Waynesboro City SchoolsNew benefit year on an Aetna benefit plan - 2016

Quality health plans & benefitsHealthier livingFinancial well-beingIntelligent solutions

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New benefit year on an Aetna benefit plan

What’s happening?

Benefit design basics and network

Medical Plan Options

The Aetna Advantage: Member tools and information

─ Helping members get started with Aetna

Questions?

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Medical benefit design basics with valuable featuresAetna Choice Point of Service II (Open Access)• Open access models

─ Selecting a PCP is not required─ Referrals are not required─ Access to national network of providers when traveling

• National Advantage Program (NAP) supports contracted rates for out-of-network claims

• Complete details in Plan Design documents• Benefits will be processed based on type of service and place of service

─ Ex: Office visit that includes surgical procedure is covered with an office visit copay.

─ Ex: Dialysis/chemo follow place of service and type of service. If done in the office then follow office cost share, if done outpatient hospital, it follows the outpatient hospital benefit

Your benefit design and network

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Medical benefit design basics with valuable features (continued)

• Lab – Quest is preferred vendor; Lab Corp is non-par. Lab services can be done at participating hospitals as well.

• Maternity ultrasounds are no longer covered at 100%, will follow place of service and type of service

• Urgent Care has an in and out of network cost share. Urgent Care Center (UCC) must be used for urgent care only, routine care not covered at UCC.

• Non-par provider (Emergency, Ambulance and HAIRPENS*) Aetna pays these providers the ‘reasonable rate.’ Member is held harmless for any balance billing upon member appeal (call to member services).

• Addition of Teladoc benefit and 24/7 nurseline• Coverage for routine eye exam (refraction) will continue to be covered as

part of your medical planHAIRPENS (Hospitalists, Anesthesiologist, Intensivists, Radiologists, Pathologists, Emergency Physicians and Neonatologists)

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Important information about your pharmacy plan

Your benefit design and network

Your formulary will be referred to as Aetna ValueWhat remains the same?• Copay structures and benefit details • Current member restrictions (use of a single provider or pharmacy) remain in place for

controlled substances

What is changing?

• Mail order benefit is 2 copays for 90 day supply for all tiers

• Days supply will be 30 day supply

What will be immediately available to members?• Open prior authorizations • Active prescriptions for mail order delivery

When will new prescriptions be needed? • Some specialty drugs, and controlled substances, expired prescriptions,

prescriptions with no refills will not transfer to mail order pharmacy upon renewal and will require new prescriptions

Details in Plan Design document

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Provider network –

Your benefit design and network

• Nearly all physicians in the current Coventry network are also in Aetna’s network.

Primary Care Physicians Specialists Hospitals

Virginia - 4,823 National – 224,329

Virginia - 8,312 National - 418,031

Virginia - 95 National - 5,602

Medical Plan Options

Open Choice POS II High Plan

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In-Network Care Out-of-Network Care

DeductibleIndividualFamily

$500$1,000

$500$1,000

Out of Pocket MaximumIndividualFamily

$3,000$6,000

$3,000$16,000

Coinsurance 20% 30%*after deductible

Preventive Care Covered at 100% 30%*; after deductible

PCPSpecialistEmergency RoomUrgent CareInpatientOutpatient

$25 copay$50 copay

20%; after deductible$75 copay

20%; after deductible20%; after deductible

30%*; after deductible30%*; after deductible

Same as in-network care30%*; after deductible30%*; after deductible30%*; after deductible

Retail RX

Mail Order Drug

$10/$30/$60

$20/$60/$120

Not covered

Not covered

* Percentage shown is of the Reasonable and Customary amount. Member is also responsible for the difference between the billed amount and the Reasonable and Customary amount.

Open Choice POS II Low Plan

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In-Network Care Out-of-Network Care

DeductibleIndividualFamily

$1,000$2,000

$1,000$2,000

Out of Pocket MaximumIndividualFamily

$4,000$8,000

$4,000$8,000

Coinsurance 30% 40%*after deductible

Preventive Care Covered at 100% 40%*; after deductible

PCPSpecialistEmergency RoomUrgent CareInpatientOutpatient

$25 copay$50 copay

30%; after deductible$75 copay

30%; after deductible30%;after deductible

40%*; after deductible40%*; after deductible

Same as in-network care40%*; after deductible40%*; after deductible40%*; after deductible

Retail RX

Mail Order Drug

$10/$30/$60

$20/$60/$120

Not covered

Not covered

* Percentage shown is of the Reasonable and Customary amount. Member is also responsible for the difference between the billed amount and the Reasonable and Customary amount.

The Aetna Advantage

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Aetna Navigator® helps members manage their health and benefits

• Review claims • Find a doctor • Look up health

information • Get an ID card • Research costs of care

Secure, easy-to-use website lets members:

Personalized health information is available 24/7

Member tools and information

The secure Coventry member website, My Online ServicesSM, will be active for 24 months from the start date of your Aetna plan. TIP

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Ask Ann online assistant

Member telephone service

Aetna Mobile

New tools and features for members support when and where they need it

Member tools and information

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Members connect with us – wherever, whenever through Aetna Mobile

• Find a doctor or urgent care center• Research claims• Get an ID card• Price-a-DrugSM

• Access their personal health record

Optimized for most devices

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Members find a doctor easily with DocFind® search tool

Your employees use our online DocFind search tool to find a doctor, pharmacy or dentist close to you, in our networks.• Easy to search• Comprehensive results

screens• Clean pages

Member tools and information

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• Find out what can be wrong and where to go for treatment

• Search symptoms, conditions and treatment options

• Book appointments (certain locations)

• Use special tools just for Aetna members– Information tailored to your plan– Access ID cards– See claims history

iTriage® – Engages members with powerful information

Member tools and information

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Changes for members:

Member tools and information

New ID cards with new features Family ID card that shows up to five family members• New ID cards will go out as renewals/new

enrollments occur• ID cards will also be available to view and

print on Aetna Navigator®• Member Services phone number and claims

mailing address are on the new ID card• Health plan product name and group

number (control number) are on the front of the ID card

It is important for members to give

providers their new ID card to use their new member ID number.

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1) A Family* Explanation of Benefits (EOB) will have a new look making it easier for members to understand claim activity

2) Track spending, savings and deductibles.

3) View common EOB terms with definitions. After the definitions, it shows totals for charges.

4) Get helpful messages from Aetna or your employer.

5) Get a payment summary for claims on the EOB.

6) See detailed information for each claim on your EOB.

Changes for members: Aetna family EOB

Member tools and information

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*Unless an individual EOB is required by a state.

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Helping to support a smooth member experienceUpon renewal, a member’s current information will be transferred, including: Open Prior Authorizations:

─ Referrals to specialists, pre-certifications and pharmacy programs. Mail order prescriptions with refills remaining.

Member Demographics: ─ Coordination of Benefits ─ PCP selections─ Preferences such as privacy and paper suppression

Transition of Care – Reviewed case by case upon request

Provider lookup - http://www.aetna.com/dse/search?site_id=dse

Formulary lookup - http://client.formularynavigator.com/Search.aspx?siteCode=5902821386

Helping members get started

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Questions?