14.02.310.1-TX C (10/11)
Your Aetna plan features,
and how to sign up
SMALL GROUP ENROLLMENT GUIDE
Texas
Learn about:
> Member Tools
> How to Enroll
> Value-Added Programs
2
Welcome to Aetna!
Health/Dental benefits, health/dental insurance and life insurance plans/policies are offered and/or underwritten by Aetna Health Inc. and/or Aetna
Life Insurance Company (Aetna). Each insurer has sole financial responsibility for its own products.
At Aetna, we know that the true worth
of any health benefits and insurance plan
is how it works for you and your family.
Aetna also recognizes all families are
different, each with their own unique
needs. Some families need a plan with
lower out-of-pocket costs when they see
their doctor, some need lower monthly
premiums, and some need the option to
seek out-of-network care. With Aetna,
each family can pick the plan that best
suits their individual needs. The choice is
yours!
Plus, each health plan from Aetna offers
a number of valuable member tools and
resources to help you and your family
make more informed decisions about
your health and well-being. Whether it’s
finding a doctor online, checking the
status of a pending claim, or finding the
lowest-cost prescription for you and your
family, Aetna provides you with the tools
you need to manage your care.
Table of Contents
Aetna Navigator
®
3
Personal Health Record 4
Aetna’s health care transparency tools 6
Employee Assistance Program (EAP) 6
RelayHealth
®
7
Informed Health
®
Line 8
Walk-in clinics 8
Urgent care 8
Special programs for the special needs of women 9
Aetna Fitness
SM
discount program 10
Aetna Weight Management
SM
discount program 11
Aetna Hearing
SM
discount program 12
Aetna Vision
SM
discount program 13
Aetna Natural Products and Services
SM
discount program 14
Preventive care 16
Medical products 18
Dental products 20
Aetna’s Group Life Insurance for employees 21
Getting to know your Aetna prescription drug plan 22
How will I find a doctor or specialist? 24
How to complete the enrollment form application 25
Your member ID card 26
3
Our secure website lets you:
■
View information about who is covered
on your plan
■
Find doctors, pharmacies or hospitals
on our DocFind
®
online provider
directory
■
Check the status of a claim or review
an Explanation of Benefits (EOB)
■
Contact Member Services with benefits
questions (also available in Spanish)
Use Aetna Navigator’s online tools to
manage your benefits and help you make
more informed health decisions:
■
Hospital Comparison Tool — helps
you decide where to receive care for
specific procedures, conditions and
diagnoses. You can compare hospitals
based on four factors you consider
important:
1. Number of patients treated per year
2. Complication rates
3. Mortality rates
4. Length of stay
Aetna Navigator
®
— our
secure member website
When you need up-to-date information
about your health insurance plan or want
information about a particular health
condition, here’s where you’ll find it!
Aetna members can turn to Aetna
Navigator, our secure member website,
that provides you with a single source for
online health and benefits information.
It’s convenient, and easy to use:
1. Go to www.aetna.com.
2. Click on Member Log In.
3. Register as a new user, or log in using
your secure user name and password.
4. Find a wealth of credible health
care information and self-service
functions — available to you anytime
of the day or night — from wherever
you have Internet access.
■
Price-A-Drug
SM
tool* — helps you
estimate the cost of prescriptions
before you buy
■
Estimate the Cost of Care tool —
provides average in- and out-of-
network costs for certain procedures
based on a geographic area
■
Pharmacy benefits summary —
allows you to locate retail pharmacies;
order prescriptions through Aetna’s
mail-order pharmacy, Aetna Rx Home
Delivery
®
; search and learn about
medications; and review the
medications available on Aetna’s
formulary
*If Included in your plan.
And, if you’re interested in learning more
about a particular health condition,
Aetna Navigator provides credible health
information resources.
■
Simple Steps To A Healthier Life
®
is an interactive online health and
wellness program that can help
employers enhance the health and
productivity of their employees and
support a more complete system
of care.
The program can help employers:
> Promote health risk reduction
> Keep healthy people healthy
> Build employee responsibility for
making informed health decisions
> Support business goals to help
improve employee health status and
productivity
> Gain valuable insight to help make
strategic decisions for offering
employee benefits
> Integrate with Aetna services and
other health outreach programs
Simple Steps To A Healthier Life helps
participants turn knowledge about their
health into action for making positive
health changes with:
> Online Health Assessment
> Tailored Health Reports
> Personalized Action Plan and online
wellness programs
> Easy-to-find health information,
resources and tools
Personal Health Record
Put your Personal Health Record
to work and make history!
Members with Aetna medical coverage
can now use Aetna’s Personal Health
Record.*
Your Personal Health Record is a secure
online tool that makes it easy to:
■
Keep your health information in a
single, safe place
■
Track doctor visits, prescriptions and
more, for you and your family
■
Give your doctor a more complete
health history
■
Receive timely, personalized health
alerts and preventive care reminders
Much of your health information
is ready for you to see now
Information from your Aetna health
claims automatically appear in your
Personal Health Record. And, you can
easily add more information. List your
allergies, your family history and more.
It’s up to you. The more you enter, the
better picture you and your doctors will
get of your overall health.
■
Aetna SmartSource
SM
delivers relevant
health information that’s specific to
each member, based on where they
live, their Aetna health plan, and other
information. Aetna SmartSource scans
Aetna’s vast resources to bring
members, in a single search:
> Specialists in their local area
> Related medications, treatment
options and estimated health costs
> Aetna programs that may help them
manage their condition
> Easy-to-understand health articles
and tips
■
Aetna InteliHealth
®
website, our
interactive consumer website for
credible health, dental and wellness
information provided by Harvard
Medical School
■
Healthwise
®
Knowledgebase, a
user-friendly online information tool
that lets you research your own issues
and preferences for health information
> Features interactive and streaming
videos about topics such as asthma
and heart health
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* The Aetna Personal Health Record should not be used as the sole source of information about the
member’s health history.
Use it to talk to your doctors
with ease
The Personal Health Record can help you
team up with your doctors. You can
share your Personal Health Record online
with individual doctors by making it
available through a secure website many
doctors already use. You also can print
your Health Summary to share at office
visits or to help you fill out medical forms
when you see a new doctor.
Stay safe and healthy with
alerts and reminders
Your Personal Health Record helps you
get the care you need. If you’re due for a
checkup or other important screening,
you might see a reminder when you log
in. You may also receive a message if
there’s an alternative treatment that may
improve your care. And, if you give Aetna
permission, you can get e-mails telling
you that a new alert or reminder is in
your secure Personal Health Record.
Portability ensures your
personal health records go
where you go
Aetna’s relationship with Microsoft
provides our members portability of their
personal health information. You can
transfer a copy of your Aetna Personal
Health Record from Aetna Navigator
directly to Microsoft HealthVault at
www.healthvault.com/personal. Your
information will be stored on this secure,
web-based consumer health platform
and remains available if you change jobs
or health plans.
You can also print and save a PDF copy of
your health record for your own files
through the same Navigator location.
Print your personalized
Emergency Card
You can print an Emergency Information
Card that pulls information from several
sections of your Personal Health Record.
It provides first responders with your
emergency contact’s name and phone
number, your insurance details, any
medications you are taking, allergies if
you have any, and information about
whether you have a living will or have
designated your organs for donation. All
this detail in a printout that folds and fits
in your wallet.
Be sure the information in these sections
is accurate and up-to-date, and start
using your Aetna Personal Health Record
today!
It’s easy to get started.
Visit your Personal Health
Record today or use our
Walk Me Through guide to
explore how this resource
works on your own.
Visit www.aetna.com/
showcase/phr/ for
answers to the most
common questions from
our members.
5
To access our health care transparency
tools, log in to Aetna Navigator. Click
on Cost of Care from the home page.
There, you can use the easy online
instructions to:
■
Check rates for doctors and specialists
for common treatments and procedures
■
Compare hospital costs side by side
■
Get personalized cost estimates to find
out what you’ll pay before you go
Employee Assistance
Program (EAP)***
Aetna’s Employee Assistance Program
is a confidential program that gives
employees and members of their
household access to useful services
and support to help them manage the
everyday challenges of work and home.
The EAP is available at no charge to
members and their family members
and includes:
■
Choice — They’ll find a range of
resources to help them balance their
personal and professional lives.
■
Easy access — EAP representatives
can be reached anytime toll free at
1-866-672-5417 or on the web at
www.aetnaeap.com.
Aetna’s health care
transparency tools
Since 2005, Aetna has empowered
members with our suite of member tools
that inform you about doctors, hospitals
and other medical facilities. You can
make more informed health care
decisions by using our online
transparency tools before visiting a
doctor or hospital.*
Our transparency tools allow you to:
■
View and compare rates for
participating doctors
■
Look up costs for medical procedures
at facilities in select locations around
the country and quickly identify medical
specialists who are high performers
in their field based on clinical quality
and efficiency**
■
Use at your convenience since the
information is available 24/7 through
Aetna Navigator, our secure member
website, and DocFind, our online
directory of doctors and facilities
Your access as a member to this
combination of physician-specific rates,
clinical quality and efficiency data, and
facility-specific medical procedure costs is
a first from a national health carrier and
demonstrates our commitment to you.
■
Professional assistance — Our
workplace-trained specialists provide
confidential phone support, assessing
needs and recommending an
appropriate course of action. Employees
and their household members receive
three phone consultations per member
in a calendar year.
Employers can also take advantage of
EAP Resources:
■
Management and human resources
assistance — Employers get unlimited
phone consultations with workplace-
trained clinicians who can provide help
in dealing with complex employee
issues that may arise.
■
Online tools — Employers can also get
online tools and materials to encourage
employees to use the EAP by visiting
www.aetnaeap.com (enter your
company ID and select the
“Promotional Materials” link).
* Always consult your doctor about your health care decisions. Members cannot view rates for dentists, vision providers or certain types of health care
professionals with these tools.
** Clinical quality and efficiency information is based on Aexcel
®
designation for specialists in 12 specialty categories. You can learn more about our Aexcel
designation in our Understanding Aexcel brochure available under the Learn More section of DocFind. We regularly upgrade our tools to provide the latest cost
and clinical quality and efficiency information about Aetna network providers. Aexcel is not available with HMO plans.
***EAP is administered by Aetna Behavioral Health, LLC and Aetna Life Insurance Company.
6
webVisit through RelayHealth links you with
your doctor, Aetna health plan and pharmacy
in a single secure network.
* Employees need to do nothing as this service will be automatically added to their coverage. This feature
does not apply to any HMO plan a prospective member may choose. Plan sponsors offering traditional
plans can customize the copay required for an online visit (webVisit). This service includes plans that
have health funds when the fund limit is exhausted. Physicians will be paid for services provided
according to the terms of their contract.
As always, a member’s financial responsibility depends on the terms of his or her plan, which may vary.
Check your service area for availability.
RelayHealth
®
Visit your doctor online with
webVisit
®
Aetna’s latest innovative health care benefit
in collaboration with RelayHealth* offers
members “webVisits.” Now you can
communicate effectively and securely online
with your doctor to seek non-urgent medical
care. You pay any required copays or
deductibles through the system as if you had
made an office visit.
webVisit is easy to use:
1. Enter the RelayHealth website for
non-urgent medical care.
2. Complete a questionnaire.
3. Submit it directly and confidentially to
your doctor.
4. Once your doctor reviews your
questionnaire, you will get a diagnosis,
instructions and information — just like at
an actual visit.
Simply register on the RelayHealth website
at https://www.relayhealth.com/
Patients/Registration.aspx to get
started.
Once registered, log in at your convenience
to take advantage of the many features
available to registered members, in addition
to the webVisit service:
■
Consult with your doctor
■
Make and/or cancel appointments
■
Obtain referrals
■
Request lab and test results
■
Order prescription refills
■
Send a note to your doctor’s office
What’s the difference between the online RelayHealth site and
e-mailing my doctor?
e-mail webVisit
■
May not be secure or HIPAA (Health
Insurance Portability and Accountability
Act)-compliant.
■
Free form — you may not know the
medical questions to address so your
doctor can diagnose your ailment.
■
Non-chargeable — eligibility needs to be
determined, and you must submit a
claim.
■
HIPAA-compliant — secure and
authenticated with user log-in.
■
Clinically structured questionnaire
focuses on your symptoms to help your
doctor determine an accurate diagnosis.
■
Reimbursable — checks eligibility
in real time, collects copayment and
submits claim automatically.
A few things to note before you get
started:
■
You must have an established
relationship with a doctor before
webVisit can be used.
■
Your doctor must be a member of
Aetna’s network and be registered as a
participating provider in the RelayHealth
physician network — participating
providers are identified on DocFind
through Aetna Navigator, our secure
member website.
7
A convenient solution for care on the go
Walk-in clinics
Looking for a convenient way to get
medical care? Consider a walk-in clinic.
It’s a convenient alternative to the
doctor’s office. If you aren’t feeling well
and have trouble getting an appointment
with your doctor, it’s your answer to
non-emergency care right away.
And walk-in clinics are not just for when
you are sick. You might be surprised by
the full spectrum of services available at a
walk-in clinic, many of which are staffed
by physician assistants and nurse
practitioners. They offer:
■
Treatment for minor burns, stings or
bites, strains, and cuts
■
Care for earaches, flu and cold
symptoms, sinus infections, and
allergies
■
Physicals and pediatric and gynecologic
services
■
Flu shots and other vaccinations
■
X-ray and lab services
Informed Health
®
Line
Access to a registered nurse —
24/7!
With Aetna’s Informed Health Line, you
can talk to a registered nurse anytime,
day or night. Just call our 24-hour
toll-free number (available upon
enrollment). While only your doctor can
diagnose, prescribe or give medical
advice, the Informed Health Line nurses
can provide information on thousands of
health topics. They can also tell you how
to ask the right questions and describe
health symptoms more effectively during
your next visit to your doctor. Remember,
always contact your doctor first with any
questions or concerns regarding your
health care needs.
Urgent care
For care that is not minor, such as
fractures, sprains or other urgent injuries,
we contract with urgent care centers to
offer you an economical alternative to
visiting an emergency room. Urgent care
sites are staffed with physicians to handle
urgent medical needs, whereas walk-in
clinics are staffed by nurse practitioners
to care for minor ailments. And just like
walk-in clinics, some urgent care centers
offer evening and weekend hours with
no appointments needed.
Check your Plan Design and Benefits
Summary to get more information about
coverage and costs to visit a walk-in clinic
or urgent care center.* To find the closest
clinic or care center near you, simply log
in to Aetna Navigator, select DocFind and
follow the easy online instructions.
*Texas HMO members must contact their medical group or primary care physician for walk-in clinic and urgent care center use.
8
For ob/gyn care, no referrals
needed
For an annual well-woman exam,
unlimited visits for gynecological
problems and routine maternity care,
women may schedule an appointment
with participating obstetrical,
gynecological or women’s health care
professionals without a referral.
Beginning Right
®
maternity
program
Aetna’s Beginning Right maternity
program offers information and services
to expectant mothers, including care
coordination by obstetrical nurses
experienced in preterm labor education,
breastfeeding support and more. We
want to make sure expectant mothers
have the information needed to make
informed decisions about health care
while pregnant or planning a pregnancy.
Members enrolled in both our medical
and dental plans, along with our
Beginning Right maternity program, may
also receive enhanced dental benefits
(additional cleaning or treatment of
periodontal (gum) disease, fully covered
with no deductible) during pregnancy.
Special programs for the
special needs of women
Ongoing health management
Work, family, friends. Too much to do,
too little time to do it. That’s today’s
woman. Add health needs that change
over time, and you’ll know why we offer
services and information to help you
manage your health.
Prevention programs for women
Our preventive programs can help
women benefit from:
■
Preventive screening reminders for
breast and cervical cancer
■
Culturally focused initiatives to help
reduce health disparities among women
of diverse ethnic backgrounds
Women’s health online
Go to http://womenshealth.aetna.com
for information on women’s health issues
— from heart health, breast cancer and
pregnancy to baby care and other topics
important to women, as well as:
■
An interactive body mass index tool
■
A pregnancy guide
■
Food pyramid recommendations
■
Information on diet and nutrition
Special maternity care
From the start of pregnancy to birth,
our maternity management program
offers expectant mothers services
and educational materials to help
give their newborns a healthy start.
Moms-to-be receive:
■
Educational materials, available in
English or Spanish, that cover:
> Prenatal care
> Labor and delivery
> Newborn and baby care
> Breastfeeding
> Postpartum depression
■
A pregnancy risk survey and nurse care
coordination for high-risk pregnancies
■
A program to help you stop smoking
9
10
How to save on a gym
membership
You can choose and save at over 10,000
gyms* (and growing) in the GlobalFit
®
network. So it’s easy to find one near
work or home.
Three easy steps:
Step 1: Visit www.globalfit.com/
fitness to find a gym.
Step 2: Pick a gym, and follow the steps
to sign up online.
Step 3: Print your confirmation and
you’re set to go!
You can also call 1-800-298-7800 to
sign up.
Keep in mind that this offer is for new
gym members only. If you belong to a
gym now, or belonged recently, you may
not be able to get discounts at that gym.
More reasons to join a gym
through GlobalFit
You can:
■
Choose from flexible membership
options
■
Get easy billing through your
bank account or major credit card
Aetna Fitness
SM
discount
program
There are a million reasons to
get fit
To name a few — you’ll look and feel
better. When you have a healthy weight,
you can also lower your risks for heart
disease, high blood pressure, diabetes …
even depression.
And with the Aetna Fitness discount
program, you can save, too. Just for
taking good care of yourself.
What you get with the program
You can:
■
Save on gym memberships
■
Save on treadmills, ellipticals and more
■
Try an at-home weight-loss program
■
Get health coaching to stop smoking,
lower stress and more
Try a gym for free
You can get a free guest pass at most
gyms. It’s a great way to check out the
gym culture, services and equipment
before you sign up. To get yours, visit
www.globalfit.com/fitness.
■
Visit a participating gym when you
travel**
■
Transfer your membership to another
participating gym or another person**
■
Freeze your membership for up to two
months per calendar year**
■
Plus — your family members on your
health plan can use the program, too!
Save on home exercise
equipment, too
Rather get fit in your own home?
You can do that, too.
You’ll get discounts on:
■
Elliptical trainers
■
Treadmills
■
Resistance bands, mats, yoga
accessories
■
And more
More support for your
healthy lifestyle
Getting fit is just the start to a
healthier you.
You can also:
■
Try out an at-home weight-loss
program
■
Get one-on-one health coaching***
to help you quit smoking, lower stress,
lose weight and more
* GlobalFit website, www.globalfit.com/fitness, 4/11.
**Not available for month-to-month memberships.
***By WellCall, Inc., through GlobalFit.
Discount programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services.
11
■
Save 15 percent on all purchases from
the eDiets Online Store. Choose from
DVDs, CDs, fitness and exercise
equipment, vitamins and supplements,
and more. You must enter the Aetna-
specific promotion code (available on
Aetna Navigator or through Member
Services) on the eDiets billing page to
receive the discount.
What else you get:
■
One-on-one professional support
■
Customized menus, recipes and
convenient food options
■
Phone, chat and e-mail support from
registered dieticians
■
Diet tools such as eDiets Nutrition
Tracker, Food Journal, Dining-Out Guide
and more
■
24/7 online member support
Save on Jenny Craig
Save on a sensible weight-loss program
that can help you lose the weight and
keep it off.
Program options:
■
Start with a FREE 30-day Trial
Program.*
■
Then receive 25 percent off a Jenny
Craig Premium Program* available at
participating Jenny Craig centres and
through Jenny Craig At Home.
Aetna Weight
Management
SM
discount program
Lose weight and feel great! It’s easier
with the Aetna Weight Management
discount program.
You can save on some of today’s most
popular weight-loss programs and meal
plans from eDiets
®
, Jenny Craig
®
and
Nutrisystem
®
.
Save on eDiets
You can choose an Online Diet Plan, or a
Meal Delivery Plan with food shipped
right to your door.
Program options:
■
Enroll in an online monthly plan and
save 30 percent on membership dues.
■
Once you enroll in a monthly plan, you
can upgrade to an online annual plan
and save 20 percent on the already
discounted annual plan price.
■
Enroll in the Meal Delivery Plan (5-day
or 7-day) and save 15 percent off the
cost of food, delivered right to your
door.
■
When you enroll in an online plan, you
can choose from over 20 online diet
plans. With the Meal Delivery Plan,
delicious, healthy, portion-controlled
food is shipped to you each week.
What else you get:
■
Weekly one-on-one scheduled
consultations
■
Personalized menus
■
Plans to help you get active and stay
motivated
■
Online support and free Jenny eTools
■
24/7 customer care support, message
boards and live chat
Save on Nutrisystem
Control your calories and curb your
hunger. You can choose from over 150
menu items that are single serve and easy
to make.
Program options:
■
Save 12 percent on any 28-day
Nutrisystem weight-loss meal plan.**
■
PLUS get other offers available from
Nutrisystem at the time you enroll.
■
Get even bigger discounts with
Auto-Delivery.***
What else you get:
■
Tasty food delivered right to your door
■
Easy-to-follow meal plans
■
Unlimited counseling by phone or web
with trained weight-loss counselors and
dieticians
■
FREE online membership
*Food and, if applicable, shipping not included. Offer applies to initial membership fee only and is valid at participating centres in the U.S., Canada and Puerto
Rico and through Jenny Craig At Home. Each offer is a separate offer and can be used only once per person. Restrictions apply.
**Applies to these plans: Basic, Silver, Diabetic, Vegetarian or Nutrisystem
®
Select
™
. The Aetna discount offer does not apply to any program in which you are
already enrolled. To receive the discounted rate, you must wait until your current program ends. If you are enrolled in Auto-Delivery, you must cancel it and
then re-enroll to receive the discounted rate.
***Offer good on new 28-day Auto-Delivery programs only. With Auto-Delivery, you receive a 10 percent discount off Nutrisystem’s regular 28-day program price
and free shipping to continental U.S. only.
Aetna Hearing
SM
discount
program
The Aetna Hearing discount program
helps you and your family save on hearing
exams, hearing aids and other hearing
services. You can choose between two
great offers at no additional premium
cost:
■
Hearing Care Solutions
■
HearPO
®
Advantages of Hearing Care
Solutions
■
Discounted rate of $42 for hearing
exams
■
Hundreds of hearing aid models to
choose from at fixed-rate pricing
– savings represent up to 63 percent
off standard retail
■
2-year supply of batteries (up to
96 cells) then a discount mail-order
program
■
In-office service at no charge one year
after purchase
■
Routine services (cleanings, instrument
checks and battery door replacements)
at no charge for the life of the
instrument
How Hearing Care Solutions
works
To schedule an appointment, call
Hearing Care Solutions directly at
1-866-344-7756. Hearing Care Solutions
will schedule an appointment for you.
You will also receive an informative
welcome packet that includes
information on hearing loss, what
to expect at your first appointment
and complete information on hearing
instruments offered.
Hearing Care Solutions offers 2,000
providers in over 1,300 locations. To
check the participating locations in
your area, go to www.aetna.com and
search DocFind, our online provider
directory. Or, log in to Aetna Navigator,
our secure member website, and click on
Find a Doctor, Facility or Pharmacy then
“hearing.”
Advantages of HearPO
■
Discounted rate of $48 for hearing
exams (40 percent off the national
retail cost)
■
Savings on many styles from
complete-canal to behind-the-ear
hearing aids
■
Cost break on the newest hearing aid
technologies, including programmable
and digital instruments from leading
manufacturers
■
Discounts on hearing aid repairs
■
Free follow-up services for one year
■
Free batteries (up to 160 cells per
hearing aid)
How HearPO works
HearPO includes access to over 1,600
participating locations. To find one near
you, call HearPO customer service at
1-888-HEARING (1-888-432-7464)
or visit http://hearpo.com/
hearpoproviderlocations.asp.
To make an appointment, call HearPO to
be sure you access the discounted rates
for services and devices.
■
HearPO will then send you a validation
packet.
■
When you receive the validation packet,
make an appointment with the selected
provider.
Receive the discounts at the point of
purchase. Also Call HearPO to learn
about their low-price guarantee.
12
* EyeMed Services and Compensation Schedule, 3/09. Prices are subject to change. Discounts may not be available on certain brand-name vision materials (that is,
designer eyeglass frames) in which the manufacturer imposes a no-discount practice.
Aetna Vision
SM
discount
program
See better for less
This program helps you save on what you
need to see better, like eye exams,
glasses, contacts … even LASIK. You also
pay less for vision items that don’t need a
prescription. So pick up some shades for
the summer or stock up on contact lens
cleaner. There are plenty more savings
where those came from!
Program locations
Choose from thousands of national chains
such as:
■
Pearle Vision
®
Centers
■
Sears
®
Optical
■
LensCrafters
®
■
Target
®
Optical
■
JCPenney
®
Optical
Plus, you can go to many eye doctors in
private practice. To find one near you,
go to www.aetna.com or call
1-800-793-8616.
What you save*
Product or Service What You Pay
Eye exams (For plans that cover eye exams) See your plan documents for details.
Eye exams (For plans that DO NOT cover eye
exams)
Complete eye exam $42
Standard contact lens fit and follow-up $40 (plus $42 exam fee)
Specialty contact lens fit and follow-up
(for example, toric, bifocal, gas permeable)
$10 off retail (plus $42 exam fee)
Lenses (per pair, uncoated plastic)
Single vision $40
Bifocal $60
Trifocal $80
Standard progressive (no-line bifocal) $120
Eyeglass frames 40% off retail price
Lens options, per pair (add to lens price
above)
Standard polycarbonate (includes
ultraviolet and scratch-resistant coating)
$40
Scratch-resistant coating $15
Ultraviolet (UV) coating $15
Solid or gradient tint $15
Standard antireflective coating $45
Glass 20% off retail price
Photochromic glass 20% off retail price
Contact lenses 15% off retail price (5% for disposables)
Contact lens replacement by mail Call 1-800-391-5367 to order a new pair.
More vision items 20% off retail price
LASIK eye surgery 15% off retail prices (5% off special
advertised prices) for U.S. Laser Network
services. You must call 1-800-422-6600
to schedule an appointment.
13
Aetna Natural Products
and Services
SM
discount
program
Save on a natural path to good
health
You get the Aetna Natural Products and
Services discount program to help. You
can save on massage therapy, natural
products, online provider consultations
and more.
You get the program at no
extra cost
It’s built right into your Aetna benefits
and insurance plan. And it helps you save
on services health plans normally don’t
cover. Once you’re an Aetna member,
just log in to Aetna Navigator, our secure
member website, at www.aetna.com
to start saving.
Save on natural therapy services
Get at least 25 percent off the normal
fee for these services though the
ChooseHealthy
®
program:*
■
Massage therapy, to release tension
and improve circulation
■
Acupuncture, to heal areas of pain or
stress with the use of needles
■
Chiropractic care, to ease neck and
back pain by adjusting the spine
■
Dietetic counseling, for advice from
registered dieticians on the foods you
should eat
How to start
Find a program provider at
www.aetna.com. Then take your Aetna
ID card to your appointment for savings
on the spot.
Save on over 2,400 health and
wellness products
You get at least 15 percent off the retail
price through the ChooseHealthy
program. Free standard shipping, too.
Get discounts on:
■
Over-the-counter vitamins
■
Herbal and nutritional supplements
■
Aromatherapy products
■
Homeopathic remedies
■
Natural body care products
■
Yoga equipment and more
How to start
You can order by phone or the web.
Visit Aetna Navigator, our secure member
website, at www.aetna.com for details.
* The ChooseHealthy program is made available through American Specialty Health Networks, Inc. (ASH Networks) and Healthyroads, Inc., subsidiaries of American
Specialty Health Incorporated (ASH). ChooseHealthy is a federally registered trademark of ASH and used with permission herein.
14
Relax, recharge and save.
Log in to www.aetna.com to start.
Get medical consultations
online — and save
You’ll get access to a network of medical
doctors — the Vital Health Network.
These doctors can help you enhance your
body’s ability to prevent disease by using
its natural powers.
You get:
■
Advice on natural remedies for joint
pain, allergies, headaches and many
other conditions
■
Secure messaging with a Vital Health
Network doctor on the topic you chose
■
30 percent off the retail price of
1 online consultation
■
50 percent off the retail price of
2 or more online consultations
How to start
Log in to Aetna Navigator, our secure
member website, at www.aetna.com.
To start your consultation, just choose a
condition and answer a few questions.
After you connect with the doctor online,
you’ll get a customized treatment plan
for healthy living. Just visit Aetna
Navigator to view your plan.
No paperwork, no waiting
The Aetna Natural Products and Services
discount program is easy to use. You can
start saving as soon as you’re an
Aetna member!
More advantages:
■
No referrals
■
No claim forms to mail in
■
No limits on how many times you
can save
If your plan covers any of these services,
figure out your plan costs before using
these discounts. You could pay less
that way.
15
Relax, recharge and save.
Log in to www.aetna.com to start.
Member health education
reminders
To help prevent, detect and monitor
problems early on, we mail women age
40 and over reminders encouraging them
to schedule an annual mammogram. We
also send important health information,
a chart of recommended preventive care
guidelines and a tear-off wallet card to
schedule and track this important
information.
Preventive care
Good health begins with prevention.
So we’ve developed an array of wellness
programs and services to help you and
your family stay healthy through all the
stages of your life.
16
Aetna Health Connections
SM
disease management
This program features Aetna nurses and
programs, including MedQuery
®
, and is
an important part of our new Aetna
Health Connections health and wellness
portfolio. Our newly redesigned
capabilities support 35 conditions and
integrate care for members with multiple
conditions. The program includes
cutting-edge technology to help improve
patient safety, doctor communication
and more.
This integrated, holistic approach using
capabilities unique to Aetna delivers
premier medical management for our
members that no one in the industry
can match. It includes innovative and
individualized clinical programs,
information and support for totally
integrated health management that
optimizes our members’ state of health.
Members are viewed holistically —
considering multiple diseases or
conditions across all benefits plans — to
deliver customized programs based on
their individual needs and preferences.
Prevention programs — helping you and your
family stay healthy
* Not scored by Clinical Stratification and Identification (CSID) process.
**Addressed as a comorbid condition.
17
Aetna Health Connections disease management program conditions
and content
Vascular
■
Heart failure
■
Diabetes —
adult and pediatric
■
Coronary artery disease
(CAD)
■
Peripheral artery disease
(PAD)
■
Hypertension —
adult and pediatric
(high blood pressure)
■
Cerebrovascular
disease/stroke (CVA)
■
Hyperlipidemia
(high cholesterol)
Pulmonary
■
Asthma —
adult and pediatric
■
Chronic obstructive
pulmonary disease (COPD)
Orthopedic/
Rheumatologic
■
Osteoporosis
■
Osteoarthritis (OA)*
■
Rheumatoid arthritis (RA)
■
Chronic lower back pain
Gastrointestinal
■
Gastro esophageal reflux
disease (GERD)
■
Peptic ulcer disease
■
I nflammatory bowel
disease (IBD)
(Crohn’s disease)
■
Chronic hepatitis
Neuro-Geriatric
■
Geriatrics
■
Migraines
■
Seizures
■
Parkinsonism
Cancer
■
General cancer
■
Breast cancer
■
Lung cancer
■
Lymphoma/Leukemia
■
Prostate cancer
■
Colorectal cancer
Renal
■
Chronic kidney disease
■
End-stage renal failure
Other
■
Weight management —
adult and pediatric
■
Cystic fibrosis —
adult and pediatric
■
HIV
■
Hypercoagulable state
■
Sickle cell disease —
adult and pediatric
■
Depression**
Aetna’s provider network in Texas has
more than 90,015 physicians and 1,022
hospitals.* So whichever plan you
choose, you will be able to find the
provider to best suit your needs.
■
Health Network/HMO Network =
22,124 doctors
and 247 hospitals
■
Managed Choice
®
Network =
32,658 doctors and 360 hospitals
■
PPO Network = 35,233 doctors
and 415 hospitals
Choose the right health plan
for you and your family in three
easy steps:
1. How much are you spending?
Evaluate your pay stubs, receipts and
canceled checks for all your medical
spending and add the total amount to
the total cost of your premium,
copayments, deductibles and
coinsurance. Think about your needs for
next year. Here are some common
scenarios:
■
Are you or your dependents scheduled
for any surgical procedures?
■
Will you be seeing a specialist for a
recently diagnosed condition?
■
Are you or your spouse pregnant or
planning a pregnancy?
* According to the Aetna Enterprise Provider Database as of January 2011. Network subject to change.
How do I pick the right health insurance plan?
Plan features
Health Network Only
(HMO Open Access)
Health Network Option
(POS Open Access)/
Managed Choice POS
(Open Access)
Coverage for preventive care • •
No PCP requirement • •
No referrals • •
Out-of-network access •
No claim forms • •
Use DocFind to search for a provider or
select a primary care physician (PCP).
www.aetna.com/docfind
Call the Member Services number on the back
of your ID card to order a provider directory.
Medical products
18
2. What are your choices?
Check with your company to see which
plans are available.
■
Compare the premium, deductibles,
copayments and out-of-pocket
maximums on each plan.
■
Review the limitations on each plan:
Chiropractic care, acupuncture and
physical therapy are some common
benefits with limited visits.
3. Choose the right plan.
Now that you know your health care
spending for the past year and the plan
choices offered by your employer,
determine your needs for the coming year.
■
Add up what you will pay for
premiums, copayments and deductibles
under your new plan based on last
year’s expenses or what you think
might happen this year.
■
Review the coinsurance maximum
amount and decide if it’s affordable
should a major medical condition
develop.
■
Remember: The most expensive plan
is not necessarily the best one for you
and your family.
■
Complete the process by submitting the
necessary paperwork and updating
your doctors of any changes.
Health care terms to know
Premiums are the amount you pay for your insurance policy, often deducted from
your paycheck.
Deductibles are paid out of pocket each year before your medical plan covers
expenses. Each family member usually has a separate deductible to meet before the
medical plan starts coverage.
Copayments (copay) are flat fees charged each time you visit the doctor or use certain
medical services, regardless of the cost of the procedure. Doctors' visits and
pharmaceutical purchases are often subject to copays.
Coinsurance requires you to pay a percentage of the cost of the medical services.
Most plans require either a coinsurance or copay — usually not both.
Coinsurance maximum or maximum out-of-pocket expense is the maximum
amount you’ll have to spend before your medical bills are covered by the medical plan.
Sometimes, certain services, such as pharmacy, may not count toward the coinsurance
maximum. Copayments may still apply.
19
A healthy body starts
with a healthy smile
Research suggests that serious gum
disease, known as periodontitis, may be
associated with many health problems.
This is especially true if serious gum
disease continues without treatment.
1,2
Now, here’s the good news. Researchers
are discovering that a healthy mouth may
be important to your overall health.
1,2
Dental products
*All family members must be enrolled in the same plan.
1
MayoClinic.com. “Oral health: A window to your overall health.” Available at www.mayoclinic.com/health/dental/DE00001. Accessed May 2010.
2
R.C. Williams, A.H. Barnett, N. Claffey, M. Davis, R. Gadsby, M. Kellett, G.Y.H. Lip, and S. Thackray. “The potential impact of periodontal disease on general
health: a consensus view.” Current Medical Research and Opinion, Vol. 24, No. 6, 2008, 1635-1643.
Need to find a participating dentist?
Just visit DocFind or give us a call.
www.aetna.com/docfind
1-888-702-3862
20
How do I pick the right dental benefits and insurance plan?
Plan features
DMO
®
PPO
Freedom-of-
Choice
*
DMO
Freedom-of-
Choice
*
PPO
Coverage for preventive
care
• • • •
No primary care dentist
requirement
• •
No referrals • •
Out-of-network access • •
No claim forms • •
No deductibles • •
No dollar annual
maximums
•
•
Aetna Life Insurance
Company plans
protect you from
financial loss.
Aetna’s Group Life Insurance for employees —
insurance solutions you can rely on
Nothing is more reassuring than knowing financial resources are available when you
need them most. Aetna’s products provide your dependents financial support when
it counts.
Protection for the future
You’ll be glad to know that if your employer selects Aetna to offer you a variety of
life insurance products, with more than 150 years' industry experience, your future
is in good hands.
Basic Term Life
The building block of financial security. You get company-sponsored protection with
flexible benefits schedules and guaranteed coverage up to a designated amount.
Dependent Term Life
Financial protection for your spouse and dependent children.
AD&D Ultra
®
This leading-edge product provides you better financial security than typical accidental
death and dismemberment plans and then some. That’s because AD&D Ultra includes
coverage for education or dependent child care expenses upon the death of the insured.
21
Understand precertification
and how it helps you
Some drugs need precertification before
your plan will cover them. This simply
means we need to approve them first for
you. Doing this helps make sure the drug
is being used at the right dose, for the
right reasons. This helps keep you safe. It
can also help you find another drug that
costs less and is just as effective —
something you could talk about with
your doctor.
Your doctor will contact us by phone, fax
or e-mail. If your request is not approved
and you still want the drug, you will have
to pay the full price of the prescription.
All decisions are made based on
FDA guidelines and current medical
findings. Learn more about this at
www.aetna.com/formulary.
Getting to know your
Aetna prescription
drug plan
Know what drugs are covered
You and your doctor can choose from
hundreds of quality, cost-effective drugs.
Your plan covers brand-name and
generic drugs on the Aetna Preferred
Drug List. (You may also see this called a
“formulary.”) It was developed based on
advice from many different health care
specialists. And all drugs on it are
approved by the U.S. Food and Drug
Administration (FDA).
Your plan also covers many drugs that
are not on this list. Remember though,
you’ll often pay less for drugs on our list.
To see this list or learn about
medication alternatives, go to
www.aetna.com/formulary.
Start your Aetna plan with
peace of mind
New plans often come with new rules.
We want to help make the change easier.
Once your plan starts, you don’t have to
worry about getting approval for most
covered drugs for your first 90 days.
In your first 90 days:
■
If you need a covered drug that
normally needs approval first, you’ll
be able to get that drug without
the approval.
■
For clinical reasons, some drugs will still
need to be approved first, even in your
first 90 days. This may be because of
questions about dosing, quantity or
other health concerns.
After 90 days:
■
You will need approval for any new
drugs your doctor prescribes that would
normally require precertification.
■
Any prescription you filled during the
first 90 days will still be covered as long
as you get the drug at the same
strength and quantity as originally
prescribed.
■
If you doctor changes the dosage of
your medication, you may then need to
get it approved first. This will happen if
the dosage is more than what the FDA
recommends.
Find out what’s covered and what
requirements apply.
22
Specialty Pharmacy Medications
With your new Aetna Specialty CareRx
SM
benefit, you can get your first fill at a retail
pharmacy. In order to receive coverage, your second fill and all other refills will need to
come from a participating specialty pharmacy.
For a full list of specialty pharmacy medications, please visit
www.aetnaspecialtycarerx.com.
Claritin
®
is a registered trademark of Schering-Plough HealthCare Products Inc.
Prilosec
®
is a registered trademark of AstraZeneca LLP.
Limitations and exclusions
Drugs that are not covered under the
standard prescription drug benefits
program include, but are not limited to:
■
Drugs used for weight loss, including
the treatment of obesity
■
Over-the-counter drugs
■
Nutritional supplements
■
Smoking cessation aids or drugs
■
Growth hormones
■
Prophylactic drugs for travel
■
Test agents and devices, other than
diabetic test agents
■
Performance, athletic performance,
or lifestyle-enhancement drugs and
supplies
■
Cosmetics or any drugs used for
cosmetic purposes or to promote
hair growth, including health and
beauty aids
■
Replacement for lost or stolen
prescriptions
For a complete list of what is not covered
by your prescription drug plan, refer to
your plan documents after enrollment.
Over-the-counter drugs may
be an option
Many health conditions can be treated
safely with drugs you can get without a
prescription. We call these drugs “over
the counter” because you can buy them
at your local stores. You don’t have to go
to a pharmacy.
These drugs have been approved by the
FDA as safe and effective, and they often
have the same active ingredients as an
original prescription version. Always talk
to your doctor before taking over-the-
counter drugs.
Your plan does not cover prescription
drugs if a similar drug is available over
the counter. This includes drugs like
Claritin
®
and Prilosec
®
20 mg. Please ask
your doctor what will work best for you.
Find out more
Once you are enrolled,
log in to Aetna Navigator,
our secure member website,
at www.aetna.com. You’ll
find benefits and claims
information, the Preferred
Drug List, cost estimates,
and more. You can also refer
to your Summary of Benefits
or call us at the toll-free
number on your Aetna
member ID card.
23
24
How will I find a doctor
or specialist?
Start your search at www.aetna.com
(or, if you are already a member, log in to
Aetna Navigator). Click on Find a Doctor.
Use the simple online instructions to
perform a general search. You also may
search for a particular physician by name,
specialty or other options.
How to find your Texas plan
When performing a search in DocFind,
you will be asked to select a plan name.
Some of the names of our Texas plans
appear by their network names. Here is a
quick reference to identify your plan:
Medical plan name as it
appears in DocFind
Common plan names
HMO HMO
Open Choice
®
PPO PPO
Managed Choice POS (Open Access) OAMC
Aetna Open Access
®
Managed Choice
POS (HealthFund)
OAMC HSA
Aetna Health Network Only
®
HNOnly HMO (Open Access)
Aetna Health Network Option
®
HNOption (Open Access Point of Service)
NOTE: Before submitting this completed form to your employer, you may wish to protect the confidentiality of your
health information by taping or stapling the form so that pages 2 and 3 are not visible.
Texas Employee Enrollment/Change Form
Large Employer: 51 or more employees
Small Employer: 2 – 50 employees
Social Security Number
Employer Name
INSTRUCTIONS: You, the employee, must complete this enrollment form in full or it will be returned to you resulting
in a delay in processing. You are solely responsible for its accuracy and completeness. If waiving coverage, please
complete Sections B and G.
Effective Date
Date of Hire
New Hire
Rehire/ Reinstatement
New Group Enrollment
Late Enrollment
Other
Change of coverage
Add Spouse/Domestic Partner/
Dependent Child
Name Change
Other
Employee Termination
Remove Spouse/
Domestic Partner/
Dependent Child
Cancel Coverage
A. Coverage Selection – Please print clearly, using black ink. (Shaded sections for Employer/Aetna Use Only)
COBRA/State Continuation for:
Employee Dependent
Length of Continuation:
18 36 Other
Original Qualifying Event Date
Reason
Control/Group No.
Suffix Account Plan No. Class Code Control/Group No. Suffix Account Plan No. Control/Group No. Suffix Account Plan No.
3. Life and Disability
Basic Life/AD&D Ultra
®
Optional Dependent Life
Life & Disability Packaged Plan
Beneficiary Designation - Full Name (First, Middle,
Last)
Beneficiary Social Security Number
1. Medical - Check one.
Aetna HMO Plan – Plan
Aetna OA MC Plan – Plan
Aetna HNOption Plan – Plan
Aetna HNOnly Plan – Plan
Aetna Savings Plus Plan – Plan
Aetna PPO Plan – Plan
Aetna Indemnity Plan
2. Dental -
To enroll, enter plan number and name elected below.
Standard Plan:
Plan Number:
Plan Name:
If FOC Option, check:
DMO
®
or PDN
Voluntary Plans:
Plan Number:
Plan Name:
If FOC Option, check:
DMO
®
or PDN
Out-of-State PDN Plans:
Plan Name:
Before today, were you covered under this employer’s dental
plan?
Yes No
Relationship to Employee
B. Employee Information - Must be completed by the employee.
Member ID Number (If Available)
Last Name, First Name, M.I.
Job Title
Home Telephone
Home Address
Apt. No.
City, State
ZIP Code
Work Address
City, State
ZIP Code
Work Telephone
Salary
$
Hourly
Weekly
Monthly
No. of Hours
Usually Worked
Per Week
Check One
Full-Time 1099 Union Seasonal
Part-Time Retiree COBRA Temporary
Marital Status
Single Divorced Legally Separated
Married Widowed
No. of Dependents
Including Spouse/
Domestic Partner
Subscriber Primary Language (other than English) Primer Idioma del suscriptor (que no sea el Ingles)
What is your primary Language?
¿Cuál es su primer idioma?
Subscriber Disability
Do you have a disability which affects your ability to communicate or read? Yes No
If Yes, please indicate the nature of your disability.
C. Individuals Covered - List individuals for whom you are enrolling or adding/changing/removing coverage. Insert additional sheets if necessary.
NOTE: Enter Domestic Partner ONLY if your employer has elected that coverage.
NOTE FOR MEDICAL AND DENTAL COVERAGE: While the Federal Patient Protection and Affordable Care Act mandates coverage of dependent children up to age 26,
your plan may allow coverage beyond age 26. Some exceptions apply. Please refer to your plan documents or contact your benefits administrator.
(A)dd
(C)hange
(R)emove
Name (Last, First, M.I.)
Sex
M/F
Social Security
Number
Birthdate
(MM/DD/YYYY)
Incapacitated
Coverage
Election
Other Health
Coverage
Other Dental
Coverage
Child less than
25 years of age
(Life/AD&D
only)
Primary Office
ID Number
(if applicable)
Current Patient
Dental Office
ID Number
(if applicable)
Current Patient
Employee
1.
Yes
N/A
Medical
Dental
Life/Dis
Yes
Yes
Yes
N/A
Yes
Yes
Spouse Domestic Partner
2.
N/A
Medical
Dental
Life
N/A
Child Stepchild Other
3.
Medical
Dental
Life
Child Stepchild Other
4.
Medical
Dental
Life
Child Stepchild Other
5.
Medical
Dental
Life
Child Stepchild Other
6.
Medical
Dental
Life
GR-67834-2 (7-11) 1 TX - SGB R-POD J
25
How to complete
the enrollment form
application
Please be sure to complete your
enrollment form thoroughly.
The sections noted below are
frequently overlooked.
1. Enter your date of hire here.
2. Select the medical plan(s) offered by
your employer. If dental plans are
offered, select your dental plan next.
3. Insert your Social Security number
here.
4. Enter your doctor’s (and dentist's, if
enrolling in a DMO plan) ID number
if enrolling in an HMO plan.
5. Sign here if you are waiving coverage
for yourself.
6. Sign and date here to complete
the form.
3
2
1
2 2
4 4
G. Declination/Waiver of Coverage - To be completed if medical and/or dental coverage is declined or refused by an eligible employee and/or their eligible family members.
1. Medical Coverage Declined for:
Myself Dependents Spouse/Domestic Partner
2. Dental Coverage Declined for:
Myself Dependents Spouse/Domestic Partner
Reason for Declining Coverage (If applicable, please attach front/back of your health coverage ID card.):
Spousal/Domestic Partner group coverage COBRA coverage
Medicare TRICARE or CHAMPVA
Medicaid Another group plan provided by my employer
Individual coverage Do not want
Retiree coverage Other
I acknowledge I have been given the right to apply for this coverage, however, I am electing not to enroll. By declining this group
coverage I acknowledge that myself and/or my dependents may have to wait until the plan's next anniversary date to be enrolled for
group coverage. Pre-existing conditions, when enrolled in other than an HMO plan, may not be covered for twelve months. NOTE: If
your Plan contains a pre-existing conditions provision, the pre-existing conditions exclusion and limitation will not apply to a person
under 19 years of age.
Please sign here ONLY if you are declining coverage for yourself or dependent(s).
X Employee Signature
Date (Month/Day/Year)
GR-67834-2 (7-11)
2 TX
5
Conditions of Enrollment
On behalf of myself and the dependents listed on the reverse side, I agree to or with the following:
1. I acknowledge that by enrolling in the following plans, coverage is provided by the following entities (collectively referred to as
“Aetna”):
● Aetna HMO Plan and Aetna HNOnly Plan: Aetna Health Inc.
● Aetna HNOption Plans: Aetna Health Inc. (In-Network) and Aetna Health Insurance Company, (Out-of-Network)
● Aetna Dental DMO: Aetna Dental Inc.
● Life, disability, dental and all other health coverages: Aetna Life Insurance Company.
2. I understand and agree that my employer’s application will determine coverage and that there is no coverage unless and until both
the eligible employee and employer applications have been accepted by Aetna. Even if this enrollment form is accepted, any
intentional misstatement or omission of material fact may result in future claims being denied.
For life and disability coverages: I understand that the effective date of insurance for myself or for any of my dependents is
subject to my being actively at work on that date and that the effective date of insurance for any of my dependents is also subject to
the dependent health condition requirements of the benefit plan. Further, I understand that any insurance subject to evidence of
good health or medical information will not become effective until Aetna gives its written consent.
3. I understand and agree that this Enrollment/Change Form may be transmitted to Aetna or its agent by my employer or its agent. I
authorize any physician, other healthcare professional, hospital or any other healthcare organization ("Providers"), to give to Aetna
or its agent information concerning the medical history, services or treatment provided to anyone listed on this Enrollment/Change
Form, including those involving mental health and substance abuse. I further authorize Aetna to use such information and to
disclose such information to affiliates, Providers, payors, other insurers, third party administrators, vendors, consultants and
governmental authorities with jurisdiction when necessary for my care or treatment, payment for services, the operation of my
health plan, or to conduct related activities. I have discussed the terms of this authorization with my spouse/domestic partner and
competent adult dependents and I have obtained their consent to those terms. This authorization will remain valid for the term of
the coverage and so long thereafter as allowed by law. I understand that I am entitled to receive a copy of this authorization upon
request and that a photocopy is as valid as the original.
4. The plan documents will determine the rights and responsibilities of member(s) and will govern in the event they conflict with any
benefits comparison, summary or other description of the plan.
5. I understand and agree that, with the exception of Aetna Rx Home Delivery
®
, all participating providers and vendors are
independent contractors and are neither agents nor employees of Aetna. Aetna Rx Home Delivery, LLC, is a subsidiary of Aetna
Inc. 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.
6. I understand and agree that, with certain exceptions described in the plan documents, HMO and DMO plans only provide coverage
for referred benefits, and that, in order to be covered, services must be performed either by a participating primary care physician,
primary care dentist or by the participating specialist, hospital, pharmacy, dentist, or other provider as authorized by a referral from
a participating primary care physician.
7. I understand and agree that, as described in the plan documents, when enrolled for medical coverage in other than an HMO plan,
any pre-existing conditions for my spouse/domestic partner, dependents or myself may not be covered for 12 months. NOTE: If
your Plan contains a pre-existing conditions provision, the pre-existing conditions exclusion and limitation will not apply to a person
under 19 years of age.
Misrepresentation
8. Any person who knowingly and with intent to injure, defraud or deceive any insurance company or other person files an application
for insurance or statement of claim containing any intentional misrepresentation of material fact or conceals, for the purpose of
misleading, information concerning any fact material thereto may commit a fraudulent insurance act, which may be a crime and may
subject such person to criminal and civil penalties.
I represent that all information supplied in this form is true and complete. I have read and agree to the Conditions of Enrollment and
Misrepresentation on this Texas Employee Enrollment/Change Form. I understand that, in the event I fail to sign this form within 31
days after the above transaction request or for any reason Aetna does not receive notice of the above transaction request within a
reasonable time following the event, my and my dependents’ eligibility may be affected. I am employed by the employer shown on
Page 1, and I am working full time, usually 30 hours per week, for this employer at the regular place of business.
If you have questions concerning the benefits and services that are provided by or excluded under this Agreement, please contact a
Member Services representative at 1-800-323-9930 before signing this form.
Employee Signature
X
Employee E-mail Address (optional)
Date (Month/Day/Year)
GR-67834-2 (7-11) 4 TX
6
26
Your member ID card
After you enroll, you will receive ID cards
that look like this. If you need care before
your ID card arrives in the mail, you may
log in to Aetna Navigator and print a
temporary ID card. Make sure to present
your Aetna ID card when receiving care
from participating providers or when
accessing emergency care. Your ID card
identifies you as an Aetna member.
1. Plan in which you are enrolled.
2. Additional information, including
precertification number for mental
health and substance abuse services.
3. Call this number to speak with a
Member Services representative.
1
2
3
©2011 Aetna Inc.
14.02.310.1-TX C (10/11)
Review the material in this brochure and speak with
your employer or human resources representative
about the choices available to you.
We look forward to welcoming you and your family
as our newest members!
www.aetna.com
If you need this material translated into another language, please call Member Services at
1-888-98-AETNA (1-888-982-3862).
Si usted necesita este documento en otro idioma, por favor llame a Servicios al Miembro al
1-888-98-AETNA (1-888-982-3862).
This material is for information only and is neither an offer or invitation to contract. The models depicted
are not Aetna members. An application must be completed to obtain coverage. Rates and benefits vary by
location. 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/dental services. If you
are in a plan that requires the selection of a primary care physician and your primary care physician is part
of an integrated delivery system or physician group, your primary care physician will generally refer you
to specialists and hospitals that are affiliated with the delivery system or physician group. Health/dental
benefits and health/dental insurance plans contain exclusions and limitations.
Not all health/dental 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. Health/dental information programs provide general health information and are not
a substitute for diagnosis or treatment by a physician or other health care professional.
HealthEquity, Inc. is the custodian of health saving accounts and independently offers investment services.
Aetna receives rebates from drug manufacturers that may be taken into account in determining Aetna’s
Preferred Drug List. Rebates do not reduce the amount a member pays the pharmacy for covered
prescriptions. Aetna Rx Home Delivery refers to Aetna Rx Home Delivery, LLC, a licensed pharmacy
subsidiary of Aetna Inc. that operates through mail order. Aetna Specialty Pharmacy refers to Aetna
Specialty Pharmacy, LLC, a subsidiary of Aetna Inc., which is a licensed pharmacy that operates through
specialty pharmacy prescription fulfillment.
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.