Your 2013 Aetna Enrollment Guide

Size: px

Start display at page:

Download "Your 2013 Aetna Enrollment Guide"

Blaise Poole
6 years ago
Views:

1 Your 2013 Aeta Erollmet Guide How it feels to make the right choice.

2 Aual Erollmet 2013: Makig the Right Choice Uited offers plas ad programs through Aeta, desiged to protect your health ad quality of life. The Build Your Ow (BYO), Smart Choice ad Aeta Select medical plas help you stay healthy ad afford quality care whe you are sick or ijured. The chart o the ext page shows the plas for which you are eligible. The Aeta Detal Maiteace Orgaizatio (DMO) pla covers a variety of detal services ad offers the coordiatio of a primary care detist. Why Aeta? Here are just some of the reasos Uited chose Aeta, ad why you ll thik Aeta is the right choice for you ad your family. Natioal etwork, local presece Aeta maitais oe of the atio s largest provider etworks, with more tha 1,000,000 health care professioals ad over 5,400 hospitals.* Most likely, the doctor(s), detist(s) ad other providers you curretly use belog to the Aeta etwork. If ot, you ca omiate them for membership. Just go to ad complete the form. Not sure? Check the DocFid directory or ask your provider if he/she belogs to the Aeta etwork. *Aeta Eterprise Provider Database as of August Olie resources The Aeta Member Portal at is your sigle access poit for a wealth of olie services ad tools. There you ca look up etwork providers, eter your secure Aeta Navigator member website ad fid liks to health ad welless programs. Tur to page 6 to lear more. Negotiated discouts We ve egotiated discouts with all the providers i our etwork, which meas you save moey whe you choose them for your care. Worldwide emergecy coverage While travelig outside the etwork, icludig outside the coutry, you are covered for medical ad detal emergecies (subject to certai limitatios). Idustry-recogized quality ad customer service excellece Aeta is a experieced health care leader ready to serve you ad your family. Whether it s a aswer to a beefits questio or help fidig care, you have access to Aeta olie, ad by phoe or . To use DocFid, visit This customized directory will help you fid medical ad detal providers i the Aeta etwork. You also may call Aeta Member Services at

3 Welcome to your 2013 Aual Beefits Erollmet October 1 to October 23, 2012 Aual Erollmet is your time to review the pla optios available ad make the best choice(s) for you ad your family. Your Aeta medical ad detal pla optios are show i the chart below: Build Your Ow Aeta Select* Detal Discout Programs ad Smart Choice See page 4 Maiteace See page 7 See page 3 Orgaizatio See page 5 Cotietal Subsidiary** Uited Subsidiary Maagemet ad Admiistrative** Uited Subsidiary Represeted * Aeta Select available to AZ, CA, DC, FL, MA, MD, MN, MI, NC, NJ, NV, NY, PA, VA. ** Icludes Egieers, Maiteace Istructors, Flight Istructors ad Chelsea Food Services employees. For more iformatio about the Aeta pla(s) for which you are eligible, go to Flyig Together > Employee Services Beefits ad click o the Your Beefits Resources lik. For aswers ad iformatio about other Uited beefits, call the Uited Airlies Beefits Ceter at , 7 a.m. to 7 p.m. CST, Moday through Friday. < What to expect i 2013 Cotietal Subsidiary co-workers There are o chages to BYO medical or Aeta DMO beefits i If you elect the BYO medical pla, your pharmacy coverage will be offered through Express Scripts.*** Your disability beefits will ow be offered through MetLife. Uited Subsidiary Maagemet ad Admiistrative co-workers There are o chages to BYO or Aeta DMO detal beefits i Your pharmacy coverage will cotiue to be offered through Express Scripts.*** Your disability beefits will cotiue to be offered through MetLife. Uited Subsidiary Represeted co-workers Your Aeta Select medical ad pharmacy beefits may chage due to state madates. Check with Aeta Member Services for details. There are o chages to the Aeta DMO pla. Your disability beefits will cotiue to be offered through MetLife. ***This year, Medco Health Solutios was acquired by Express Scripts. Importat! Are you i a active course of treatmet? If you will be a ew Aeta member ad you or someoe i your family are udergoig medical treatmet with a out-of-etwork doctor for certai situatios such as pregacy beyod 24 weeks, chemotherapy or a recet surgery, you may be able to avoid disruptio i care. Call Aeta Member Services at to ask for a Trasitio of Care form. If approved, you will be able to cotiue with your preset doctor ad receive i-etwork beefits for up to 90 days. 2

4 Medical Coverage for Cotietal Subsidiary ad Uited Subsidiary Maagemet ad Admiistrative* Oly Build Your Ow (BYO) ad Smart Choice Pla Optios The BYO plas allow you to pick the pla that is right for you. The Smart Choice pla optio (detailed below) offers low premiums, low office visit copays, ad is worth cosiderig ad comparig with the other plas to see if it s right for you. The Smart Choice pla features a $15 PCP/$50 specialist copay, $1,000 idividual/$3,000 family deductible with 80% coisurace. The out-of-pocket maximum is $2,000 idividual/$4,000 family. *Icludes Egieers, Maiteace Istructors, Flight Istructors ad Chelsea Food Services employees. Beefit Your Pla Optios Office visit copay** Choose oe: 1. $20 primary care/$25 specialist 2. $15 primary care/$50 specialist Aual deductible Choose oe: 1. $0 idividual/$0 family 2. $200 idividual/$600 family 3. $500 idividual/$1,500 family 4. $1,000 idividual/$3,000 family Coisurace (for most services) Choose oe: ad out-of-pocket maximums*** You Pay Coisurace Out-of-Pocket maximum 1. 0% 100% N/A 2. 5% 95% $1,000 idividual/$2,000 family 3. 20% 80% $2,000 idividual/$4,000 family Outpatiet surgery Coisurace applies after deductible. (If you choose the $0 aual deductible optio, you pay a $100 copay.) Emergecy room $125 copay, the coisurace applies after deductible. (Copay ot waived if admitted.) Ipatiet admissio Coisurace applies after deductible. (If you choose the $0 aual deductible optio, you pay a $250 copay.) ** Primary care icludes pediatricias, family practice, iteral medicie ad Ob/Gys. Copays help to meet the deductible ad out-of-pocket maximum, but still apply after these are met. *** Whe you meet your idividual or family out-of-pocket maximum, your eligible expeses are covered at 100% for the remaider of the year for that idividual or family. Copays ad your aual deductible apply to the aual out-of-pocket maximum. For emergecies, please seek care immediately from the earest emergecy facility. No-etwork care is covered for emergecies, but you or someoe else must call Aeta withi 48 hours or as soo as possible. Questios? Call Aeta Member Services at for: Iformatio about Build Your Ow ad out-of-coutry coverage Help with emergecy trasportatio eeds through the Natioal Medical Excellece Program Help with claims, icludig collectio issues Verifyig whether a service or supply is covered uder the pla I additio: Ask about pharmacy coverage from Express Scripts at Note: This year, Medco Health Solutios was acquired by Express Scripts. Ask about metal health/substace abuse coverage at ValueOptios

5 Medical Coverage for Uited Subsidiary Represeted Co-workers Oly Aeta Select* PCP ad Referrals may be required Here s a easy-to-use health beefits pla from Aeta. The pla lets you work oe-o-oe with your primary care physicia (PCP). Whe it comes to your health, othig is better tha gettig persoal care! It s as easy as... Step #1 Choose a PCP You ca choose ay PCP from the Aeta Select etwork by visitig DocFid at Your PCP is the doctor you go to first. He or she will help you lear about your health ad how to maage it. Choosig a doctor is a persoal decisio that s why each member of your family ca have his or her ow PCP. You ca chage your PCP aytime. Just call Aeta Member Services at , or log i to the Aeta Navigator secure member website at Helpful olie tools Search the Aeta Preferred Drug List for covered drugs ad less costly alteratives. Fid a participatig pharmacy ear you. Uderstad drug safety ad how to prevet harmful drug iteractios. Check the status of your claims ad beefits paymets. Estimate prescriptio drug costs. Step #2 Visit your PCP for care Go to your PCP for checkups or wheever you are sick or hurt. Your PCP will help you decide if you eed care from aother doctor. If so, your PCP will give you a referral.** Sometimes you may eed care that requires approval from Aeta before your visit. Your PCP ad other etwork doctors will ask for this approval for you. *Aeta Select is available i AZ, CA, DC, FL, MA, MD, MN, MI, NC, NJ, NV, NY, PA, VA. **PCP referrals are ot required i FL, MI ad NC. See how much you could save if you switched to a geeric drug or used the mail-order delivery service. You ll also fid aswers to frequetly asked questios. Aeta Rx Home Delivery service is a coveiet way to fill ad refill prescriptios for maiteace medicatios. Get a 90-day supply set to your home or ay locatio you choose. Step #3 Pay your copay After you visit your doctor, you will have to pay a copay. This is a flat dollar amout or a percetage of your bill, depedig o the desig of your health beefit pla. Copays vary by locatio. Through Your Beefits Resources, which ca be accessed by goig to Flyig Together > Employee Services > Beefits, you ca fid the covered services ad copaymets for medical, metal health/substace abuse ad pharmacy beefits covered by Aeta. Take a look to fid out how much you will pay. Or, call Aeta Member Services at for more iformatio. Aeta pharmacy pla tools ad mail-order services located at Depedig o your pla, you may pay less by usig this service. Ad, stadard shippig is always free. Pharmacists check all prescriptios for accuracy ad ca aswer questios aytime, ight or day. Shippig is quick ad cofidetial. 4

Aeta Detal Maiteace Orgaizatio: A Healthy Body Starts with a Healthy Smile For all Uited Co-workers, both subsidiary compaies The beefits of good detal care do t stop at your mouth Routie detal

6 Aeta Detal Maiteace Orgaizatio: A Healthy Body Starts with a Healthy Smile For all Uited Co-workers, both subsidiary compaies The beefits of good detal care do t stop at your mouth Routie detal visits ca help idetify other medical coditios. That s why regular visits to the detist ad a quality detal pla are some of your best defeses agaist illess ad disease i both the mouth ad the body. The Aeta DMO pla provides geerous coverage for prevetive services that keep your teeth healthy ad catch problems early. You ll select a primary care detist (PCD) from the Aeta etwork for yourself ad each covered family member. Your PCD will provide most of your detal care ad referrals to specialists whe you eed them. Aeta DMO Beefits at a Glace Pla Feature You Pay Deductible $0 Aual beefit maximum Noe Office visit copay $0 Prevetive care Oral exams, cleaigs, fluoride, X-rays $0 Basic care 20% Root caals (aterior or bicuspids), filligs, simple extractios Major care 40% Crows, root caals (molars), surgery to remove impacted teeth, ilays ad olays, full ad partial detures Orthodotic treatmet 40% (child ad adult) Orthodotic deductible $0 Orthodotic lifetime beefit maximum Noe* *No dollar maximum. Oe treatmet per lifetime, which icludes comprehesive treatmet of 24 moths active treatmet plus 24 moths retetio. I a Emergecy The pla provides coverage for emergecy detal services (such as pai relief) both i ad out of the Aeta etwork. You should always cotact your PCD first for treatmet. If you are treated by a o-etwork detist while more tha 50 miles from home, the pla will cover emergecy services up to $100, subject to state requiremets. Questios? Wat to kow more about the Aeta DMO pla? Just call Aeta Member Services at for help fidig a detist ad aswers to questios about coverage, claims, beefits ad more. 5

The Beefits of Beig a Aeta Member Take advatage of powerful olie tools ad health ad welless programs The Aeta Member Portal At www.aeta.

You ca search for medical ad detal providers ad get iformatio o patiet safety, quality, ad welless programs available to Aeta members.

Lear about Aeta programs ad services such as the Iformed Health Lie, Wome s Health website, Heart/Stroke Recogitio Program, alterative health care programs ad more.

com/uited, you ll fid a lik to Aeta Navigator, your persoalized member website. Here you ca: Use cost-of-care tools to get estimated ad actual provider fees, ad prescriptio drug costs.

E-mail Aeta Member Services for help with claim ad beefit questios, address chages ad replacemet ID cards. Lik to Aeta IteliHealth ad Healthwise Kowledgebase for the latest health iformatio.

7 The Beefits of Beig a Aeta Member Take advatage of powerful olie tools ad health ad welless programs The Aeta Member Portal At you ca: Sig i to Aeta Navigator, your secure member website (see ext colum). Eter DocFid, the olie provider directory customized for all Uited co-workers. You ca search for medical ad detal providers ad get iformatio o patiet safety, quality, ad welless programs available to Aeta members. Remember, you also may call Aeta Member Services at for help with etwork providers. Fid cotact iformatio for Aeta Member Services ad the Uited Airlies Beefits Ceter. Lear about Aeta programs ad services such as the Iformed Health Lie, Wome s Health website, Heart/Stroke Recogitio Program, alterative health care programs ad more. Call Aeta Member Services at for help with claim, beefit ad coverage questios; ID card requests; ad address chages. Aeta Navigator At the top of you ll fid a lik to Aeta Navigator, your persoalized member website. Here you ca: Use cost-of-care tools to get estimated ad actual provider fees, ad prescriptio drug costs. View care you ve received ad whe o your Health History Report. Look up claims ad claim paymets. Prit temporary member ID cards. Aeta Member Services for help with claim ad beefit questios, address chages ad replacemet ID cards. Lik to Aeta IteliHealth ad Healthwise Kowledgebase for the latest health iformatio. Lear about discouts o visio ad hearig care, atural products ad services, fitess memberships ad weight maagemet programs. Use the SmartSource search egie to fid all Aeta resources o a give disease or coditio. To use Aeta Navigator, you ll complete a simple registratio process. Ask A, Aeta s virtual assistat, will be there to help with this ad more. Aeta Mobile Did you kow? You ca access Aeta from your smart phoe or other web-eabled device. Just eter i your browser to fid etwork providers, cotact Member Services ad more wherever you go. 6

8 Health & Welless Resources Helpig you stay well ad live well Iformed Health Lie ( ), a toll-free umber to call whe you have a health questio or cocer.* The lie is staffed by experieced registered urses who ca provide iformatio ad advice 24/7. itriage, a free mobile ad web app, lets you look up symptoms ad coditios, fid the right care ad services, ad make iformed decisios. It features a atiowide directory of health facilities, gives tur-by-tur directios ad eve provides hospital ER wait times. The Begiig Right Materity Program, provides oe-o-oe support for expectig moms to help them stay healthy durig pregacy ad deliver healthier babies. Get started by callig CRADLE1 ( ). MidBloom, a olie social, game, let s you build a Life Tree with braches that represet your goals i such areas as health, lifestyle, ad career, ad helps you Grow the life you wat. *The Iformed Health Lie is ot iteded to replace a doctor visit or a doctor s care. It ca, however, give you aswers about health coditios ad medical procedures, ad help you better commuicate with your doctor. Discout Programs Stay healthy with savigs that come with your Aeta health pla: Aeta Visio discout program Save o eye exams, cotact leses, ad prescriptio ad o-prescriptio eyeglasses. Aeta Fitess discout program Get preferred rates o gym memberships i the GlobalFit etwork, home exercise equipmet ad other healthy perks. Aeta Weight Maagemet discout program Lose weight ad save o today s most popular weight-loss programs ad meal plas, icludig ediets, Jey Craig ad Nutrisystem. Aeta Natural Products ad Services discout program Get discouts o services ad products through the ChooseHealthy program. Aeta Hearig discout program Save o hearig aids ad exams through Hearig Care Solutios ad HearPO. Ad more! Health ad detal beefits ad isurace plas ad policies are offered, uderwritte or admiistered by Aeta Life Isurace Compay, Aeta Detal Ic., Aeta Detal of Califoria Ic. ad/or Aeta Health Ic. For self-fuded accouts, beefits coverage is offered by your employer, with oly admiistrative services provided by Aeta Life Isurace Compay. Not all health ad detal services are covered. See pla documets for a complete descriptio of beefits, exclusios, limitatios ad coditios of coverage. Providers are idepedet cotractors ad are ot agets of Aeta. Provider participatio may chage without otice. Aeta does ot provide care or guaratee access to health services. Health iformatio programs provide geeral health iformatio ad are ot a substitute for diagosis or treatmet by a physicia or other health care professioal. Discout programs provide access to discouted prices ad are NOT isured beefits. The member is resposible for the full cost of the discouted services. Pla features ad availability may vary by locatio ad are subject to chage. For more iformatio about Aeta plas, refer to CCG CONTAIR-0003 (10/12) 2012 Aeta Ic.

The attached brochures explain a number of benefits for logging on and creating your account with Medical Mutual.

The attached brochures explain a number of benefits for logging on and creating your account with Medical Mutual. OPEC-HC Medical Mutual My Health Pla Dear Member. The attached brochures explai a umber of beefits for loggig o ad creatig your accout with Medical Mutual. Not oly ca you access etwork providers, claims