1. Staunton City Schools New benefit year on an Aetna benefit plan - 2016
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Staunton City Schools New benefit year on an Aetna benefit plan
As you know, Coventry Health Care and Aetna are one company Alt: Today I’d like to talk with about your renewal to an Aetna benefit plan and what it means for you and your employees.

2. New benefit year on an Aetna benefit plan
What’s happening?
Benefit design basics and network
Medical Plan Options
The Aetna Advantage: Member tools and information
Helping members get started with Aetna
Questions?
We’ll start with more about what’s happening and what you can expect from us. We’ll also cover -
New features you and your members will get with your new benefit year with Aetna. We’ll talk about benefit plan design, network and the tools and information available to your members as well as important information specifically for plan sponsors.
We’ll also review at a high level the activities around renewing to an Aetna benefit plan like implementation process and timeline. (or we’ll also review the activities and timelines around renewing to an Aetna benefit plan. )
Address your questions 2

3. Medical benefit design basics with valuable features
Aetna Choice Point of Service II (Open Access)
Open access models
Selecting a PCP is not required
Referrals are not required
Access to national network of providers when traveling
National Advantage Program (NAP) supports contracted rates for out-of-network claims
Complete details in Plan Design documents
Benefits will be processed based on type of service and place of service
Ex: Office visit that includes surgical procedure is covered with an office visit copay.
Ex: Dialysis/chemo follow place of service and type of service. If done in the office then follow office cost share, if done outpatient hospital, it follows the outpatient hospital benefit
PRESENTER: Choose the plan that applies to your group. Talking points below are a sample for open access plan.
This is an open access model, where members do not have to sign-up for PCPs and referrals are encouraged but not required
Your covered employees and their dependents will have in-network access to our national network of providers when traveling or away at school; we call this reciprocity.
In addition, members will have access to National Advantage Program (NAP) which supports contracted rates for out-of-network claims.
Refer to the Plan Design Document for details of your plan.
Presenter—Customize the last bullet, if appropriate. Spike out specific customer differences/or develop standard differences by geography.
Your benefit design and network

4. Medical benefit design basics with valuable features (continued)
Lab – Quest is preferred vendor; Lab Corp is non-par. Lab services can be done at participating hospitals as well.
Maternity ultrasounds are no longer covered at 100%, will follow place of service and type of service
Urgent Care has an in and out of network cost share. Urgent Care Center (UCC) must be used for urgent care only, routine care not covered at UCC.
Non-par provider (Emergency, Ambulance and HAIRPENS*) Aetna pays these providers the ‘reasonable rate.’ Member is held harmless for any balance billing upon member appeal (call to member services).
Addition of Teladoc benefit and 24/7 nurseline
Coverage for routine eye exam (refraction) will continue to be covered as part of your medical plan
HAIRPENS (Hospitalists, Anesthesiologist, Intensivists, Radiologists, Pathologists, Emergency Physicians and Neonatologists)

5. Important information about your pharmacy plan
Your formulary will be referred to as Aetna Value
What remains the same?
Copay structures and benefit details
Current member restrictions (use of a single provider or pharmacy) remain in place for controlled substances
What is changing?
Mail order benefit is 2 copays for 90 day supply for all tiers
Days supply will be 30 day supply
What will be immediately available to members?
Open prior authorizations
Active prescriptions for mail order delivery
When will new prescriptions be needed?
Some specialty drugs, and controlled substances, expired prescriptions, prescriptions with no refills will not transfer to mail order pharmacy upon renewal and will require new prescriptions
PRESENTER – Aetna Open is for January to June renewal dates. Prermier Plus is for July 1 and later renewal dates.
In most cases, your plan designs will stay the same or be similar to what you had with Coventry. PRESENTER: ACCOUNTS WITH LIVES MAY MOVE TO A STANDARD PLAN THAT IS SLIGHTLY DIFFERENT
Open prior authorizations for drugs that apply to the pharmacy benefit will transfer upon renewal.
Members who are required to use a single provider or pharmacy for controlled substances will retain that restriction.
Active prescriptions for mail-order delivery will transfer upon renwal. PRESENTER—Delete for small group (2-100).
Some specialty drugs, controlled substances, expired prescriptions and prescriptions with no refills remaining will NOT transfer to Aetna’s mail order pharmacy - Aetna Rx Home Delivery. If a member is currently filling medication at Aetna Specialty Rx with refills remaining, then NO new prescription is needed. Aetna Specialty Rx will need the member’s new information from the ID card to process the next fill.  However, if the member uses a pharmacy other than Aetna Specialty RX, they will need a new prescription. (PRESENTER — this will vary depending on whether the plan design had a force to specialty – ASRx).
Refer to Plan Design document for details.
Details in Plan Design document
Your benefit design and network

6. Primary Care Physicians
Provider network –
Primary Care Physicians
Specialists
Hospitals
Virginia - 4,823
National – 224,329
Virginia - 8,312
National - 418,031
Virginia - 95 National - 5,602
Nearly all physicians in the current Coventry network are also in Aetna’s network.
PRESENTER: Customize with information for your group. It is recommended that every market have a slide on network either at the group or market level.
Talking points example: customize for your particular network slide.
The WVA network grew by 25% with the addition of Aetna’s physicians.
Giving you and your employees even more choice of where you get your care.
Additionally, we were able to add key facilities that [ local market benefit of adding these facilities]
Your benefit design and network

7. Medical Plan Options

8. Open Choice POS II High Plan
In-Network Care
Out-of-Network Care
Deductible
Individual
Family
$500
$1,000
Out of Pocket Maximum
$3,000
$6,000
$16,000
Coinsurance
20%
30%*after deductible
Preventive Care
Covered at 100%
30%*; after deductible
PCP
Specialist
Emergency Room
Urgent Care
Inpatient
Outpatient
$25 copay
$50 copay
20%; after deductible
$75 copay
Same as in-network care
Retail RX
Mail Order Drug
$10/$30/$60
$20/$60/$120
Not covered
Aetna’s negotiated rates with network doctors can be
significantly less than the charges of non-network providers. 
For non-network providers, you will also be responsible for
amounts in excess of the amount covered under your plan.
* Percentage shown is of the Reasonable and Customary amount. Member is also responsible for the difference between the billed amount and the Reasonable and Customary amount.

9. Open Choice POS II Low Plan
In-Network Care
Out-of-Network Care
Deductible
Individual
Family
$1,000
$2,000
Out of Pocket Maximum
$4,000
$8,000
Coinsurance
30%
40%*after deductible
Preventive Care
Covered at 100%
40%*; after deductible
PCP
Specialist
Emergency Room
Urgent Care
Inpatient
Outpatient
$25 copay
$50 copay
30%; after deductible
$75 copay
30%;after deductible
Same as in-network care
Retail RX
Mail Order Drug
$10/$30/$60
$20/$60/$120
Not covered
Aetna’s negotiated rates with network doctors can be
significantly less than the charges of non-network providers. 
For non-network providers, you will also be responsible for
amounts in excess of the amount covered under your plan.
* Percentage shown is of the Reasonable and Customary amount. Member is also responsible for the difference between the billed amount and the Reasonable and Customary amount.

10. The Aetna Advantage

11. 24/7 Aetna Navigator® helps members manage their health and benefits
Secure, easy-to-use website lets members:
Review claims
Find a doctor
Look up health information
Get an ID card
Research costs of care
Personalized health information is available
24/7
Here’s a closer look at Aetna Navigator where members can get virtually all the information they need to make the most of their health and benefits.
The secure Coventry member website, My Online Services, will remain active for two years after the start date of your Aetna plan. Members can access their information, including claims, for that period.
The secure Coventry member website, My Online ServicesSM, will be active for 24 months from the start date of your Aetna plan.
TIP
Member tools and information

12. New tools and features for members support when and where they need it
Ask Ann online assistant
Member telephone service
Aetna Mobile
PRESENTER:  24/7 support is available through our on-line tools and telephonic interactive voice response (IVR) , Aetna Voice Advantage.  In addition our middle market customers have 24/7 live customer service available. National Account and Public & Labor customers can buy up to this capability if desired
Ann is a virtual assistant who helps members navigate their Aetna Navigator® secure member website. They can access personalized information, tools, and programs that are available to them (Ann is aware of a member’s specific benefits). Ann aligns closely with our commitment to provide members with innovative solutions that educate them and improve health care decisions.
For those members who prefer to use the phone, we have 24/7 member service available to answer their questions and help them with their health and benefits.
With so many people relying on their smartphones, we maximize this avenue for health and benefits information through Aetna Mobile.
Again, it’s all about meeting members where they are. Let’s take a look at some of the award-winning tools that your employees will have with Aetna.
Member tools and information

13. Optimized for most devices
Members connect with us – wherever, whenever through Aetna Mobile
Find a doctor or urgent care center
Research claims
Get an ID card
Price-a-DrugSM
Access their personal health record
Members will have a new mobile app to replace Coventry Mobile. Aetna Mobile is optimized for most devices and helps members get the information they need when they need it. To download, members simply text Apps to *
*Text messaging rates apply.
IS there a key difference/benefit to Aetna Mobile versus Coventry Mobile?
Optimized for most devices

14. Members find a doctor easily with DocFind® search tool
Your employees use our online DocFind search tool to find a doctor, pharmacy or dentist close to you, in our networks.
Easy to search
Comprehensive results screens
Clean pages
Instead of the Online Provider Search, members will now use the DocFind search tool. DocFind is very easy to use and it lets members:
Get the most up-to-date information because DocFind is updated six days a week.
Access a plan-specific DocFind when they log in to Navigator.
View additional quality information in the results.
Refine results using filters based on provider characteristics. For example, members can limit a search by specifying gender, hospital affiliations, languages and programs and recognitions.
Expand/shrink geographic radius of results.
Member tools and information

15. iTriage® – Engages members with powerful information
Find out what can be wrong and where to go for treatment
Search symptoms, conditions and treatment options
Book appointments (certain locations)
Use special tools just for Aetna members
Information tailored to your plan
Access ID cards
See claims history
PRESENTER:Itriage is a public application, however certain capabilities are available for Aetna customers, such as ID card availability.  In addition, the app can be integrated with the customer’s network.  These capability is included for all Middle Market customers, and a buy up for National Accounts and Public and Labor:
This integrated network capability helps with the following:
The iTriage app helps members answer the two most common medical questions: What could be wrong? and Where can I go for treatment?
iTriage improves employee engagement with:
• Guidance to the most appropriate level of care
• Encouragement to use more cost-effective, in-network providers
• Increased network usage and reduced ER visits
For example, the Symptom-to-Provider™ pathway lets members search symptoms, conditions, and treatment options and helps them decide where to get care. Pop-ups let members know if they choose an out-of-network or more costly option. They have a range of appropriate treatment options.
iTriage puts health and benefit information in the palm of members’ hands.
Personal health record only if you have one.
Member tools and information

16. Changes for members: New ID cards with new features
Family ID card that shows up to five family members
New ID cards will go out as renewals/new enrollments occur
ID cards will also be available to view and print on Aetna Navigator®
Member Services phone number and claims mailing address are on the new ID card
Health plan product name and group number (control number) are on the front of the ID card
It is important for members to give providers their new ID card to use their new member ID number.
With Aetna members will get a family ID card . Members will now get a family ID card with up to five members. New ID cards come out only with renewals and new enrollments.
Health plan product name and group number
View and print ID cards on Aetna Navigator
If your household includes more than five plan members, a second ID card will be included that shows their names.
Member tools and information

17. Changes for members: Aetna family EOB
A Family* Explanation of Benefits (EOB) will have a new look making it easier for members to understand claim activity
Track spending, savings and deductibles.
View common EOB terms with definitions. After the definitions, it shows totals for charges.
Get helpful messages from Aetna or your employer.
Get a payment summary for claims on the EOB.
See detailed information for each claim on your EOB. 1 2 3 4
PRESENTER:There are situations where someone can request an individual EOB if they do not want other family members to see medical activity. For example:  a member who is divorced, or an adult child may prefer that their EOBs be separate and directed to only them.  In these situations the ember would just call customer service to arrange for their individual EOB.
We think your employees will like their new family EOBs. It’s a new look for them, but it will make it even easier for them to understand their claims.
As a matter of fact, in 2013 Aetna was noted* as an industry leader in creating easy-to-understand EOBs. Specifically called out was our ability to simplify information about who paid for what, how much a consumer still needs to pay, and for clearly presenting the 'math' involved. Aetna was also commended for the use of effective graphics and consolidated layout.
*DALBAR fourth annual "Trends and Best Practices in Explanation of Benefit Statements.“
Remember, Coventry members can access My Online Services for two years if they need to get information about claims, etc.
Members can get EOBs electronically. . 5
*Unless an individual EOB is required by a state.
Member tools and information

18. Helping to support a smooth member experience
Upon renewal, a member’s current information will be transferred, including:
 Open Prior Authorizations:
Referrals to specialists, pre-certifications and pharmacy programs. Mail order prescriptions with refills remaining.
Member Demographics:
Coordination of Benefits
PCP selections
Preferences such as privacy and paper suppression
Transition of Care – Reviewed case by case upon request
Provider lookup -
Formulary lookup -
We know that no one wants to start over, rest assured your employees don’t have to. Aetna will make it easy. Important current member information will be transferred to the new plan upon renewal . We’re committed to helping to support a smooth member experience.
For example all deductibles that have been met
Helping members get started

19. Questions?