Page 1 PASADENA ISD AND AETNA EFFECTIVE JANUARY 1, 2012.

PASADENA ISD AND AETNA

EFFECTIVE JANUARY 1, 2012

WELCOME TO AETNA!

Pasadena ISD – Aetna Plan Comparisons

PLAN FEATURESChoice POSII Plan

(Plan I)

Aetna HealthFund Choice CPOSII Plan

(Plan II)

Network In-Network Out-Network* In-Network Out-Network*

HealthFund Amount contributed by Pasadena ISD

$500 Employee $1,000 EE+S,

Ch, F

Plan Coinsurance 20% 50% 20% 50%

Calendar Year Deductible Individual Family

$500 per person $1,500 per family

$1,500 per person $4,500 per family

$2,500 per person $7,500 per

family

$7,500 per person

$22,500 per family

Out-of-Pocket Maximum Individual Family

$3,500 per person $10,500 family



$15,000 per person

$45,000family

Lifetime Maximum Benefit Unlimited Unlimited Unlimited Unlimited

Primary Care Physician (PCP) Office Visits $25 copay 50% after ded 20% after ded 50% after ded

Specialty Care Office Visits $35 copay 50% after ded 20% after ded 50% after ded

Preventive Care Annual routine physical:Adult and Well Child, GYN, Mammograms, Colorectal Cancer Screenings,PSA Tests 100% 50% after ded 100% 50% after ded

Diagnostic Outpatient Lab/ X-rays/Testing (part of office visit) PCP or Specialist copay 50% after ded 100% ded waived 50% after ded

Diagnostic Outpatient Lab/ X-rays/Testing (Facility) 100% 50% after ded 20% after ded 50% after ded

Complex Imaging Services 20% after ded 50% after ded 20% after ded 50% after ded

Pasadena ISD – Aetna Plan Comparisons cont’d

PLAN FEATURES Choice POSII Plan Choice POSII PlanAetna HealthFund Choice CPOSII Plan

Aetna HealthFund Choice CPOSII Plan

Network In-Network Out-Network* In-Network Out-Network*

Inpatient Hospital Services$500 per confinement copay,

then 20% after ded

$500 per confinement copay, then 50% after

ded 20% after ded 50% after ded

Outpatient Surgery 20% after ded 50% after ded 20% after ded 50% after ded

Emergency Room Copay/Coinsurance (Copay waived if admitted)

$250 copay, then 20% after ded same as preferred care

$250 copay, then 20% after ded same as preferred care

Ambulance 20% after ded same as preferred care 20% after ded same as preferred care

Urgent Care Copay/Coinsurance (Copay waived if admitted) $50 copay 50% after ded 20% after ded 50% after ded

Walk In Clinics $25 copay 50% after ded 20% after ded 50% after ded

*Out of Network benefits are paid at the Limited Fee Schedule

Out-of-Network Limited Benefit Payment Schedule

• Pasadena ISD has a Limited Out-of-Network benefit payment schedule. When you need medical care, your Aetna health benefits plan gives you and your participating physician a choice. Advise your participating physician that it is important to you that the highest level of benefit coverage is desired by ensuring to you that they refer you to only in network facilities and providers with Aetna.

• Limits on authorized costs associated with Out-of-Network facilities/providers. To help curb excessive out-of-network facility/provider costs, Pasadena ISD has established a Limited Out-of-Network fee schedule that limits the Plan’s exposure to the market rate for non-emergency services and procedures. If you use an out-of-network facility or provider, you will be responsible for paying the difference between the covered amount (which is based on established rates for our geographic area) and the amount the facility charges. If you incur these expenses, they will not apply to your coinsurance maximum.

• When you use a Network provider, you are protected from charges that are greater than the "allowed" amount. However, when you use an out-of-network provider, you may have to pay for any of the charges that are greater than the "allowed" amount in addition to your coinsurance and deductible.

• All out-of-network provider and facility types will be included in the Limited Out-of Network benefit reimbursement. Examples include, but are not limited to: hospitals, ambulatory surgery centers, physicians, pathology laboratories, radiology centers, psychologists, master social workers, physical therapists, certified nurse anesthetists, outpatient dialysis, radiology, laboratory, sleep lab, MRI/CT etc.

• NOTE: It is your responsibility to make sure your physician, facility or hospital is in-network or you will pay out-of-network costs. You can help keep costs down by using network providers.

Your Personal Website – Aetna NavigatorYour easy to use Online Resource

• How to use Aetna.com/Navigator program – Go to www.aetna.com– Register just like you would register for your on-line banking or other sites.

Temporary LOGIN: choicepos2 Temporary PW: choicepos2

• Doc Find - a complete listing of Aetna participating providers. Select your provider category. You can search by city, state, zip, specialty, hospital affiliation, provider name, gender, language and education. Select the “CPOSII Open Access” network

• Estimate the Cost of Care – get estimates for what you will pay for visits to doctors or common procedures

• View Deductible and Plan Limits – review amounts applied to your individual and family deductibles and out-of-pocket maximums

• View Explanation of Benefits – review portion of claims paid by the plan and the amount you must pay

• Take a Health Assessment – Take your Simple Steps personal health risk assessment

• Aetna Life Essentials – discount programs for vision care, hearing aids, fitness, etc

https://member.aetna.com/memberSecure/featureRouter/MbrSecure?createSession=true&serviceName=home

https://member.aetna.com/memberSecure/featureRouter/MbrSecure?createSession=true&serviceName=home

Aetna Health Connections – Disease ManagementCONFIDENTIAL PROGRAM!!!

Aetna program designed to help you or your eligible family member(s) learn more about your condition and work closely with your doctor to improve your health and quality of life. Educational information is provided and for high risk members, access to a registered nurse “Health Coach” is offered. The adjacent list includes a few of the 35 conditions managed by this program. To learn more about Disease Management, login to www.aetna.com

• If you receive a call or letter from Aetna please return their call or contact them as requested. All information is confidential with Aetna and is not shared with Pasadena ISD.

• If you have one of the conditions listed or think you are at risk for one of these conditions, you can volunteer into the program by calling

1-866-269-4500 OR make an appointment to discuss with the Aetna on-site nurse.

Asthma HIV

Back Pain Hepatitis

Cancer Hypertension

Cerebrovascular Inflammatory

Disease Bowel Disease

Chronic Heart Failure Kidney Failure

Chronic Obstructive Peripheral Artery

Pulmonary Disease Disease

Coronary Artery Disease Rheumatoid

Cystic Fibrosis Arthritis

Depression Sickle Cell

Diabetes Anemia

Digestive Weight Management

Simple Steps ProgramYour Health Risk Assessment – CONFIDENTIAL!

• Simple Steps To A Healthier Life is an interactive online health and wellness program that can help you improve or maintain your health in ways that fit your lifestyle.

• You start by taking an online Health Assessment that will help identify some of your health needs. Questions focus on health habits and family health history and all answers are kept secure and confidential. Note: It is best to have your current lab and biometric results to input into the assessment (Blood pressure, cardiac CRP, total cholesterol, LDL and HDL cholesterol, triglycerides, and fasting glucose). However, even if you don’t have all of these results - you can still complete your health assessment and fill these results in at a later date ).

• Once your health needs are identified, you’ll receive easy-to-understand Health Reports and a personal invite to join the program most likely to help meet your needs and an Action Plan that’s just for you, suggesting a combination of Healthy Living Programs.

• Choose the programs, tools and information that are right for you. Each program includes interactive tools to help you reach your health goals in a fun and interesting way. You can use an online Fitness Planner, a Healthy Shopping List and more.

• Take the first step to healthier living. Visit www.simplestepslife.com. Be sure to complete or update your health assessment at www.aetna.com! ALL information is confidential and is not shared with Pasadena ISD!

NEED MORE INFORMATION? Aetna InteliHealth®

Aetna InteliHealth® is an exclusive resource that can be accessed online (www.aetna.com) to find up-to-date health information and resources including:

– Information on diseases & conditions– Articles on lifestyle improvement– Gender and age specific health issues– Medication information– Health assessments– Quizzes– Medical dictionary– Health calculators (BMI, etc.)– Current health research news– “How-to” slide shows– Email health updates

Need questions answered FAST???Call Aetna's Informed Health® Line

• Aetna's Informed Health® Line gives you easy access to credible health information. All Informed Health Line services are available 24 hours a day, 365 days a year on demand from your touch-tone phone.

• If you prefer to view health information online, simply login to www.aetna.com and click on the link for the Healthwise® Knowledgebase.

• 24 Hour NurseLine - Speak with a registered nurse who has experience in a variety of health topics at any time of the day*.

• Audio Health Library - Phone in to choose from thousands of common health topics via recorded messages.

Easily transfer to the Nurse Line for questions.

• Healthwise® Knowledgebase - Search for detailed information about health conditions, medical tests and procedures, medications and treatment options at www.aetna.com.

• To reach the 24-Hour Nurse Line or Audio Health Library call 1-800-556-1555.

* Informed Health Line Nurses cannot diagnose, prescribe or give any medical advice. Contact your physician with any questions or concerns regarding your health care needs.

Choosing A Plan that is Right for You

• Making the right plan choice can be a difficult decision. This decision should be based on several things such as your personal medical condition and usage of services, financial situation, and your level of comfort with coinsurance vs. copayments. The following definitions may assist you in the decision-making process.

• Co-payment: the predetermined dollar amount you will pay for a service (Examples: physician office visits, urgent care, emergency room, physical therapy, counseling).

• Coinsurance: percentage employee is responsible for paying up to a specific dollar amount per calendar year (Covered services paid from 50-100% depending on the plan selected and service rendered).

• Deductible: initial out-of-pocket costs that must be paid before the plan begins to pay benefits (Either $500 or $2,500 based on plan elected).

• Your Aetna Choice POS II Plans do not require you to select a network primary care physician (PCP), although selecting a PCP is encouraged. These plans also allow you to self-refer to a specialist. Your choice of provider dictates the amount you will pay in copayments, coinsurance and/or deductibles.

PASADENA AREA URGENT CARE FACILITIES

Immediate Medical Care Group Pasadena Community Health6825 Spencer Hwy 4002 Burke Road

Pasadena, TX 77505 Pasadena, TX 77504

(281) 335-0606 (281) 606-2020

Concentra Health Services, Inc.125 East 8th St

Deer Park, TX 77536

(281) 930-8555

NOTE: It is your responsibility to make sure your physician, facility or hospital is in-network or you will pay out-of-network costs. You can help

keep costs down by using network providers.

PASADENA AREA WALK IN CLINICS

H-E-B - RCMH, LLC dba RediClinic MinuteClinic Diagnostic of Texas, LLC

6210 Fairmont Pkwy. CVS Pharmacy – 2900 Broadway St.

Pasadena, TX 77505 Pearland, TX 77581

(866) 607-7334 (866) 389-2727

Take Care Health Texas, P.C. H-E-B - RCMH, LLC dba RediClinic

Walgreens- 8430 Broadway St. 2955 Gulf Freeway South

Pearland, TX 77584 League City, TX 77573

(866) 825-3227 (866) 607-7334

H-E-B - RCMH, LLC dba RediClinic

701 West Parkwood

Friendswood, TX 77546

(866) 607-7334

NOTE: It is your responsibility to make sure your physician, facility or hospital is in-network or you will pay out-of-network costs. You can help keep costs down by using network

providers.

When utilizing these clinics, regular plan will provisions apply

(ie; copays, deductibles and out of pocket limits).

Need More Information?

•Aetna on-site Contact:

•Deaneva Taylor•713-740-0105

What is the Cost to the Employee?

• Choice POSII Plan Rates (Plan 1) Employee’s Cost

• Employee $170.00

• +Spouse $500.00

• +Child (Children) $400.00

• +Family $725.00

What is the Cost to the Employee?

• Aetna Health Fund (Plan2) Employee’s Cost

• Employee $ 70.00

• + Spouse $210.00

• + Child (Children) $175.00

• + Family $350.00

Page 1 PASADENA ISD AND AETNA EFFECTIVE JANUARY 1, 2012.

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