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Open Enrollment Wichita Public Schools

©2016 Aetna Inc. Changes in 2017

• Your plans are moving from an open access plan to a Quality Point of service (QPOS) plan.

• You will be required to pick a Primary Care Physician for yourself and your family.

• You will be utilizing a new process to select your plan and PCPs for open enrollment.

• You will be required to obtain referrals for specific services and to receive care from a specialist.

• You will have the choice between 3 medical plan options.

Aetna Inc. 2 Wichita Preferred QPOS New ID cards

285558-010-0001

Please note: You will receive separate cards this year from Maxor for your pharmacy (prescription) benefits.

Aetna Inc. 3 Wichita Preferred QPOS Plans are moving from Open access to QPOS (Wichita Preferred QPOS)

What does this mean and what is different:

• A QPOS plan gives you health maintenance organization features • Requires you to select a primary care physician for yourself and each of your family members / dependents o A primary care provider (PCP) is your primary partner for your health. Your PCP focuses on your overall health, making sure you get recommended screenings and risk assessments, focusing on wellness and prevention. A PCP also helps navigate you through your medical care options; providing referrals to specialist and/or specialized services based on specific health care needs you may have. • You will need to obtain a referral for a Specialist that you have been receiving care from in 2016 to continue any care beginning January 1, 2017. • You can seek care from out of network providers but you may be required to pay higher out-of-pocket costs.

Aetna Inc. 4 Wichita Preferred QPOS Copayments, deductibles and coinsurance amounts

2017 Plan Overview Base 2017 Overview Prem 1 2017 Overview Prem 2

In Network Out of Network In Network Out of Network In Network Out of Network

PCP Co-Payment $30 N/A $30 N/A $30 N/A

Specialist Co-Payment $50 N/A $50 N/A $50 N/A

Individual Deductible $4,500 $9,000 $1,500 $3,000 $2,000 $4,000

Family Deductible $9,000 $18,000 $3,000 $6,000 $4,000 $8,000

Coinsurance 70% 50% 70% 50% 70% 50%

Individual Maximum Payment Limit* $6,150 $12,300 $4,500 $9,000 $6,000 $12,000

Family Maximum Payment Limit* $12,300 $24,600 $9,000 $18,000 $12,000 $24,000

Urgent Care Co-Payment $50 $50 $50 $50 $50 $50

Emergency Room Co-Payment $100 $100 $100 $100 $100 $100 *Incudes Deductible, Coinsurance and Copayments - once met you no longer pay out of pocket.

The amount of benefits provided depends on the plan selected and the premium will vary based on the plan and benefits selected.

Aetna Inc. 5 Wichita Preferred QPOS Highlighted benefit reminders

• Laboratory services billed with a physician’s office visit will have a single co-payment.

• If you have varied dates of service for your laboratory at your physician’s office, different from your office visit, you will be subject to an additional co-payment.

• Diagnostic radiology is subject to a separate co-payment.

Aetna Inc. 6 Wichita Preferred QPOS Pick a primary care physician for yourself and each family member • During the open enrollment process you will be required to select a primary care physician (PCP) for you and your dependents • You will utilize a list within the open enrollment system • You can contact customer service to assist you in selecting PCPs • You can go to the following link to select your PCP www.aetna.com/dse/custom/wps • During open enrollment you will enter that information into the open enrollment system • If you do not select a PCP, one will be assigned to you and your family members • If you are assigned a PCP automatically, you will receive a letter notifying you of this auto assignment • You can change your PCP anytime, and as many times as you would like • You can change your PCP by calling 800-228-6481 on the back of your card, and speaking to a representative • You can change your PCP by logging into your Navigator (personal portal) • You can select a different PCP for each of your family members. • Your new PCP selection will be effective the first day of the following month • You will receive a new ID card each time you select a new PCP • Your PCP must be a physician - Family Practitioner, Pediatrician, Internal Medicine or General Practitioner. It CAN NOT be a Physician Assistant(PA), Nurse Practioner (NP) or a Specialist

Aetna Inc. 7 Wichita Preferred QPOS Selecting a PCP Home Page for selecting a primary care physician

If you would like assistance in finding a primary care physician please call the USD 259 provided nurse navigator at (316)347-1527 to assist you in choosing and transitioning to another primary care physician. You can also reach the nurse navigator by sending an e-mail to [email protected]

Aetna Inc. 8 Wichita Preferred QPOS You need a PCP referral except for the following • Behavioral Health • Durable Medical Equipment • Gynecology care (routine, non routine, pregnancy) • Home Health Care • Hospital Ambulatory Surgery • Hospital Outpatient Services (Automated Ambulatory Blood Pressure Monitoring, Diagnostic Radiology, Dialysis/Hemodialysis, Dysplastic Nevi Total Body Photography, Nuclear Medicine Procedures, Physical, Occupational & Speech Therapy, Radiology) • Midlevel practitioners (Physician Assistant, Nurse Practitioner) – at the PCP’s office, or at the specialist offices (when a referral is given to that specialist) • Preventative Immunizations when given at the PCP’s office • Radiology, Pathology, Lab • Routine Vision Care • Physical, Occupational, Speech Therapy • Urgent Care Facility/Emergency Room care • Walk-In Clinic (The Little Clinic, Take Care Clinic) • Nutritional Counseling • Termination of Pregnancy (Involuntary) You may still need to have a prescription or precertification for services whether or not they require a referral.

Aetna Inc. 9 Wichita Preferred QPOS

Getting a referral from your PCP

• Your PCP is responsible for coordinating your care and issuing your referral • Make sure your referral is on file before visiting a specialist o The referral will specify the total number of visits or be defined for a period of time. o A specialist can only provide services authorized by the referral. If more services are necessary, the specialist or member must contact the PCP to obtain a new referral. o The PCP can refer a member to a participating specialist using our electronic or paper referral. The referral may authorize either: o A consult and treat o A consult only o Specific services o If you do not obtain a referral prior to seeking services, your claim will be paid as out of network. • You can call 800-228-6481 to verify the referral has been approved & is on file. • Referrals will not be visible within the Aetna Navigator .

Aetna Inc. 10 Wichita Preferred QPOS If you seek care outside of your network

• Remember - you will have higher out of pocket expenses o Higher deductible o Higher coinsurance percentage o You can be billed for the difference between the billed charges and the allowed amount, in addition to your deductible and coinsurance o Even if you reach the maximum payment limit and begin to receive 100% benefit, you can still be responsible for the difference between billed charges and allowed charges • You may be required to obtain precertification or review for certain services

You may be required to pay the bill and submit the claim to be considered for review and processing under your plan of benefits.

Aetna Inc. 11 Wichita Preferred QPOS Out of area plans Retirees: • If you permanently live out of the area, you will need to select a PCP in counties listed below to stay on the QPOS plan. Your address needs to be within the counties in Kansas listed below. o Butler, Cowley, Dickinson, Elk, Greenwood, Harper, Harvey, Kingman, Marion, McPherson, Sedgwick and Sumner. • If your zip code is outside of the counties listed above, you will be enrolled in the retiree plan (benefits mirror the 2017 base plan on slide 5)

Out of Area Dependents: • If you permanently live out of the area, where your dependents address is not within the counties of Kansas within the service area of WPS (see counties listed above) • If your dependents zip code is outside of the counties listed above, you will be enrolled in the 2017 Out of area plan that corresponds to the employee’s plan selection (benefits mirror the 2017 plans on slide 5) • The out of area dependent will be subject to their own deductible and out of pocket maximum and not part of the family Aetna Inc. 12 Wichita Preferred QPOS Transition of care

Confidential disclaimer or title of presentation here, edit in View/slide master Aetna Inc. Transition of care/coverage • Transition of care/coverage is the form you complete and process you follow to get care, should you have a medical event prior to getting in to see your new physician. • Any charges that you incur with your out of network provider may be covered, provided you complete the Transition of Care form and are approved for transition coverage. • Please note a Transition of Care form does not apply to care received by a Via Christi Clinic PCP for dates of service January 1 – March 31, 2017. • If you are seeing an in-network specialist and have an appointment after 1/1/17, you will need to obtain a referral from your selected PCP. If you can’t get into the new PCP to get the referral, you will submit a TOC form and check the box, unable to get into PCP for a referral to specialist. You will submit the TOC form to Aetna with the specialist information and be approved for TOC and allow without referral for that planned visit. This will be required to obtain in-network coverage for the specialist. • NOTE: You were required to select an in-network Primary Care Physician (PCP) during open enrollment to be effective January 1, 2017. If you did not select a PCP, Aetna automatically assigned one to you. You should establish a relationship with your new PCP as soon as possible in order to obtain referrals to in-network specialists to minimize disruption of your healthcare.

Aetna Inc. 14 Wichita Preferred QPOS Transition of care/coverage continued

• You can obtain a form by: o Calling your Aetna customer service team at 1-800-228-6481 to obtain a form o Contacting the USD 259 Nurse Navigator at [email protected] or 316- 347-1527 • You will be required to fill out the form and have your provider complete a portion of the form • You will submit the form to Aetna to be reviewed at the fax number listed on the form • Once Aetna reviews your completed form, you will receive a decision and the time frame for the approved care

• Transition of Care Coverage Form

Aetna Inc. 15 Wichita Preferred QPOS Via Christi Clinic ancillary service providers that will not be in network

Via Christi Hospitals were not in network for 2016 and will remain out of network for 2017. Effective 1/1/17

• All primary care and many specialty physicians • Radiology/Imaging (technical component) • Surgery Center Via Christi Clinic Day Surgery • Via Christi Surgery Center at Founder’s Circle • Via Christi Immediate Care (urgent care) Clinics • Via Christi Sleep Medicine Center • Via Christi Clinic Diagnostic (radiology) services • Via Christi Clinic Independent Laboratory

To help you find or change your primary care physician or find a specialist you can visit your custom DocFind® online provider directory at www.aetna.com/dse/custom/wps It can tell you if your doctor is in the network or help you find a participating provider for your Aetna plan. Aetna Inc. 16 Wichita Preferred QPOS

Wichita Preferred QPOS Via Christi Clinic specialists with limited services agreement

Via Christi Specialties with preliminary Limited Service Agreements Specialists Allergy/Immunology Ambulatory Surgicenter Aetna has negotiated Anesthesiology, Hospice and Palliative Care Limited Service Agreements with Via Christi to keep the Audiologist following specialties in our Dermatology network for 2017. Endocrinology, Diabetes & Metabolism Gastroenterology  Click here to see which specific Neurology Via Christi Specialist will be Otorhinolaryngology (Ear, Nose & Throat (ENT)) potentially remaining in-network Pediatric Allergy & Immunology for 2017: *Via Christi Specialist Pediatric Gastroenterology Pediatric Neurology Rheumatology

*This list is preliminary and Via Christi has not yet executed the Limited Services Agreement. This list is accurate as of 10.26.16 pending signed agreements from Via Christi and is subject to change without notice, please verify providers by visiting Aetna’s Wichita Public Schools custom docfind – 2017 QPOS, at: www.aetna.com/dse/custom/wps.

Aetna Inc. 17 Wichita Preferred QPOS Via Christi Clinic PCP’s and specialists that will not be in network

PRIMARY CARE Family Practice (PCP) General Practice (PCP) Internal Medicine (PCP) Pediatrics (PCP) SPECIALISTS - with no Limited Specialty Agreement Cardiology/Cardiovascular Disease Maternal & Fetal Medicine Nurse Practitioner (primary & specialty) Obstetrics & Gynecology Pathology Physical Medicine & Rehabilitation Physical Therapist Physician Assistant (primary & specialty) Physician Assistant-BH Podiatrist Psychiatry Pulmonary Disease Radiology Registered Dietitian Registered Nurse Anesthetist Sleep Medicine & Sleep Diagnostic Center Surgery Surgery, Colon & Rectal Surgery, Orthopedic Surgery, Plastic and Reconstructive Urgent Care Center Urology Aetna Inc. 18 Via Christi rehabilitation center providers that will not be in network

Effective 1/1/17

• Via Christi Rehabilitation Hospital

• Affiliated outpatient therapy clinics

Aetna Inc. 19 Wichita Preferred QPOS Via Christi affiliated providers that continue to be in network

Via Christi providers that will remain in-network for 2017. Effective 1/1/17 • The Center for Same Day Surgery • Via Christi Home Health (all locations) • Via Christi Home Medical (all locations) • AMS Diagnostics, LLC dba Anatomi Imaging • Preferred PET Imaging lf Kansas, LLC • Via Christi Imaging, LLC (Manhattan) • Affiliated Medical Services (AMS) Laboratory • Via Christi Hospital and Providers – Pittsburg • Via Christi Hospital and Providers – Manhattan • Wamego Hospital and Family Clinic - Wamego

Aetna Inc. 20 Wichita Preferred QPOS

An easier experience makes people happy

21 Aetna Inc. Our website makes it easy to use your benefits

Everything you need on one website, www.aetna.com

Quality of care Cost of care Quality AND cost

Find and compare Get estimates for your Look up symptoms, doctors using DocFind out-of-pocket costs conditions and medications Use information to Track claims and help make treatment account balances Download digital ID decisions cards

Chat with a doctor Access coverage and chat 24/7 benefits information

Aetna Inc. Wichita Preferred QPOS Aetna Navigator home page

Aetna Inc. 23 Wichita Preferred QPOS Aetna Navigator claim details

Aetna Inc. 24 It’s easy to register

How to Register Go to www.aetna.com Select "Log In/Register" Select "Register" Complete the requested information Who Can Register Aetna Navigator is available to all Aetna customers. The following people can register within 24-48 hours after their eligibility information is loaded into Aetna's systems: Aetna subscribers Aetna dependents - dependents registered for Navigator can change their primary care doctor or dentist and view their:

Deductibles and plan limits Claims Coverage & benefits Health History Report (HHR) Accumulators Simple Steps To A Healthier Life (18 years and older) Personal Health Record (18 years and older) Registration Rules Other - Members of other insurance plans who are eligible for certain Aetna programs and services. When registered, they'll be able to access: Simple Steps To A Healthier Life (18 years and older) Personal Health Record, if offered through their plan (18 years and older)

Aetna Inc. 25 Wichita Preferred QPOS Here for you whenever, wherever

With the Aetna Mobile app, your information travels with you Find a doctor or urgent care center

Research claims

Access your personal health record

You can view your ID card anytime on TIP your phone using our mobile app.

Aetna Inc. Wichita Preferred QPOS Get the best value for your health care dollars

Compare costs and outcomes by doctor and facility

Find your: Aetna member rate and savings Amount paid towards deductibles Estimated out-of-pocket cost of coinsurance, and/or copays

Standard text messaging and other rates from your wireless carrier may apply. Estimated costs not available in all markets. The tool provides an estimate of what would be owed for a particular service based on the plan at that very point in time. Actual costs may differ from an estimate if, for example, claims for other services are processed after the estimate is provided but before the claim for this service is submitted. Or, if the doctor or facility performs a different service at the time of the visit.

Aetna Inc. Wichita Preferred QPOS Teladoc™ Easy and affordable

Helps prevent unnecessary 92% ER/UC visits resolution rate Talk to a doctor for $15 copay

Leads the industry with more 95% than 50,000 consults this year customer satisfaction1

To use Teladoc, call 1-800-TELADOC, TIP upload the app or visit www.Teladoc.com/Aetna.

12015, Teladoc

Aetna Inc. Wichita Preferred QPOS Count on us to keep you informed

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29 Enrollment information you should know

Open Enrollment is November 7 – 18, 2016

What types of changes are allowed during Open Enrollment?

Add or remove eligible dependents

Enroll or waive enrollment in various benefit plans

Change benefit plans

You will not have the opportunity to enroll in the benefit plans again until the next annual enrollment period, unless you experience a qualifying event during the year.

Aetna Inc. Wichita Preferred QPOS Qualifying events include:

Marriage Birth of a child Divorce Legal separation Employment status Dependent eligibility Death Loss of coverage

Notify Employee Benefits within 31 days of a qualifying event!

Aetna Inc. Money saving tips

Use In-network Urgent Care Centers for non-emergency, after-hours care

American Family Care Urgent Care, Immediate Medical Care , Maria Medical Group, McPherson Hospital Urgent Care Clinic, MedExpress Urgent Care, Salina Regional Urgent Care Clinic, Susan B. Allen Immediate Care, West Wichita Family Physician Minor Emergency, Wichita Treatment Center Use your preventive benefits. Get recommended screenings and checkups Use cost tools on Aetna Navigator® to make smart choices Use your Aetna ID Card to gain discounts for various products and services.

Aetna Inc. Wichita Preferred QPOS Count on saving with the Aetna Discount Program

Fitness Books Natural products and services Oral health LifeMart® shopping website Hearing Weight management Vision At-home products

Log in to Aetna Navigator, go to health programs, see discounts

Aetna Inc. Wichita Preferred QPOS State-of-the-Art technology solutions with bSwift

Benefits Online ACA administration enrollment compliance

Decision support tools

Data exchange services

Aetna Inc.

Thank you

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35 This material is for information only. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Not all health services are covered. See 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. Discounts for non-covered dental services may not be available in all states. Providers participating in the Aetna Vision network are contracted through EyeMed Vision Care, LLC. EyeMed and Aetna are independent contractors and not employees or agents of each other. Participating vision providers are credentialed by and subject to the credentialing requirements of EyeMed. Aetna does not provide medical/vision care or treatment and is not responsible for outcomes. Aetna does not guarantee access to vision care services or access to specific vision care providers and provider network composition is subject to change without notice. Vision insurance plans contain exclusions and limitations. Not all vision services are covered.

Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Health benefits and health insurance plans contain exclusions and limitations. The Aetna Personal Health Record should not be used as the sole source of information about the member's medical history. The CareEngine is a proprietary technology platform developed by ActiveHealth Management, an Aetna company. In conjunction with clinicians, the CareEngine continuously analyzes claims and other data against evidenced-based best practices and alerts the members and their physicians about possible care gaps and other inconsistencies. Information is not a substitute for diagnosis or treatment by a physician or other health care professional. iTriage® is a free mobile app from Aetna®. Information on iTriage is general in nature and is not intended and should not be used to replace the advice of a health care professional. Network provider information may be limited.

Information is believed to be accurate as of the production date; however, it is subject to change.

For more information about Aetna plans, refer to www.aetna.com.

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©2016 Aetna Inc.