Easy steps to renew your coverage - Aetna...Aetna Navigator, which features online resources and information to help your employees make ... Nevada Small Group Sales Manager Aetna

Easy steps to renew your coverage

Nevada renewal instructions

For 2 – 50 eligible employees

Effective July 1, 2011

14.02.130.1-NV E (08/11)

Aetna makes the renewal process easy.

1

It’s renewal time, with Aetna

Dear Valued Employer:

Thank you for choosing Aetna for your employee benefits. We value your business and appreciate your trust in us to protect you and your employees’ assets.

This booklet is your guide for current and new plan information and outlines the renewal process. If you are pleased with your current plan(s) and would like to renew with the plan(s) that most closely matches the in-force plan(s), the renewal process is complete, and your coverage will automatically renew prior to its effective date.

In order to comply with the Patient Protection and Affordable Care Act (PPACA), as well make improvements that drive value, as your health benefits carrier, we’ve changed and eliminated some plans to introduce new plans that broaden your options with regard to price.

Aetna Avenue® — Your Destination for Small Business Solutions®

Aetna Avenue is our commitment to value for Nevada’s small businesses. Whether or not you make medical health insurance plan changes, you and your employees will have continued access to Aetna’s discount programs and health resources, including our award-winning member website, Aetna Navigator, which features online resources and information to help your employees make more informed decisions about their health.

Aetna Avenue also means access to care from one of Nevada’s most solid health provider networks and flexibility on plan choices. Using Pick-A-Plan 3, groups of five or more can select up to three plans in our portfolio. Elect Pick-A-Plan 3 and you control expenses while providing employees superior health benefits coverage.

In addition, Aetna Avenue offers you corporate buying power through Aetna’s Resource Connection, which features discounted goods and services. While not insurance, these discounts can help you save on office supplies, HR support, payroll, technology assistance and more.

If you have questions or need additional information, please contact your broker or Aetna at

1-877-249-2472, prompt #6. We understand you have a choice of carriers and thank you for placing your confidence with Aetna.

Sincerely,

Rachel D. Scales

Nevada Small Group Sales Manager

Aetna

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. Those companies include Aetna Health Inc., Aetna Life Insurance Company and Aetna Health Insurance Company (Aetna).

2

Contact informationAetna Small Group Broker and General Agents

BrokEr SAlES Support uNit

1-877-249-2472 phone 1-888-258-4530 fax

Choose the following numbers, when prompted, to access the information you need.

1 If you know your party’s extension

2 Claims

3 Commissions

4 Licensing and Appointment

5 Billing, Enrollment and Eligibility

6 Broker Liaison

E-mail Address

Nevada: [email protected]

Existing Business Submissions

Regular mail: PO Box 91507 Arlington, TX 76015-0007

Overnight mail: 4300 Centreway PlaceArlington, TX 76018

New Business Quoting

Nevada: 1-877-362-0870 fax

Standard quote: [email protected]

Medical review: [email protected]

New Buisness Case Submission

Aetna New Business Underwriting PO Box 91507 Arlington, TX 76015-0007

Online: [email protected]

Aetna Navigator and producer World®

1-800-225-3375 Monday – Friday 7 a.m. – 9 p.m. Et


Prompt 1 (Aetna Navigator) Prompt 3 (Producer World)

1 Assistance with password or user name

2 Assistance with registration

3 Access assistance

4 All other website technical assistance

plAN SpoNSor SErviCES

1-877-249-7235 phone 1-888-258-4528 fax


1 Renewals

2 Claims

3 Billing and Enrollment

Billing

For lockbox information, see customer bill or please contact the Plan Sponsor Services toll-free number for more information.

Enrollment

Aetna PO Box 24005 Fresno, CA 93779-4005

3

MEdiCAl

1-888-702-3862 For benefits questions or claims inquiries for Aetna HMo plan, Aetna Choice®

plan (poS)

1-888-802-3862 (prompt 1) For benefits questions or claims for Aetna ppo plan, Aetna indemnity plan

Claims Addresses

For Aetna HMo plan, Aetna Choice plan (poS)

Aetna PO Box 981106 El Paso, TX 79998-1106

For Aetna ppo plan, Aetna indemnity plan

Aetna PO Box 981106 El Paso, TX 79998-1106

dENtAl

1-877-238-6200

prompt 1 (dental plan member) prompt 2 (dental care provider)

Claims Address

Aetna PO Box 14094 Lexington, KY 40512-4094

liFE

1-800-523-5065

Claims Address

Aetna Life Insurance PO Box 14549 Lexington, KY 40512-4549

pHArMACy

1-800-AEtNA rX or 1-800-238-6279

prompt 2 (Member or calling on behalf of a member)

Claims Address

Aetna Pharmacy Management Attn: Claims PO Box 14024 Lexington, KY 40512 Fax: 860-262-9437

Mail-order drug

1-866-612-3862

Ordering address: Aetna Rx Home Delivery PO Box 417019 Kansas City, MO 64179-9892

otHEr proGrAMS

Aetna visionSM discount program

1-800-793-8616 Call for closest eye care provider

informed Health® line

1-800-556-1555 24-hour nurse help line

Behavioral Health Services Magellan Behavioral Health/HAi

1-800-424-5702

Alternative Health Care programs, Fitness program, docFind®, Aetna Navigator and other information

Information can be accessed through our website at www.aetna.com.

Member Services

4

How to renew your Aetna health plans

trAditioNAl plAtForM HMo plAtForM

NV PPO HSA-Compatible Plans NV Aetna Value NetworkSM HMO Plans

Indemnity Plans NV CPOS Plans

NV CPOS HSA-Compatible Plans

All items (completed in full) are to be received by Aetna no later than the day before the requested effective date. Ancillary adds need to be submitted 15 days in advance of the requested effective date.

Correspondence can also be mailed to:

Aetna po Box 91507Arlington, tX 76015-0007

to keep your existing benefits ANd select an alternate plan(s) — n Please check off the “Renewal” plan

and also check off any “Alternate” plans you’d like to add on the Plan Sponsor Signature Page in your renewal packet and fax it to 1-888-258-4530.

n Employees moving plans between platforms will need to submit an Employee Change of Coverage Form. These applications should be faxed along with the Plan Sponsor Signature Page.

n Employees moving plans within the same platform will not need to submit an Employee Change of Coverage Form.

n Please submit a letter or list of employees to identify the correct plan selection of all employees.

to delete your existing benefits and move to an alternate plan(s) — n Please check off any “Alternate”

plans you’d like to add on the Plan Sponsor Signature Page in your renewal packet and fax it to 1-888-258-4530.

n Employees moving plans between platforms will need to submit an Employee Change of Coverage Form. These applications should be faxed along with the Plan Sponsor Signature Page.

n Employees moving plans within the same platform will not need to submit an Employee Change of Coverage Form.

n Please submit a letter or list of employees to identify the correct plan selection of all employees.

to request an upgrade in benefits not listed in your renewal —

If you’re not enrolled in Pick-A-Plan, medical underwriting is required on all upgrade requests and may be declined.

Please submit the following items:n A letter on company letterhead

requesting the upgraded plan(s).n Employee Change of Coverage

Form with the medical question completed only for those employees wishing to move.

n A completed Employer Application (pages 1 and 4).

n Copy of the most recent filed NUCS 4072 and NUCS 4073.

n Please fax all information to 1-888-258-4530.

2010 summary comparison

Aetna Small Group is always looking to enhance our health care solutions to better serve you. Our goal is to provide flexible, affordable health benefits that align with your company’s objectives. This year’s Nevada portfolio includes fourteen new plan designs. Seven plan designs were eliminated in 2010. Please refer to the list below for a quick overview of your 2010 options.

produCt your CurrENt plAN your rENEWAl plAN CoMpAriSoN

NV CPOS $500 80% compared to NV CPOS $500 80% Page 6

NV CPOS $1,000 80% compared to NV CPOS $1,000 80% Page 6

NV CPOS $2,500 70% compared to NV CPOS $2,500 70% Page 7

NV AVN HMO $15 compared to NV AVN HMO $15 Page 7



NV AVN HMO $25 GRx compared to NV AVN HMO $25 GRx Page 9

NV PPO $500 80% compared to NV PPO $500 80% Page 9

NV PPO $1,000 80% compared to NV PPO $1,000 80% Page 10



NV PPO Saver $5,000 compared to NV PPO Saver $5,000 Page 11

NV PPO HSA $3000 90% compared to NV PPO HSA $3000 90% Page 12

NV Indemnity compared to NV Indemnity Page 12

5

6

Plans revised for October 1, 2010Current plan

Nv CpoS $500 80%renewal plan

Nv CpoS $500 80%In Network Out of Network In Network Out of Network

Lifetime Maximum Benefit $3,000,000 Unlimited

Plan Coinsurance 80% 60% 80% 60%

Calendar-Year Deductible2 (Accumulates separately in/out of network)

$500 per member (three-member maximum)

$1,000 per member (three-member maximum)

$500 per member (three-member maximum)


Calendar-Year Payment Limit3 (Excludes deductible; copayments and certain payments do not apply; accumulates separately in/out of network)





Primary Physician Office Visit $20 60% $20 60%

Specialist Office Visit $40 60% $40 60%

Outpatient Lab $0 60% $20 60%

Outpatient X-ray $40 60% $20 60%

Outpatient Complex Imaging 80% 60% 80% 60%

Physical Exams - Adult $20 60% $0 70%

Inpatient Hospital 80% 60% 80% 60%

Outpatient Surgery 80% 60% 80% 60%

Emergency Room 80% after $150 copay Paid as in network 80% after $150 copay Paid as in network

Urgent Care $50 60% $50 60%

Prescription Drugs Retail: per 30-day supply Mail Order: 2.5X retail copay, 31-90-day supply, includes insulin

$10/$30/$50/20% Not Covered $10/$30/$50/20% Not Covered

Self-Injectables (Retail and mail order; does not include insulin)

80% Not Covered 80% Not Covered

Current plan Nv CpoS $1000 80%

renewal plan Nv CpoS $1000 80%

In Network Out of Network In Network Out of Network






















Urgent Care $50 60% $50 60%


$10/$35/$60/20% Not Covered $15/$40/$60/20% Not Covered



See footnotes on page 13.

7

Current plan Nv CpoS 2500 70%

renewal plan Nv CpoS 2500 70%























Urgent Care $100 50% $100 50%


$15 Generic/Member pays 100% of contracted rate for Brand

Not Covered $15 Generic/Member pays 100% of contracted rate for Brand

Not Covered



Current plan Nv Aetna value Network HMo $15

renewal plan Nv Aetna value Network HMo $15

In Network In Network

Member Benefits1

PCP Referrals Required Yes Yes

Member Coinsurance (Applies to most services)

N/A N/A

Calendar Year Deductible2 (Accumulates separately in/out of network)

N/A N/A

Calendar Year Payment Limit3 (Excludes deductible; copayments and certain payments do not apply; accumulates separately in/out of network)

$5,000 per member (2 member maximum)


Lifetime Maximum Benefit (Combined in/out of network)

$3,000,000 Unlimited

Primary Physician Office Visit $15 $15

Specialist Office Visit $30 $30

Outpatient Lab $15 $15

Outpatient X-ray $30 $15

Physical Exams – Adult $15 $0

Inpatient Hospital $1,000 $1,000

Outpatient Surgery $250 $250

Emergency Room (Copay waived if admitted) $250 $250

Urgent Care $75 $75


$10/$35/$60 $10/$35/$60


80% 80%


8




Member Benefits1


Member Coinsurance (Applies to most services) N/A N/A


$500 per member (2 member maximum)

$500 per member (2 member maximum)














Urgent Care $75 $75


$10/$35/$60 $10/$35/$60


80% 80%




Member Benefits1



















Urgent Care $75 $75


$10/30%/50% $10/30%/50%


80% 80%


9

Current plan Nv Aetna value Network HMo $25 Grx

renewal plan Nv Aetna value Network HMo $25 Grx


Member Benefits1



Calendar-Year Deductible (Accumulates separately in/out of network)






Lifetime Maximum Benefit3 (Combined in/out of network)






Physical Exams - Adult $25 $0

Inpatient Hospital $300 per day for 7 days per admission $300 per day for 7 days per admission



Urgent Care $75 $75


$15 Generic; member pays 100% for Brand $15 Generic; member pays 100% for Brand


80% 80%

Current plan Nv ppo $500 80%

renewal plan Nv ppo $500 80%





$500 Individual; $1,500 Family

$1,000 Individual; $3,000 Family

$500 Individual; $1,500 Family


Calendar-Year Payment Limit3 (Excludes deductible; copayments and certain payments do not apply; accumulates separately in/out of network













Emergency Room 20% after $150 copay Paid as in-network 20% after $150 copay Paid as in-network

Urgent Care $50 60% $50 60%


$10/$30/$50/20% 30% after $10/$30/$50/20%

$10/$30/$50/20% 30% after $10/$30/$50/20%


80% 80% 80% 80%


10

New plans for 2010 Current plan

Nv ppo $1000 80%renewal plan

Nv ppo $1000 80%In Network Out of Network In Network Out of Network






















Urgent Care $50 60% $50 60%


$10/$35/$60/20% 30% after $10/$30/$50/20%

$10/$35/$60/20% 30% after $10/$35/$60/20%


80% 80% 80% 80%

























Urgent Care $100 60% $100 60%


$10/$35/$60/20% 30% after $10/$30/$50/20%

$10/$35/$60/20% 30% after $10/$35/$60/20%


80% 80% 80% 80%


11






Calendar Year Deductible2 (Accumulates separately in/out of network)





Calendar Year Payment Limit3 (Excludes deductible; copayments and certain payments do not apply; accumulates separately in/out of network)














Urgent Care $100 60% $100 60%


$15/$35/$60/20% 30% after $15/$35/$60/20%

$15/$35/$60/20% 30% after $15/$35/$60/20%


80% 80% 80% 80%

Current plan Nv ppo Saver $5,000

renewal plan Nv ppo Saver $5,000















Specialist Office Visit 100% 70% 100% 70%







Emergency Room 100% Pais as in network 100% Pais as in network

Urgent Care $100 70% $100 70%


$20/$40/$70/20% 30% after $20/$40/$70/20%

$20/$40/$70/20% 30% after $20/$40/$70/20%


80% 80% 80% 80%


12

Current plan Nv ppo HSA $3000 90%

renewal plan Nv ppo HSA $3000 90%














Primary Physician Office Visit 90% 70% 90% 70%

Specialist Office Visit 90% 70% 90% 70%

Outpatient Lab 90% 70% 90% 70%

Outpatient X-ray 90% 70% 90% 70%


Physical Exams - Adult 100% 70% $0 70%



Emergency Room 90% Paid as in network 90% Paid as in network

Urgent Care 90% 70% 90% 70%


$10/$30/$50/20% after plan deductible

30% after $10/$30/$50/20% after plan deductible

$10/$30/$50/20% after plan deductible



80% after plan deductible 80% after plan deductible 80% after plan deductible 80% after plan deductible

Current plan Nv indemnity

renewal plan Nv indemnity

Out of Network Out of Network


Plan Coinsurance 70% 70%







Primary Physician Office Visit 70% 70%

Specialist Office Visit 70% 70%

Outpatient Lab 70% 70%

Outpatient X-ray 70% 70%

Outpatient Complex Imaging 70% 70%

Physical Exams - Adult 70% 100%

Inpatient Hospital 70% 70%

Outpatient Surgery 70% 70%

Emergency Room 70% 70%

Urgent Care 70% 70%



$10/$35/$60/20%


80% after plan deductible 80% after plan deductible


13

* Payment for out-of-network care is determined based upon Aetna’s Allowable Fee Schedule. These charges are referred to in your plan documents as “recognized” charges.

1 Some benefits are subject to limitations, exclusions and visit maximums. Members or providers may be required to precertify or obtain approval for certain services such as non-emergency hospital care. For a summary list of limitations and exclusions, contact your Aetna sales executive.

2 All services are subject to the deductible unless otherwise noted. All covered services accumulate separately toward the preferred and non preferred deductible. Coinsurance applies after the deductible is met. Once three individual members of a family each satisfy their deductible separately, all family members are considered to have met their deductible for the remainder of the calendar year.

2a All services are subject to the deductible unless otherwise noted. All covered services accumulate separately toward the preferred and non preferred deductible. Coinsurance applies after the deductible is met. Once the family deductible is met, all family members will be considered as having met their deductible for the remainder of the calendar year. No one family member may contribute more than the individual deductible amount to the family deductible.

2b All services are subject to the deductible unless otherwise noted. All covered services accumulate separately toward the preferred and non preferred deductible. Coinsurance applies after the deductible is met. Once two individual members of a family each satisfy their deductible separately, all family members are considered to have met their deductible for the remainder of the calendar year.

3 All covered expenses accumulate separately toward the preferred and non-preferred payment limit. Only those preferred and non-preferred expenses resulting from the application of coinsurance percentage (except any penalty amounts) may be used to satisfy the payment limit. Certain member cost-sharing elements including copays, pharmacy, deductible, mental health and substance abuse do not apply toward the payment limit. Once three individual members of a family each satisfy their payment limit separately, all family members will be considered as having met their payment limit for the remainder of the calendar year.

3a All covered expenses accumulate separately toward the preferred and non-preferred payment limit. Only those preferred and non-preferred expenses resulting from the application of coinsurance percentage (except any penalty amounts) may be used to satisfy the payment limit. Certain member cost-sharing elements, including copays, pharmacy, deductible, mental health and substance abuse do not apply toward the payment limit. Once two individual members of a family each satisfy their payment limit separately, all family members will be considered as having met their payment limit for the remainder of the calendar year.

4 All covered expenses accumulate separately toward the preferred and non-preferred payment limit. Only those out-of-pocket expenses resulting from the application of coinsurance percentage, deductibles, and copays (except any penalty amounts) may be used to satisfy the payment limit. Once the family payment limit is met, all family members will be considered as having met their payment limit for the remainder of the calendar year. No one family member may contribute more than the individual payment limit amount to the family payment limit.

State-mandated basic and standard plans are available upon request.

14

Deleted plans for 2010 NV CPOS HSA $3000 90%

In Network Out of Network

Lifetime Maximum Benefit $3,000,000

Primary Care Office Visit 90% 70%


Calendar-Year Deductible $3,000 Individual / $6,000 Family $ 6,000 Individual / $12,000 Family

Coinsurance 90% 70%

Coinsurance Maximum (Excludes deductible) $5,000 Individual/$10,000 Family $12,000 Individual/$24,000 Family




Hospital Inpatient 90% 70%

Emergency Room (Copay waived if admitted) 90%

Prescription Drugs $10/$30/$50/20% Not Covered

NV CPOS $1500 80%

In Network Out of Network


Primary Care Office Visit $25 copay 60%

Specialist Office Visit $50 copay 60%

Calendar-Year Deductible $1,500 Individual/$4,500 Family $3,000 Individual/$9,000 Family

Coinsurance 80% 60%


Outpatient Lab $0 60%

Outpatient X-ray $50 Copay 60%



Emergency Room (Copay waived if admitted) 80% after $150 copay


15

NV CPOS $2000 80%

BENEFIT In Network Out of Network





Coinsurance 80% 60%







Prescription Drugs $15/$40/$70 Not Covered

NV PPO $750 80%





Calendar-Year Deductible $750 Individual/$2,250 Family $1,500 Individual/$4,500 Family

Coinsurance 80% 60%








16

NV PPO Basic $1500 80%



Primary Care Office Visit 3 visits per member per calendar year, primary and specialist office visits combined. Any visits over this limit are Not covered** / Office visits are limited to 3 per member per calendar year for all types of office visits combined (primary physician, specialist physician, preventive care, chiropractic, physical/occupational/speech therapy, vision exam). Routine X-ray provided by the provider during a covered office visit and billed

with the office visit is included in the office visit copay. Preventive care (routine physicals, routine Gyn exams and well-child exams) are included in the 3 office visit benefit. If the member chooses NOT to use any/all of their 3 office visits for preventive care, preventive

care is still covered after the deductible.

Specialist Office Visit $50 60%


Coinsurance 80% 60%







Prescription Drugs $15 Generics/Member pays 100% of contracted rate for Brand

30% after $15 for Generics, member pays 100% of cost for Brand

NV PPO HSA $1500 80% TIF



Primary Care Office Visit 80% 60%



Coinsurance 0% 60%

Coinsurance Maximum (Deductible applies) $4,000 Individual/$8,000 Family $10,000 Individual/$20,000 Family





Emergency Room 80%

Prescription Drugs $10/$30/$50/20% after plan deductible 30% after $10/$30/$50/20% after plan deductible

17

NV PPO $1500 80%



Primary Care Office Visit $25 60%

Specialist Office Visit $50 60%


Coinsurance 80% 60%







Prescription Drugs $10/$35/$60/20% 70% after $10/$35/$60/20%

18

PPO Products

NEW PLANS NEW PLAN NEW PLANS

Current Plan Renewal Plan NV PPO 500 80%

NV PPO 750 80%

NV PPO 1000 80%

NV PPO 1500 80%

NV PPO 2000 80%

NV PPO 3000 80%

NV PPO Basic 1500 80%

NV PPO $1,500 80%

TIF HSA

NV PPO $3,000 90%

HSA

NV PPO $5,000 90%

HSA

NV PPO Saver $5000

NV PPO Saver $10,000

NV INDEMNITY

NV POS $250 90% NV CPOS $500 80% U U D D D D D D D D D D U



NV POS $500 70% NV CPOS $1000 80% U U U U D D D U D D D D U



NV POS $1500 100% NV CPOS $1500 80% U U U U U D D U U D D D U


NV POS $2500 100% NV CPOS $2000 80% U U U U U U D U U D D D U

NV POS HSA $2500 100% NV CPOS HSA $3000 90% U U U U D D D U D D D D U


NV PPO $500 80% NV PPO $500 80% D D D D D D D D D D D U

NV PPO $750 80% NV PPO $750 80% U D D D D D D D D D D U

NV PPO $1000 80% NV PPO $1000 80% U U D D D D D D D D D U

NV PPO $1500 80% NV PPO $1500 80% U U U D D D D D D D D U

NV PPO Basic $1500 80% NV PPO Basic $1500 80% U U U U U U U U D U D U

NV PPO HSA $2500 100% NV PPO HSA $3000 90% U U U U U D D U D D D U

PPO Limited Benefit 50/50 NV PPO Basic $1500 80% U U U U U U U U D U D U

Indemnity NV Indemnity U U U U U U U U U U U U

CPOS Products Aetna Value Network Products

NEW PLANS

Current Plan Renewal Plan NV CPOS 500 80%

NV CPOS 1000 80%

NV CPOS 1500 80%

NV CPOS 2000 80%

NV CPOS 2500 70%

NV CPOS HSA 3000 90%

NV AVN $15 NV AVN $20 NV AVN $25 NV AVN $25 GRx

NV POS $250 90% NV CPOS $500 80% D D D D D D D D D



NV POS $500 70% NV CPOS $1000 80% U D D D D D D D D



NV POS $1500 100% NV CPOS $1500 80% U U D D D U D D D


NV POS $2500 100% NV CPOS $2000 80% U U U D U U U D D

NV POS HSA $2500 100% NV CPOS HSA $3000 90% U U D D D D U D D D


NV PPO $500 80% NV PPO $500 80% D D D D D D D D D D


NV PPO $1000 80% NV PPO $1000 80% U D D D D D D D D D


NV PPO Basic $1500 80% NV PPO Basic $1500 80% U U U U D U U U U D

NV PPO HSA $2500 100% NV PPO HSA $3000 90% U U D D D D U D D D

PPO Limited Benefit 50/50 NV PPO Basic $1500 80% U U U U D U U U U D

Indemnity NV Indemnity U U U U U U U U U U

19

Nevada 2010 Buy-up/Buy-down guide

PPO Products

NEW PLANS NEW PLAN NEW PLANS

Current Plan Renewal Plan NV PPO 500 80%

NV PPO 750 80%

NV PPO 1000 80%

NV PPO 1500 80%

NV PPO 2000 80%

NV PPO 3000 80%

NV PPO Basic 1500 80%

NV PPO $1,500 80%

TIF HSA

NV PPO $3,000 90%

HSA

NV PPO $5,000 90%

HSA

NV PPO Saver $5000

NV PPO Saver $10,000

NV INDEMNITY









NV POS $2500 100% NV CPOS $2000 80% U U U U U U D U U D D D U



NV PPO $500 80% NV PPO $500 80% D D D D D D D D D D D U

NV PPO $750 80% NV PPO $750 80% U D D D D D D D D D D U

NV PPO $1000 80% NV PPO $1000 80% U U D D D D D D D D D U

NV PPO $1500 80% NV PPO $1500 80% U U U D D D D D D D D U

NV PPO Basic $1500 80% NV PPO Basic $1500 80% U U U U U U U U D U D U

NV PPO HSA $2500 100% NV PPO HSA $3000 90% U U U U U D D U D D D U

PPO Limited Benefit 50/50 NV PPO Basic $1500 80% U U U U U U U U D U D U

Indemnity NV Indemnity U U U U U U U U U U U U

20

u = upgrade, subject to medical underwriting

d = downgrade, no medical underwriting required

CPOS Products Aetna Value Network Products

NEW PLANS

Current Plan Renewal Plan NV CPOS 500 80%

NV CPOS 1000 80%

NV CPOS 1500 80%

NV CPOS 2000 80%

NV CPOS 2500 70%

NV CPOS HSA 3000 90%

NV AVN $15 NV AVN $20 NV AVN $25 NV AVN $25 GRx









NV POS $2500 100% NV CPOS $2000 80% U U U D U U U D D







NV PPO Basic $1500 80% NV PPO Basic $1500 80% U U U U D U U U U D

NV PPO HSA $2500 100% NV PPO HSA $3000 90% U U D D D D U D D D

PPO Limited Benefit 50/50 NV PPO Basic $1500 80% U U U U D U U U U D

Indemnity NV Indemnity U U U U U U U U U U

21

BENEFitS CHANGES WHEN EliGiBlE rEQuESt MuSt BE rECEivEd rEQuirEd doCuMENtAtioN

upgrade Medical Benefits (To include adding medical plans to existing medical plans)

New business During the initial plan year, a group may only change plans 6 months post sale (no changes are allowed within the 4-month period prior to the renewal date). Existing business Upgrades are allowed once* in a 12-month rolling period, limited to the 8-month period following the renewal date. Example: A 1-1 renewal may request a plan change through 8-1.

On renewal – request must be submitted on or prior to the effective date of the renewal. Off renewal – request must be submitted 30 days prior to the requested effective date.

1. A new Employer Application (complete pages 1 and 4 and indicate the requested effective date) or a letter from the group requesting the change.

2. Completed Employee Change of Coverage Form.

3. A copy of the most recent filed NUCS4072 and NUCS4073.

4. A joinder agreement where applicable.

downgrade Medical Benefits

New business During the initial plan year, a group may only change plans 6 months post sale (no changes are allowed within the 4-month period prior to the renewal date).Existing business Downgrades are allowed twice* in a 12-month rolling period, limited to the 8-month period following the renewal date. Example: A 1-1 renewal may request a plan change through 8-1.

On renewal – request must be submitted on or prior to the effective date of the renewal. Off renewal – request must be submitted 30 days prior to the requested effective date.

1. A Plan Sponsor Signature Page or a new Employer Application (complete pages 1 and 4 and indicate the requested effective date) or a letter from the group requesting the change.

2. Completed Employee Change of Coverage Form.

3. A joinder agreement where applicable.

Add life to Exisiting Medical plans (Refer to life underwriting guidelines)

Anytime On renewal – request must be submitted on or prior to the effective date of the renewal.Off renewal – request must be submitted two weeks prior to the requested effective date.

1. A new Employer Application (complete page 1, 2 and 4) is required for all life adds. Plan Sponsor Signature Page or a letter from the group requesting the change may be submitted in addition to the ER application.

2. New employee enrollment forms are required for all employees enrolling or declining life benefits (if the group is electing 100% contrib., 100% participation is required).

Add Another Class of Employee Coverage

Renewal date only Request must be submitted on or prior to the effective date of the renewal.

1. A letter from the group requesting the change or a new Employer Application.

2. New employee enrollment forms for all eligible part-time employees who are enrolling or declining the coverage (please provide a copy of the ID cards for those employees waiving coverage).

3. A copy of the most recent filed NUCS4072 and NUCS4073.

Name Change Anytime Anytime 1. A letter from the group requesting the change.

2. A completed name change form.3. A copy of the most recent filed

NUCS4072 and NUCS4073.

BWp Change May be requested anytime. Can only be requested once in a 12-month rolling period – NO EXCEPTIONS.

Request must be submitted prior to the requested effective date.

1. A letter from the group requesting the change or a new Employer Application.

downgrades(New hires must always submit an enrollment form, pages 1 – 4)

Anytime a change in coverage is “across platforms,” an Employee Change of Coverage Form is required.

If a group makes a plan change within the same platform where more than one plan is involved, the Employee Plan Change Template or a letter may be submitted by the employer on company letterhead. The letter must list each individual employee and what plan they are going to be enrolled in (regardless if the employee is moving plans).

If a group makes a plan change within the same platform where more than one plan is involved and more than one platform is involved, the Employee Plan Change Template or a letter must be submitted by the employer on company letterhead. This letter must list each individual employee, and what plan they are going to be enrolled in (regardless if the employee is moving plans). In addition, any employee moving platforms must complete the Employee Change of Coverage Form.

life Additions Require all employees to complete an enrollment or waiver form (if applicable).

upgrades** Require all employees moving to the upgraded plan to complete the Employee Change of Coverage Form.

CHANGES TO THE RENEWAL DATE ARE NOT ALLOWED*Renewal plan changes are counted towards the maximum number of allowable changes.**Buy ups are subject to Medical Underwriting and may receive a new RAF based on medical conditions reviewed.

NEvAdA plAN CHANGE rEQuirEMENtS

22

Frequently asked questions

How do I secure a quote for life coverage?If you are already participating in an Aetna Group Life product (sold on after January 2002), your plan options are included in your renewal. If you would like to add new life coverage, please contact your broker or the Aetna Sales Support Unit at 1-877-249-2472.

What are participation requirements?Your plan is contingent upon meeting participation guidelines as follows:n Employers with fewer than 4 employees:

Enrollment in an Aetna plan must be equal to 100 percent of total eligible employees excluding valid waivers, such as coverage through a spouse. Waiver forms are required.

n Employers with 4 – 50 employees: Enrollment in an Aetna plan must be equal to at least 75 percent of eligible employees excluding valid benefits waivers, such as coverage through a spouse. Waiver forms are required.

n Option sales alongside other carriers: Standard participation of 75 percent of all eligible employees must be met in order for a group to qualify for coverage.

How are renewal rates calculated?Renewal rates include census characteristics, trends in health care costs, coverage selected (single vs. family), location of employees, your group’s benefits and demographics.

The current medical and pharmacy trend is also an important component of your medical premium. Some of the most significant causes for increases include:n Advances in medical technology

and new drug developmentn An aging population

n Increased use of health services.n Escalating costs of treatment for

serious illnessn Employee contributions — shifting

medical expenses from the public to the private sector

Can I get a blended (that is, composite) rate?n Aetna changed our rating structure in

mid-2002 to tabular rating for groups with 2 – 9 employees. Tabular rates (rates for individual employees based on age, rating area and benefits tier) allow for more accurate premiums.

n Composite rates are available in Nevada for employers with 10 or more employees.

n If you have had a census increase or decrease of less than 20 percent from your prior year’s census, your rating calculation will not change. For example, if you were composite rated last year with 10 employees, and now you have 9 employees, you will still receive composite rating since your change in census is less than 20 percent. This policy serves to reduce the frequency of employees having to switch between tabular and composite rates from year to year.

Besides alternative plans presented as part of our proposal, are there additional options we may consider?If available, Aetna has included a number of lower-cost alternative plan designs for your consideration. Generally, the alternative plans listed in your proposal do not require underwriting approval and may represent potential savings versus your current plan design. There are, however, richer plan options from this portfolio that may not be included in your renewal, but would be available for quoting and may require underwriting approval.

n Nevada now offers Pick-A-Plan 3, which will allow an employer to offer any 3 of the 14 available plans. A change to a plan that is considered an upgrade will require medical underwriting approval. One person must enroll and remain enrolled in each plan for it to be active.

n Rates for medical are guaranteed for a 12-month period.

n If there is an employee on COBRA and the employer moves plans, the former employee has to move as well.

How much may our employees contribute to premiums?You may choose to have your employees pay a portion of the medical premium up to a maximum of 50 percent of the employee-only rate. For Life coverage, the employer must contribute 100 percent of the cost for groups with 2 – 9 lives and at least 50 percent of the cost for groups with 10 – 50 lives (excluding Optional Dependent Life).

For Pick-A-Plan 3, the employer must contribute 50 percent of the employee premium OR the employer may choose to offer a defined contribution of at least $120 or the actual cost of the plans picked, whichever is less.

How much may our employees’ dependents contribute to premiums?You may choose to have your employees pay all or part of the premium cost for their dependent coverage.

Are new ID cards issued at renewal time?If you are covered under a new plan, new ID cards will be issued. ID cards will be sent directly to the enrollee’s home address.

23

out-of-state employeesAetna will offer the in-state portfolio and rating structure to out-of-state employees who live in an out-of-state network area. Out-of-state employees who do not live in an out-of-state network area will be eligible for the in-state indemnity plans.

Renewing plan sponsor1. Renewing plan sponsors are eligible

for this solution upon their next renewal only.

2. Beginning with January 1, 2007, renewals, requests for in-state PPO offerings for out-of-state employees must be sent to Underwriting.

3. If a renewing plan sponsor has a current 2007 in-state PPO plan with out-of-state PPO employees and wants the in-state plan for new out-of-state employees, all other out-of-state PPO membership must also move to an in-state PPO plan. If the employee does not reside in an Aetna PPO network, he or she will be offered the in-state indemnity plan.

4. If renewing plan sponsors do not have a current 2007 in-state plan, they must switch to a currently marketed in-state plan in addition to offering their out-of-state employees the in-state plan.

Underwriting requirementsn Plan sponsors must have 51 percent

of their employees living within the headquartered state.

n HMO and CPOS are not available products for employees who live outside the headquartered state.

n The rating structure will follow the headquartered state rating methodology.

For HMo customers

Group Agreements

You will be receiving your updated Group Agreement/Group Policy under separate cover effective upon your renewal date. We have updated the form of the agreement/policy to improve clarity and readability.

Interest on late premiums

Interest is charged from the premium date due (first of the month) rather than the end of the grace period. Census adjustments: Billing adjustments for changes in enrollment data are subject to Aetna’s discretion and are not automatic.

Termination

This provision was revised to reflect various state and federal law requirements. In addition, we added this provision to encourage and simplify the process for groups to provide Aetna with their intent to terminate coverage.

Amendments

The Agreement provides Aetna with the ability to amend the Group Agreement/Group Policy after providing notice to the group. This change reflects several modifications to the standard Group Agreement/Group Policy. The applicable agreement/policy you receive after renewal may include language that differs from our standard agreement/policy due to state-specific regulations.

Special notices

24

Limitations and exclusions

n Non-medically necessary services or supplies

n Orthotics, except diabetic orthoticsn Outpatient prescription drugs (except for

treatment of diabetes), unless covered by a prescription plan rider and over-the-counter medications (except as provided in a hospital) and supplies

n Reversal of sterilizationn Services for the treatment of sexual

dysfunction or inadequacies, including therapy, supplies or counseling or prescription drugs

n Special-duty nursingn Therapy or rehabilitation, other than

those listed as covered

Aetna PPO and Indemnity

All medical or hospital services not specifically covered or that are limited or excluded in the plan documents.n Charges related to any eye surgery

mainly to correct refractive errorsn Cosmetic surgery, including breast

reductionn Custodial caren Dental care and X-raysn Donor egg retrievaln Experimental and investigational

proceduresn Hearing aidsn Immunizations for travel or workn Infertility services, including, but not

limited to, artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI and other related services, unless specifically listed as covered in the plan documents

n Non-medically necessary services of supplies

n Orthotics, as specified in the plann Over-the-counter medications and

suppliesn Reversal of sterilizationn Services for the treatment of sexual

dysfunction or inadequacies, including therapy, supplies counseling and prescription drugs

n Special-duty nursingn Weight control services including

surgical procedures, medical treatments, weight control/loss programs, dietary regimens and supplements, appetite suppressants and other medications; food or food supplements, exercise programs, exercise or other equipment; and other services and supplies that are primarily intended to control weight or treat obesity, including morbid obesity, or for the purpose of weight reduction, regardless of the existence of comorbid conditions

MedicalThese plans do not cover all health care expenses and include exclusions and limitations. Members should refer to their plan documents to determine which health care services are covered and to what extent. The following is a partial list of services and supplies that are generally not covered. However, the plan documents may contain exceptions to this list based on state mandates or the plan design purchased.

Aetna Value Network HMO and CPOS

All medical and hospital services not specifically covered or that are limited or excluded by the plan documents, including costs of services before coverage begins and after coverage terminates.n Cosmetic surgeryn Custodial caren Dental care and dental X-raysn Donor egg retrievaln Experimental and investigational

procedures (except for coverage for medically necessary routine patient care costs for members participating in a cancer clinical trial)

n Hearing aidsn Home birthsn Immunizations for travel or workn Implantable drugs and certain

injectable drugs, including injectable infertility drugs

n Infertility services, including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI and other related services, unless specifically listed as covered in the plan documents

25

Aetna PPO and Indemnity

Pre-existing conditions exclusion provisionThese plans impose a pre-existing conditions exclusion, which may be waived in some circumstances (that is, creditable coverage) and may not be applicable to you. A pre-existing conditions exclusion means that if you have a medical condition before coming to our plan, you might have to wait a certain period of time before the plan will provide coverage for that condition. This exclusion applies only to conditions for which medical advice, diagnosis or treatment was recommended or received, or for which the individual took prescribed drugs within 180 days.

Generally, this period ends the day before your coverage becomes effective. However, if you were in a waiting period for coverage, the 180-day period ends on the day before the waiting period begins. The exclusion period, if applicable, may last up to 365 days from your first day of coverage, or if you were in a waiting period, from the first day of your waiting period.

If you had prior creditable coverage within 63 days immediately before the date you enrolled under this plan, then the pre-existing conditions exclusion in your plan, if any, will be waived. If you had no prior creditable coverage within 63 days prior to your enrollment date (either because you had no prior coverage or because there was more than a 63-day gap from the date your prior coverage terminated to your enrollment date), we will apply your plan’s pre-existing conditions exclusion.

In order to reduce or possibly eliminate your exclusion period based on your creditable coverage, you should provide us a copy of any Certificates of Creditable Coverage you may have. Please contact your Aetna Member Services representative at 1-888-802-3862 for PPO and 1-888-702-3862 for CPOS if you need assistance in obtaining a Certificate of Creditable Coverage from your prior carrier or if you have any questions on the information noted above.

The pre-existing conditions exclusion does not apply to pregnancy nor to a child under age 18, who is enrolled in the plan within 31 days after birth, adoption or placement for adoption.

Note: For late enrollees, coverage will be delayed until the plan’s next open enrollment; the pre-existing exclusion will be applied from the individual’s effective date of coverage.

Ad&d ultraThis coverage is only for losses caused by accidents. No benefits are payable for a loss caused or contributed to or by:n A bodily or mental infirmityn A disease, ptomaine or bacterial

infection*n Medical or surgical treatment*n Suicide or attempted suicide (while

sane or insane)n An intentionally self-inflicted injuryn A war or any act of war (declared or

not declared)n Voluntary inhalation of poisonous

gasesn Commission of or attempt to commit

a criminal actn Use of alcohol, intoxicants or drugs,

except as prescribed by a physician. An accident in which the blood alcohol level of the operator of the motor vehicle meets or exceeds the level at which intoxication would be presumed under the law of the state where the accident occurred shall be deemed to be caused by the use of alcohol.

n Intended or accidental contact with nuclear or atomic energy by explosion and/or release

n Air or space travel. This does not apply if a person is a passenger, with no duties at all, on an aircraft being used only to carry passengers (with or without cargo).

* These do not apply if the loss is caused by an infection that results directly from the injury or surgery needed because of the injury. The injury must not be one that is excluded by the terms of the contract.

26

©2010 Aetna Inc.14.02.130.1-NV E (08/11)

This material is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only a partial, general description of plan benefits or programs and does not constitute a contract. Aetna does not provide health care or dental services and, therefore, cannot guarantee any results or outcomes. Consult the plan documents (Schedule of Benefits, Evidence of Coverage, Group Agreement, Group Insurance Certificate, Booklet, Bookletcertificate, Group policy) to determine governing contractual provisions, including procedures, exclusions and limitations relating to the plan. The availability of a plan or program may vary by geographic service area. Participating providers and vendors are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. Notice of the change shall be provided in accordance with applicable state law. Certain primary care providers are affiliated with integrated delivery systems or other provider groups (such as independent practice associations and physician-hospital organizations), and members who select these providers will generally be referred to specialists and hospitals within those systems or groups. However, if a system or group does not include a provider qualified to meet a member’s medical needs, the member may request to have services provided by non-system or non-group providers. The member’s request will be reviewed and will require prior authorization from the system or group and/or Aetna to be a covered service. Aetna assumes no responsibility for any circumstances arising out of the use, misuse, interpretation or application of any information supplied by Aetna InteliHealth®. Information supplied by InteliHealth is for informational purposes only, is not medical advice and is not intended to be a substitute for proper medical care provided by a physician. Informed Health® Line nurses cannot diagnose, prescribe, or give medical advice. Specific questions should be addressed to your doctor. Alternative health care programs, Aetna VisionSM and Aetna FitnessSM discount programs are rate-access programs and may be in addition to any plan benefits. Program providers are solely responsible for the products and services provided thereunder. Aetna does not endorse any vendor, product or service associated with these programs. Discounts offered hereunder are not insurance.

Some benefits are subject to limitations or visit maximums. Members and providers may be required to precertify, or obtain prior approval of coverage, for certain services such as non-emergency inpatient hospital care. Depending upon the plan selected, new prescription drugs not yet reviewed by our medication review committee are either available at the highest copay under the plans with an open formulary, or excluded from coverage unless a medical exception is obtained under plans that use a closed formulary. They may also be subject to precertification or step-therapy. Non-prescription drugs and drugs in the Limitations and Exclusions section of the plan documents (received upon enrollment) are not covered, and medical exceptions are not available for them.

Easy steps to renew your coverage - Aetna...Aetna Navigator, which features online resources and information to help your employees make ... Nevada Small Group Sales Manager Aetna

Documents