the treatment of a chroniccondition like arthritis, diabetes or heart disease.

When it is time for a refill, you may call the mail orderpharmacy and place your request. For more information,please refer to your benefit plan documents or call themember services number on your ID card.

Additional Pharmacy Services (What other pharmacyservices does my health plan cover?)

Our prospective, concurrent, and retrospective drugutilization review (DUR) programs help promote safe andappropriate dispensing. In addition Aetna provides:

■ Support for Disease Management. Aetna hasprograms to help physicians identify and risk stratifyplan members who have a chronic disease such asasthma, congestive heart failure, diabetes, or lowerback pain.

■ Support for Case Management. Our managedpharmacy program integrates with and complementsthe Aetna medical plan in support of casemanagement for members who have long term orcatastrophic illnesses.

■ In addition, by going to www.aetna.com, thefollowing information and services specific topharmacy are available:

■ Pharmacy Provider Directories. Our DocFind onlineprovider directory - searchable online directory ofparticipating providers accessible from our publicwebsite. Using our DocFind online provider directorymakes it easy for members to find the providerinformation they need, when they need it, includingthe locations of 24 hour network pharmacy stores.

■ Formulary, Precertification and Step TherapyInformation. Current formulary, precertification andstep-therapy information is available to customers,members and providers. Users can inquire about aspecific drug using the formulary search engine thissite provides.

■ Claim Forms. Members can contact member servicesto order prescription drug claim forms to submit forreimbursement when utilizing a nonparticipatingpharmacy.

Members should consult with their treating physiciansregarding questions about specific medications. Refer toyour plan documents or contact Member Services forinformation regarding terms and conditions limitations ofcoverage. If you use the mail order prescription of AetnaRx Home Deliver, LLC, you will be acquiring theseprescriptions through an affiliate of Aetna. Aetna'snegotiated charge with Aetna Rx Home Delivery® may behigher than Aetna Rx Home Delivery's cost of purchasingdrugs and providing mail-order pharmacy services. Forthese purposes, Aetna Rx Home Delivery's cost ofpurchasing drugs takes into account discounts, credits andother amounts that it may receive from wholesalers,manufacturers, suppliers and distributors.

If you use the Aetna Specialty Pharmacy specialty drugprogram, you will be acquiring these prescriptions throughAetna Specialty Pharmacy, LLC, which is jointly owned byAetna and Priority Healthcare, Inc. Aetna's negotiatedcharge with Aetna Specialty Pharmacy may be higher thanAetna Specialty Pharmacy's cost of purchasing drugs andproviding specialty pharmacy services. For these purposes,Aetna Specialty Pharmacy's cost of purchasing drugs takesinto account discounts, credits and other amounts that itmay receive from wholesalers, manufacturers, suppliersand distributors.

State of Washington law requires that the following noticebe provided to covered persons at the time of enrollment.

Your Right To Safe And Effective PharmacyServicesState and federal laws establish standards to assure safeand effective pharmacy services, and to guarantee yourright to know what drugs are covered under this plan andwhat coverage limitations are in your contract.

If you would like more information about the drugcoverage policies under this plan, or if you have a questionor concern about your pharmacy benefit, please contactAetna at 1-800-323-9930.

If you would like to know more about your rights underthe law, or if you think anything you received from thisplan may not conform to the terms of your contract, youmay contact the Washington State Office of InsuranceCommissioner at 1-800-562-6900. If you have a concernabout the pharmacists or pharmacies serving you, pleasecall the State Department of Health at 1-360-236-4825.

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Behavioral Health NetworkBehavioral health care services are managed by Aetna.Aetna is responsible for making initial coveragedeterminations and coordinating referrals to providers. Aswith other coverage determinations, you may appealadverse behavioral health care coverage determinations inaccordance with the terms of your health plan.

The type of behavioral health benefits available to youdepends upon the terms of your health plan. InWashington (except for Individual Conversion plans) youwill be covered for mental health conditions and/or drugand alcohol abuse services, including inpatient andoutpatient services, partial hospitalizations and otherbehavioral health services. You can determine the type ofbehavioral health coverage available under the terms ofyour plan and how to access services by calling the AetnaMember Services number listed on your ID card.

If you have an emergency, call 911 or your localemergency hotline, if available. For routine services, youmay access covered behavioral health services availableunder your health plan by the following methods:

■ Call the toll-free Behavioral Health number (whereapplicable) on your ID card or, if no number is listed,call the Member Services number on your ID card forthe appropriate information.

■ Where required by your plan, call your PCP for areferral to the designated behavioral health providergroup.

■ When applicable, an employee assistance or studentassistance professional may refer you to yourdesignated behavioral health provider group.

You can access most outpatient therapy services without areferral or pre-authorization. However, you should firstconsult with Member Services to confirm that any suchoutpatient therapy services do not require a referral orpreauthorization.

Behavioral Health Provider Safety DataAvailableFor information regarding our Behavioral Health providernetwork safety data, please go to www.aetna.com andreview the quality and patient safety links posted:http://www.aetna.com/docfind/quality.html#jcaho.You may select the quality checks link for details regardingour providers' safety reports.

Behavioral Health Prevention ProgramsAetna Behavioral Health offers two prevention programsfor our members: Perinatal Depression Education,Screening and Treatment Referral Program also known as"Mom's to Babies Depression Program" and Identificationand Referral of Adolescent Members Diagnosed WithDepression Who Also Have Co-morbid Substance AbuseNeeds. For more information on either of these preventionprograms and how to use the programs, ask MemberServices for the phone number of your local CareManagement Center.

Answers to Your Mental Health BenefitsQuestions(a) "What are the steps that must be taken to haveoutpatient mental health services paid for by myplan?"

Mental health services are managed by Aetna. To haveyour services covered, you must contact Aetna at thenumber on your ID card for coordination and authorizationof care. You do not need a referral from your primary careprovider.

Yes No

X Direct self-referral to aparticipating provider with noprior authorization or approval.

X Primary care provider referralrequired; Primary care providermay determine the number ofvisits.

X Pre-authorization, pre-determination of medicalnecessity, pre-verification ofbenefits and eligibility or referralrequired.

(b) "What information about my mental conditionwill anyone other than my mental health providersee?"

The following information will generally be viewed byAetna in order to authorize services and pay claims.Additionally, if you elect to sign a release, your PCP will besent a summary of your treatment containing theinformation marked below:

No information, other than your diagnostic category andnumber of treatments you received.

X Diagnostic details.

X Treatment codes.

X Treatment plans, including expected outcomes.

X Progress notes. Other.

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(c) "Do I have to pay a higher copay, deductible orother charges than I pay for my other coveredmedical services to get mental health services underthis plan?"

Same Less More

X Deductibles.

X Co -pays.

X for inpatient

X for outpatient

X Co-insurance.

X Other cost sharing.

(d) "What is the maximum number of medicallynecessary inpatient days and outpatient visits I canget each year under this plan?"

Inpatient Outpatient

Days Visits Less than ten.

Eleven to twenty.

30 days 20 visits Twenty-one to thirty.

More than thirty.

Other.

Additional visits: In accordance with Aetna standards andupon prior authorization, a member may exchange up to amaximum of 10 inpatient days according to the followingformula:1 inpatient day = 4 outpatient visits (40 additionalvisits max).

(e) "What is the average number of outpatient visitsthis plan pays for people who have been providedmental health services?"

8 visits Average

Less than ten.

Eleven to twenty. X

Twenty-one to thirty.

More than thirty.

Other.

(f) "In which of the following circumstances where Imight need mental health services would I find themexcluded or subject to restrictions or limitations otherthan medical necessity?"

Diagnostic testing to determine if a mental disorderexists.

✓ Psychiatric testing is subject to the mental healthbenefit maximums and requires prior approval Aetna.

✓ Neuropsychiatric testing is covered as a medicalbenefit, and should be authorized through the PCP.

A mental disorder has a congenital or physical basis,such as Tourette's syndrome, or may be partiallycovered under the medical services portion of the healthplan.

✓ Covered mental health services are subject to mentalhealth benefit maximums.

A court orders treatment.

✓ Medical necessity criteria and mental health benefitlimits apply.

Treatment surrounding self inflicted harm, such as asuicide attempt.

✓ Related mental health services are covered, subject tothe plan 's mental health benefit maximums. Medicaltreatment of actual physical damage is covered undermedical services benefits.

There are diagnosed learning disabilities.

✓ Not covered under mental health benefits, but maybe allowed under neurodevelopmental benefit.

There is a diagnosed eating disorder.

✓ Covered subject to mental health benefit maximums.

There is a diagnosed mental disorder related to sexualfunctioning, or a sex change.

✓ Not covered Couples or marriage therapy.

✓ Not covered Custodial care.

✓ Not covered.

(g) "What is this plan's most common goal infinancing treatment in adults? In children?"

Goals would be similar for adults and children and any ofthe following may be appropriate depending on theparticular patient's diagnosis.

Medical necessity criteria are used. Benefit limits apply toall treatment.

Stabilization and symptom management. Yes

Return to previous functioning. Yes

Ongoing maintenance for long-term illness. Yes

How Aetna Compensates Your Health CareProviderAll the health care providers are independent practicingproviders that are neither employed by nor exclusivelycontracted with Aetna. Individual physicians and otherproviders are in the network by either directly contractingwith Aetna and/or affiliating with a group or organizationthat contract with us.

Participating providers in our network are compensated invarious ways:

■ Per individual service or case (fee for service atcontracted rates).

■ Per hospital day (per diem contracted rates).

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■ Capitation (a prepaid amount per member, permonth).

■ Through Integrated Delivery Systems (IDS),Independent Practice Associations (IPA), PhysicianHospital Organizations (PHO), Physician MedicalGroups (PMG), behavioral health organizations andsimilar provider organizations or groups. Aetna paysthese organizations, which in turn may reimburse thephysician, provider organization or facility directly orindirectly for covered services. In such arrangements,the group or organization has a financial incentive tocontrol the cost of care.

One of the purposes of managed care is to manage thecost of health care. Incentives in compensationarrangements with physicians and health care providers areone method by which Aetna attempts to achieve this goal.

Quality EnhancementIn some regions, the PCP can receive additionalcompensation based upon performance on a variety ofmeasures intended to evaluate the quality of care andservices the PCP provides to you. This additionalcompensation is typically based on the scores received onone or more of the following measures of the PCP's office:

■ member satisfaction,

■ percentage of members who visit the office at leastannually,

■ medical record reviews,

■ the burden of illness of the members that haveselected the primary care physician,

■ management of chronic illnesses like asthma,diabetes and congestive heart failure;

■ whether the physician is accepting new patients; and

■ participation in Aetna's electronic claims and referralsubmission program.

Some regions may use some different measures designedto enhance physician performance or improveadministrative efficiency. You are encouraged to ask yourphysicians and other providers how they are compensatedfor their services.

Claims Payment for NonparticipatingProviders and Use of Claims SoftwareIf your plan provides coverage for services rendered bynonparticipating providers, you should be aware thatAetna determines the usual, customary and reasonable feefor a provider by referring to commercially available datareflecting the customary amount paid to most providers fora given service in that geographic area or by accessingother contractual arrangements. If such data is notcommercially available, our determination may be based

upon our own data or other sources. Aetna may also usecomputer software (including ClaimCheck®) and othertools to take into account factors such as the complexity,amount of time needed and manner of billing. You may beresponsible for any charges Aetna determines are notcovered under your plan.

Technology ReviewAetna reviews new medical technologies, behavioral healthprocedures, pharmaceuticals and devices to determinewhich one should be covered by our plans. And we evenlook at new uses for existing technologies to see if theyhave potential. To review these innovations, we may:

■ Study medical research and scientific evidence on thesafety and effectiveness of medical technologies.

■ Consider position statements and clinical practiceguidelines from medical and government groups,including the federal Agency for Healthcare Researchand Quality.

■ Seek input from relevant specialists and experts inthe technology.

■ Determine whether the technologies areexperimental or investigational.

You can find out more on new tests and treatments in ourClinical Policy Bulletins. You can find the bulletins atwww.aetna.com, under the "Members and Consumers"menu.

Medical NecessityUnless defined differently by applicable state law or amember's specific plan document, to be medicallynecessary, the service or supply must:

■ be care or treatment as likely to produce a significantpositive outcome as, and no more likely to produce anegative outcome than, any alternative service orsupply, both as to the disease or injury involved and themember's overall health condition;

■ be care or services related to diagnosis or treatment ofan existing illness or injury, except for covered periodichealth evaluations and preventive and well baby care, asdetermined by Aetna;

■ be a diagnostic procedure, indicated by the healthstatus of the member and be as likely to result ininformation that could affect the course of treatmentas, and no more likely to produce a negative outcomethan, any alternative service or supply, both as to thedisease or injury involved and the member's overallhealth condition;

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■ include only those services and supplies that cannot besafely and satisfactorily provided at home, in aprovider's office, on an outpatient basis, or in anyfacility other than a hospital, when used in relation toinpatient hospital services; and;

■ as to diagnosis, care and treatment be no more costly(taking into account all health expenses incurred inconnection with the service or supply) than any equallyeffective service or supply in meeting the above tests.

■ In determining if a service or supply is medicallynecessary, Aetna will consider:

■ information provided on the member's health status;

■ reports in peer reviewed medical literature;

■ reports and guidelines published by nationallyrecognized health care organizations that includesupporting scientific data (including but not limited toMilliman & Robertson Health Care ManagementGuidelines©, InterQual®) ISD criteria and Aetna CPBs);

■ professional standards of safety and effectiveness whichare generally recognized in the United States fordiagnosis, care or treatment;

■ the opinion of health professionals in the generallyrecognized health specialty involved;

■ the opinion of the attending providers, which havecredence but do not overrule contrary opinions; and anyother relevant information brought to Aetna 'sattention.

■ Only medical directors make decisions denying coveragefor services for reasons of medical necessity. Coveragedenial letters for such decisions delineate any unmetcriteria, standards and guidelines, and inform theprovider and member of the appeal process. All coveredbenefits will be covered in accordance with theguidelines determined by Aetna.

Clinical Policy Bulletins ("CPBs")Aetna's CPBs are used as a guide when determining healthcare coverage for our members. CPBs are written onselected clinical issues, especially addressing newtechnologies, new treatment approaches, and procedures.CPBs are based on peer-reviewed medical literature, therecommendations of leading medical organizations, and(where appropriate) the Centers for Medicare & MedicaidServices' Medicare coverage policies. Some CPBs areavailable online at www.aetna.com. Because CPBs can behighly technical and are designed to be used by ourprofessional staff making coverage determinations,members may want to review the CPBs of interest withtheir provider so they may fully understand them. CPBs donot constitute medical advice and treating providers aresolely responsible for medical advice and treatment ofmembers. Actual coverage decisions are made on a case-

by-case basis by Aetna. CPBs are used as a tool to beinterpreted in conjunction with the member's specificbenefit plan and after consultation with the treatingprovider. CPBs are subject to change.

PrecertificationPrecertification is the process of collecting information priorto inpatient admissions and performance of selectedambulatory procedures and services. The process permitsadvance eligibility verification and communication with theprovider and/or member. It also allows Aetna to coordinatethe patient's transition from the inpatient setting to thenext level of care (discharge planning), or to registerpatients for specialized programs like diseasemanagement, case management, or our perinatalprogram. In some instances, precertification is used toinform providers, members and other health care providersabout cost effective programs and alternative therapiesand treatments.Certain health care services, such as hospitalization oroutpatient surgery, require precertification with Aetna toensure coverage for those services. When a member is toobtain services requiring precertification through aparticipating provider, this provider should precertify thoseservices prior to treatment. If your plan covers self-referredservices to network providers, (i.e. QPOS), or out ofnetwork benefits and you may self-refer for coveredbenefits, it is your responsibility to contact Aetna toprecertify those services which require precertification toavoid a reduction in benefits paid for that service.

Utilization Review/Patient ManagementAetna has developed a patient management program toassist in determining what health care services are coveredunder the health plan and the extent of such coverage.The program assists you in receiving appropriate healthcareand maximizing coverage for those healthcare services.You can avoid receiving an unexpected bill with a simplecall to Aetna's Member Services team. You can find out ifyour preventive care service, diagnostic test or othertreatment is a covered benefit - before you receive care -just by calling the toll-free number on your ID card. Incertain cases, Aetna reviews your request to be sure theservice or supply is consistent with established guidelinesand is included or a covered benefit under your plan. Wecall this "utilization management review."

We follow specific rules to help us make your health a topconcern:

■ Aetna employees are not compensated based ondenials of coverage.

■ We do not encourage denials of coverage. In fact,our utilization review staff is trained to focus on therisks of members not adequately using certainservices.

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Where such use is appropriate, our UtilizationReview/Patient Management staff uses nationallyrecognized guidelines and resources, such as The MillimanCare Guidelines® to guide the precertification, concurrentreview and retrospective review processes. To the extentcertain Utilization Review/Patient Management functionsare delegated to IDSs, IPAs or other provider groups("Delegates"), such Delegates utilize criteria that theydeem appropriate. Utilization Review/Patient Managementpolicies may be modified to comply with applicable statelaw.

Only medical directors make decisions denying coveragefor services for reasons of medical necessity. Coveragedenial letters for such decisions delineate any unmetcriteria, standards and guidelines, and inform the providerand you of the appeal process.

For more information concerning utilization management,you may request a free copy of the criteria we use to makespecific coverage decisions by contacting Member Services.

You may also visitwww.aetna.com/about/cov_det_policies.html to findour Clinical Policy Bulletins and some utilization reviewpolicies. Doctors or health care professionals who havequestions about your coverage can write or call our PatientManagement department. The address and phone numberare on your ID card.

Concurrent ReviewThe concurrent review process assesses the necessity forcontinued stay, level of care, and quality of care formembers receiving inpatient services. All inpatient servicesextending beyond the initial certification period will requirea concurrent review.

Discharge PlanningDischarge planning may be initiated at any stage of thepatient management process and begins immediatelyupon identification of post discharge needs duringprecertification or concurrent review. The discharge planmay include initiation of a variety of services/ benefits to beutilized by the member upon discharge from an inpatientstay.

Retrospective Record ReviewThe purpose of retrospective review is to retrospectivelyanalyze potential quality and utilization issues, initiateappropriate follow up action based on quality or utilizationissues, and review all appeals of inpatient concurrentreview decisions for coverage and payment of health careservices. Aetna 's effort to manage the services provided tomembers includes the retrospective review of claimssubmitted for payment, and of medical records submittedfor potential quality and utilization concerns.

Complaints, Appeals and External Review This Complaint Appeal and External Review process maynot apply if your plan is self-funded. Contact your BenefitsAdministrator if you have any questions.

Filing a Complaint or AppealAetna is committed to addressing your coverage issues,complaints and problems. If you have a coverage issue orother problem, call Member Services at the toll freenumber on your ID card or e-mail us from your securemember website, Aetna Navigator. Click on "Contact Us"after you log in. You can also contact Member Servicesthrough the Internet at: www.aetna.com. If MemberServices is unable to resolve your issue to your satisfaction,it will be forwarded to the appropriate department forhandling.

If you are dissatisfied with the outcome of your initialcontact, you may file an appeal. Your appeal will bedecided in accordance with the procedures applicable toyour plan and applicable state law. Refer to your plandocuments for further details regarding your plan's appealprocedure.

About Coverage DecisionsSometimes we receive claims for services that may not becovered by your health benefits plan or that aren't in linewith the terms of your plan. It can be confusing - even toyour doctors. Our job is to make coverage decisions basedon your specific benefits plan.

If a claim is denied, we'll send you a letter to let you know.If you don't agree you can file an appeal. To file an appeal,follow the directions in the letter that explains that yourclaim was denied. Our appeals decisions will be based onyour plan provisions and any state and federal laws orregulations that apply to your plan. You can learn moreabout the appeal procedures for your plan from your plandocuments.

External ReviewAetna established an external review process to give youthe opportunity of requesting an objective and timelyindependent review of certain coverage denials. Once theapplicable appeal process has been exhausted, you mayrequest an external review of the decision. Standards mayvary by state, if a state-mandated external review processexists and applies to your plan.

An Independent Review Organization (IRO) will assign thecase to a physician reviewer with appropriate expertise inthe area in question. After all necessary information issubmitted, an external review generally will be decidedwithin 30 calendar days of the request.

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Expedited reviews are available when your physiciancertifies that a delay in service would jeopardize yourhealth. Once the review is complete, the plan will abide bythe decision of the external reviewer. The cost for thereview will be borne by Aetna.

For further details regarding your plan's appeal process andthe availability of an external review process, call theMember Services toll-free number on your ID card or visitour website www.aetna.com where you may obtain anexternal review request form. You also may call your stateinsurance or health department or consult their website foradditional information regarding state mandated externalreview procedures. These state mandates may not apply toself-funded plans.

Member Rights & ResponsibilitiesYou have the right to receive a copy of our Member Rightsand Responsibilities Statement. This information is availableto you online athttp://www.aetna.com/about/MemberRights/. You canalso obtain a print copy by contacting Member Services atthe number on your ID card.

Interpreter/Hearing ImpairedWhen you require assistance from an Aetna representative,call us during regular business hours at the number onyour ID card. Our representatives can:

■ Answer benefits questions

■ Help you get referrals

■ Find care outside your area

■ Advise you on how to file complaints and appeals

■ Connect you to behavioral health services (if includedin your plan)

■ Find specific health information

■ Provide information on our Quality Managementprogram, which evaluates the ongoing quality of ourservices

Spanish-speaking hotline - 1-800-533-6615Multilingual hotline - 1-888-982-3862(140 languages are available. You must ask for aninterpreter.)TDD 1-800-628-3323 (hearing impaired only)

Quality Management Programs Call Aetna to learn about the specific quality efforts wehave under way in your local area. Ask Member Servicesfor the phone number of your regional QualityManagement office. If you would like information aboutAetna Behavioral Health's Quality Management Program,ask Member Services for the phone number of your CareManagement Center Quality Management office.

Member ServicesTo file a compliant or an appeal, for additional informationregarding copayments and other charges, informationregarding benefits, to obtain copies of plan documents,information regarding how to file a claim or for any otherquestion, you can contact Member Services at the toll-freenumber on your ID card, or e-mail us from your securemember website, Aetna Navigator at www.aetna.com.Click on "Contact Us" after you log in.

Privacy NoticeAetna considers personal information to be confidentialand has policies and procedures in place to protect itagainst unlawful use and disclosure. By "personalinformation," we mean information that relates to yourphysical or mental health or condition, the provision ofhealth care to you, or payment for the provision of healthcare to you. Personal information does not include publiclyavailable information or information that is available orreported in a summarized or aggregate fashion but doesnot identify you.

When necessary or appropriate for your care or treatment,the operation of our health plans, or other relatedactivities, we use personal information internally, share itwith our affiliates, and disclose it to health care providers(doctors, dentists, pharmacies, hospitals and othercaregivers), payors (health care provider organizations,employers who sponsor self-funded health plans or whoshare responsibility for the payment of benefits, and otherswho may be financially responsible for payment for theservices or benefits you receive under your plan), otherinsurers, third party administrators, vendors, consultants,government authorities, and their respective agents. Theseparties are required to keep personal informationconfidential as provided by applicable law. Participatingnetwork providers are also required to give you access toyour medical records within a reasonable amount of timeafter you make a request.

Some of the ways in which personal information is usedinclude claims payment; utilization review andmanagement; medical necessity reviews; coordination ofcare and benefits; preventive health, early detection, anddisease and case management; quality assessment andimprovement activities; auditing and anti-fraud activities;performance measurement and outcomes assessment;health claims analysis and reporting; health servicesresearch; data and information systems management;compliance with legal and regulatory requirements;formulary management; litigation proceedings; transfer ofpolicies or contracts to and from other insurers, HMOs andthird party administrators; underwriting activities; and duediligence activities in connection with the purchase or saleof some or all of our business. We consider these activities

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key for the operation of our health plans. To the extentpermitted by law, we use and disclose personalinformation as provided above without your consent.

However, we recognize that you may not want to receiveunsolicited marketing materials unrelated to your healthbenefits. We do not disclose personal information for thesemarketing purposes unless you consent. We also havepolicies addressing circumstances in which you are unableto give consent.

To obtain a hard copy of our Notice of Privacy Practices,which describes in greater detail our practices concerninguse and disclosure of personal information, please write toAetna's Legal Support Services Department at 151Farmington Avenue, W121, Hartford, CT 06156. You canalso visit our Internet site at www.aetna.com. You canlink directly to the Notice of Privacy Practices by Plan Type,by selecting the "Privacy Notices" link at the bottom of thepage, and selecting the link that corresponds to youspecific plan.

Additional Consumer Disclosure InformationUpon request, Aetna will provide written informationregarding any health care plan it offers, that includes thefollowing written information: (a) Any documents,instruments, or other information referred to in themedical coverage agreement; (b) A full description of theprocedures to be followed by a member for consulting aprovider other than the primary care provider and whetherthe member's primary care provider, Aetna 's 's medicaldirector, or another entity must authorize the referral; (c)Procedures, if any, that an member must first follow forobtaining prior authorization for health care services; (d) Awritten description of any reimbursement or paymentarrangements, including, but not limited to, capitationprovisions, fee-for-service provisions, and health caredelivery efficiency provisions, between Aetna and aprovider or network; (e) Descriptions and justifications forprovider compensation programs, including any incentivesor penalties that are intended to encourage providers towithhold services or minimize or avoid referrals tospecialists; (f) An annual accounting of all payments madeby Aetna that have been counted against any paymentlimitations, visit limitations, or other overall limitations on aperson 's coverage under a plan; (g) A copy of Aetna 'sComplaints, Appeals and External Review process for claimor service denial and for dissatisfaction with care and; (h)Accreditation status with one or more national managedcare accreditation organizations, and whether Aetna tracksits health care effectiveness performance using the healthemployer data information set (HEDIS), whether it publiclyreports its HEDIS data, and how interested persons canaccess its HEDIS data. Members may contact MemberServices at the toll free number on their ID card for moreinformation.

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Special Enrollment RightsIf you are declining enrollment for yourself or yourdependents (including your spouse) because of otherhealth insurance or group health plan coverage, you maybe able to enroll yourself and your dependents in this planif you or your dependents lose eligibility for that othercoverage (or if the employer stops contributing towardsyour or your dependents' other coverage). However, youmust request enrollment within 31 days after your or yourdependents' other coverage ends (or after the employerstops contributing toward the other coverage).

In addition, if you have a new dependent as a result ofmarriage, birth, adoption or placement for adoption, youmay be able to enroll yourself and your dependents.However, you must request enrollment within 31 daysafter the marriage. If you are enrolling yourself orotherwise formerly eligible dependents because of a birthadoption or placement for adoption, you must do sowithin 61 days after the birth, adoption or placement foradoption. To request special enrollment or obtain moreinformation, contact your benefits administrator.

Request for Certificate of CreditableCoverageIf you are a member of an insured plan sponsor or amember of a self insured plan sponsor who havecontracted with us to provide Certificates of Prior HealthCoverage, you have the option to request a certificate.

This applies to you if you are a terminated member, or area member who is currently active but who would like acertificate to verify your status. As a terminated member,you can request a certificate for up to 24 months followingthe date of your termination. As an active member youcan request a certificate at any time. To request aCertificate of Prior Health Coverage, please contactMember Services at the telephone number on your IDcard.

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For self-funded accounts, benefits coverage is offered by your employer, with administrative services only provided by Aetna Life Insurance Company.Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care orguarantee access to health services. Information subject to change.

The NCQA Accreditation Seal is a recognized symbol of quality. The seal, located on the front cover of your provider directory, signifies that your planhas earned this accreditation for service and clinical quality that meets or exceeds the NCQA's rigorous requirements for consumer protection andquality improvement. The number of stars on the seal represents the accreditation level the plan has achieved.

Providers who have been duly recognized by the NCQA Recognition Programs are annotated in the provider listings section of this directory. Providers, inall settings, achieve recognition by submitting data that demonstrates they are providing quality care. The program constantly assesses key measuresthat were carefully defined and tested for their relationship to improved care, therefore, NCQA provider recognition is subject to change. Providers areindependent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guaranteeaccess to health services. For up-to-date information, please visit our DocFind® directory at www.aetna.com or, if applicable, visit the NCQA's new top-level recognition listing at http://web.ncqa.org/tabid/58/Default.aspx/.

Health Insurance Portability andAccountability Act Member NoticeNote: The following information is provided to inform you of certain provisions contained inthe Group Health Plan, and related procedures that may be utilized by you in accordance withFederal law.

If you need this material translated into another language, please call Member Services at 1-888-982-3862.

Si usted necesita este documento en otro idioma, por favor llame a Servicios al Miembro al 1-888-982-3862.

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Notes