Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Maine 2–100 Plan guide The health of business, well planned. Plans effective October 1, 2012 For businesses with 2-100 eligible employees www.aetna.com 64.10.302.1-ME (6/12) Team with Aetna for the health of your business Introducing a new suite of products and services designed specifically for companies with 2 to 100 eligible employees. 64.44.302.1-ME (6/12) 64.44.302.1-ME 64.43.302.1-ME (6/12) Health benefits and health insurance, dental benefits/dental insurance, life insurance and disability insurance plans/policies are offered, underwritten or administered by Aetna Health Inc. and/or Aetna Life Insurance Company (Aetna). 2 You can count on Aetna to provide health plans that help simplify decision making and plan administration so you can focus on the health of your business. Aetna is committed to helping employers build healthy businesses. In this guide: In today’s rapidly changing economy, we recognize the need for 5 Small-business commitment less expensive, less complex health plan choices. Now, Aetna offers a variety of newly streamlined medical and dental 5 Benefits for every stage of life 64.44.302.1-ME (6/12) 64.44.302.1-ME benefits and insurance plans to provide more affordable options 6 Medical overview and to help simplify plan selection and administration. 8 Managing health care expenses 10 Medical plan options 24 Dental overview 26 Dental plan options 64.43.302.1-ME (6/12) 33 Life & disability overview 36 Life & disability plan options 38 Underwriting guidelines 48 Product specifications 58 Limitations and exclusions 3 Employers and their employees can benefit from… Simplicity • Affordable plan options We know that the health of your business is your top priority. • Online self-service tools and capabilities Aetna’s streamlined plans and variety of services make it easier for • Enhanced services for consumer-directed health plans you to focus on your business by simplifying administration and management. • 24-hour access to Employee Assistance Program services • Preventive care covered 100% Aetna makes it easy to manage health insurance benefits with simplified enrollment, billing and claims processing so you can • Aetna disease management and wellness programs focus on what matters most. With Aetna, we know it’s about... Trust Options We work hard to provide health plan solutions you can trust. Our account executives, underwriters and customer service We provide a variety of health plan options to help meet your representatives are committed to providing businesses and employees’ needs, including medical, dental, disability and their employees with service they can trust. life insurance. And, with access to a wide network of health care providers, Aetna resources are designed to fortify the health you can be sure that employees have options in how they of your business access their health care. • Track medical claims and take advantage of online services with Medical plans your Aetna Navigator® secure member website. It features automated enrollment, personal health records and printable • HSA-compatible plans temporary member ID cards. • Hospital deductible plans • Get real cost and health information to help make the right care • Up-front deductible plans decision with an online Cost of Care Estimator. Dental plans • Manage health records online with the Personal Health Record. • PPO • Use the Aetna Health ConnectionsSM Disease Management • Indemnity Program, which provides personal support to members to help them manage their conditions. Life and disability plans* • Leverage 24/7 access to a nurse to help with personal • Basic life health-related questions. • Supplemental life • Help members work toward health goals with wellness initiatives, ® • AD&D Ultra® such as the Simple Steps to a Healthier Life online program. • Supplemental AD&D Ultra® • Take advantage of discount programs for vision, dental, and general health care that encourage use of plan offerings. • Dependent life • Short-term disability • Long-term disability *For groups 51 to 100 please consult your sales representative for a plan design to meet your group needs. 4 Aetna is committed to the health of your business We understand that your business has unique needs. That’s why we have streamlined our plan options for employers with 2 to 100 employees. We are committed to providing you with value and quality you can count on. Our variety of products and services allows you to focus on the health of your business. Aetna’s health plan options are designed with the Health insurance benefits for every stage of life health of your business in mind For young individuals and couples without children… Basic plans • Lower monthly payments • Modest out-of-pocket costs • Basic benefits for your employees • Quality preventive care • Limit the expense to your business • Prescription drug coverage • Allow employees to buy up and share more of the cost • Financial protection - ME HNOnly 1000 HD 20/35 - ME HNOnly 3000 UD 25/45 HSA-compatible plans - ME PPO 2500/80 Hospital deductible plans Up-front deductible plans Value plans For married couples and single parents with teens and • Encourage employee responsibility in their health care decisions college-aged children… • Tools and resources to support consumerism • Checkups and care for injuries and illness • Innovative plan design • Preventive care and screenings that promote a healthy lifestyle - ME HNOnly 3000/90 HSA Compatible • National network of health care providers - ME HNOnly 5000/90 HSA Compatible HSA-compatible plans - ME PPO 2500/80 HSA Compatible Hospital deductible plans Standard plans For married couples and single parents with young • Standard benefits plans children or teens… • Limit the financial impact on employees • Lower fees for office visits - ME HNOnly 500 HD 20/30 51+ • Lower monthly payments - ME PPO 1000/90 51+ • Caps on out-of-pocket expenses - ME PPO 1500/80 • Quality preventive care for the entire family Hospital deductible plans For men and women 55 years of age and over with no children at home… • Financial security • Quality prescription drug coverage • Hospital inpatient/outpatient services • Emergency care HSA-compatible plans Hospital deductible plans Up-front deductible plans 5 Aetna Medical Overview At Aetna, we are committed to putting the employee at the center of everything we do. You can count on Aetna to provide health plans that help simplify decision making and plan administration so you can focus on the health of your business. 6 Medical Overview Maine Provider network All medical plans are available in the following counties: Androscoggin Hancock Oxford Somerset Aroostock Kennebec Penobscot Waldo Cumberland Knox Piscataquis Washington Franklin Lincoln Sagahadoc York Product Product PCP Referrals DocFind® Name Description Required Required Plan Name PPO PPO plan members can see any recognized provider for No No Open Choice® covered services without a referral. Each time members seek PPO health care, they have the freedom to choose either network providers at lower out-of-pocket costs, or non-network providers at higher out-of-pocket costs. Aetna Health Aetna Health Network Only (HNOnly) is a health maintenance Optional No Aetna Health Network OnlySM organization plan that uses a network of participating Network OnlySM (HNOnly) providers. Each family member may select a primary care (Open Access) physician (PCP) participating in the Aetna network to provide routine and preventive care and help coordinate the member’s total health care. Members never need a referral when visiting a participating specialist for covered services. Only services rendered by a participating provider are covered, except for emergency or urgently needed care. Traditional Choice This indemnity plan option is available for employees who live No No N/A (TC) outside the plan’s network service area. Members coordinate their own health care and may see any recognized provider for covered services without a referral. 7 Aetna High-Deductible HSA-Compatible Health No Cost Health Incentive Credit† Network Only and PPO plans Members can earn $50 in just a few simple steps Health Network Only and PPO health plans are compatible with Members earn a $50 credit toward their out-of-pocket expenses a health savings account (HSA). HSA-compatible plans provide when they: integrated medical and pharmacy benefits. Preventive care services are exempt from the deductible. • Complete or update their Health Assessment on Simple Steps To A Healthier Life. HSAs provide employers and their qualified employees with an affordable tax-advantaged solution that allows them to better • Complete one online wellness program. manage their qualified medical and dental expenses. If the employee’s spouse is covered under the plan, he or she is • Employees can build a savings fund to help cover their future also eligible for the same incentive credit. So a family could save medical and dental expenses. HSAs can be funded by the $100 in out-of-pocket expenses each year. Incentive rewards will employer or employee and are portable. be credited toward the deductible and maximum out-of-pocket limit. This program is included at no additional cost, except with • Fund contributions may be tax deductible (limits apply). HSA-compatible plans. • When funds are used to cover qualified out-of-pocket medical and dental expenses, they are not taxed. COBRA administration • It is completely at the discretion of the employer or employee Aetna COBRA administration offers a full range of notification, whether or not to establish an HSA. documentation and record-keeping processes that can help Note: Employers and employees should consult with their tax employers manage the complex billing and notification processes advisor to determine eligibility requirements and tax advantages required for COBRA compliance, while also helping to save them for participation in the HSA plan. time and money. Health Savings Account (HSA) No set-up or administrative fees The Aetna HealthFund HSA, when coupled with an HSA-compatible high-deductible health benefits and health insurance plan, is a tax-advantaged savings account.