1. Ready today for the future of consumer-directed health plan solutions Aetna HealthFund ® Health Reimbursement Arrangement (HRA) 32.25.102.1 (3/09)

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4. 4©2009 Aetna Support member engagement  Help members become better health care consumers  Educate members on the process  Enable behavior change  Support doctor-patient relationships  Provide personalized information  Make connections for optimal health

5. 5©2009 Aetna Aetna HealthFund ®  High deductible health plan, Health Reimbursement Arrangement( HRA)*, Health Savings Account (HSA)*, Aetna performance networks  Decision tools for value-based purchasing  Health incentives  Health care transparency  Integrated care management  Effective communications and education *HRAs and HSAs are currently not available to HMO members in Illinois

6. 6©2009 Aetna Health benefits - current environment  Health care costs continue to rise  Employers looking for solutions and savings  New competitive options emerging  Legislative and political impact  Consumer’s role changing  Result – CDHP (Consumer-Directed Health Plans)

7. 7©2009 Aetna An industry transformation  Greater member responsibility  Promotes consumer engagement  Can improve employee satisfaction  Saves employers money  Drives cost down

8. 8©2009 Aetna The Aetna HealthFund ® Health Reimbursement Arrangement (HRA)*  Fully integrated systems, including Pharmacy  Full product and funding spectrum  Actuarial modeling capabilities  Plan design flexibility  Full medical management services  Personalized Aetna Navigator ® consumer decision support tools  Favorable network discounts  Monthly member statements *HRAs are currently not available to HMO members in Illinois

9. 9©2009 Aetna Aetna HealthFund HRA*  Fund integrated with deductible-based medical plan – Fund Established by employer Notional account / unfunded liability Pays eligible out-of-pocket expenses Balances roll over, option to cap Fund reduces deductible (standard model) – Medical plan Deductible Coinsurance and/or copayments 100% preventive care, not subject to fund or deductible Out-of-pocket maximum  Consumer tools and information *HRAs are currently not available to HMO members in Illinois

10. 10 *HRAs are currently not available to HMO members in Illinois. *

11. Helps you pay for eligible out-of-pocket expenses ………………………. Employer funded each plan year 11 *HRAs are currently not available to HMO members in Illinois. *

12. Helps you pay for eligible out-of-pocket expenses ………………………. Employer funded each plan year You pay this amount before your health plan begins to pay for eligible expenses 12 *HRAs are currently not available to HMO members in Illinois. *

13. Helps you pay for eligible out-of-pocket expenses ………………………. Employer funded each plan year You pay this amount before your health plan begins to pay for eligible expenses Once you meet your deductible, your health plan pays a larger % of eligible costs while you pay a smaller % 13 *HRAs are currently not available to HMO members in Illinois. *

14. 14©2009 Aetna Employer-established fund  Various fund amounts available  Generally half deductible amount  Fund rollover options  Fund typically forfeited at termination of employment or termination of plan  Health fund can be limited to: – Traditionally covered PPO expenses – IRS Section 213 deductible health expenses (ASC)  Rollover maximum  One fund per family, not member  Fund-tiering available

15. 15©2009 Aetna HRA* common plan designs  Underlying Plan deductible ranges – Individual range:$500 - $3,000($1,000 / $1,500 / $2,000) – Family range:$1,500 - $9,000($2,000 / $2,500 / $3,000)  Out-of-Pocket maximum – Individual range:$2,000 - $4,000 – Family range:$4,000 - $8,000  Fund ranges – Individual range:$350 - $1,000($500 / $750 / $1,000) – Family range:$750 - $3,000($1,000 / $1,500 / $2,000)  Underlying plan coinsurance levels: 80/60, 90/70 or 100/70  100% preventive care  Tiering – Standard is 2-tier (Individual or Family) – Each tier has one deductible to meet for the entire group Note: Effective member responsibility is a result of utilizing many of the plan design components as opposed to each component individually. * HRAs are currently not available to HMO members in Illinois.

16. 16©2009 Aetna Preventive care coverage  Generally 100% covered for each individual – Does not apply to fund or deductible  Preventive care schedule on Aetna Navigator ®  Covers medical services such as routine physicals, immunizations, screening, well-woman exams, well-child visits  Encourages employee to obtain preventive care

17. 17©2009 Aetna HRA* medical plan  Fund deductible coinsurance options – Fund pays member responsibility (deductible and member coinsurance) – Fund pays until exhausted (may or may not reduce deductible) – Before-fund deductible fund coinsurance (ASC only) – Deductible fund deductible coinsurance  Self-funded plans (ASC) – PPO, Aetna Choice ® POS II, Open Access Aetna Select SM  Fully insured plans – PPO, Open Access Managed Choice ® (POS) and Aetna Choice POS (HMO)  Optional standalone or integrated pharmacy and dental  Flexible plan designs *HRAs are currently not available to HMO members in Illinois

18. 18©2009 Aetna Additional options & features  Dental integration  Long Term Care premium reimbursement  Chronic & preventive medications  Incentives  Hybrid funding arrangement (insured plan, ASC fund)  Simple Steps To A Healthier Life ®  Informed Health ® Line  Medical management programs  Aexcel ®

19. 19©2009 Aetna Pharmacy integration  Real-time claim adjudication  Discounted cost of prescriptions applied to fund and/or deductible depending upon fund model  Once fund exhausted and deductible met, pharmacy plan can be: – Same or lower coinsurance level as medical, or – Copay plan  Participating pharmacy knows whether to collect anything from member – handled at point of sale with no balance billing  Price-A-Drug SM tool available to assist members

20. 20 Comparing HRA*, HSA*, FSA Note: HSAs can be purchased with a “limited purpose” HRA/FSA, post deductible HRA/FSA, suspended HRA, retirement HRA FeatureHealth Reimbursement Arrangement (HRA* or RRA) Health Savings Account (HSA*) Flexible Spending Account (FSA) EligibilityAll eligible employeesIndividual covered by high deductible health plan (HDHP) All eligible employees ContributorEmployer onlyEmployer, individual or both Employer, associate or both Roll-OverUsually yes, but at employer discretion YesNo Tax AdvantagedYes PortabilityNo, forfeit upon termination Employer has option to roll to RRA on retirement YesNo Ability to Earn Investment Income NoYesNo Rx Integration for HDHP AvailableRequiredN/A *HRAs and HSAs are currently not available to HMO members in Illinois

21. 21 Aetna HealthFund ® HRA* / HSA* Health Reimbursement Arrangement 819 customers 133 National 123 Key 290 Select 68 Small Group 52 full replacement plans* ~ 882K members High-Deductible Health Plan/HSA 9,712 customers 131 National 146 Key 350 Select 9,085 Small Group 51 full replacement plans* ~401K members HDHP/HSA ~75K members HDHP only As of 12/2008 Aetna’s HRA/HSA growth 1/02 – ~482 1/03 – ~39K 1/04 – ~160K 1/05 – ~359K 1/06 – ~463K 1/07 – ~826K 1/08 – ~1.29M * >1,000 lives *HRAs and HSAs are currently not available to HMO members in Illinois

22. 22©2009 Aetna Plan sponsor tools  Cost modeling  Pricing tool  Reporting

23. 23©2009 Aetna Consumer tools Aetna Navigator ® Plan Selection & Cost Estimator Tool

24. 24©2009 Aetna Consumer tools  DocFind ®  Hospital Comparison Tool  Plan Selection & Cost Estimator  Transparency Suite of Tools – Price and Clinical Quality  Cost of Care Tool  Healthwise ® Knowledgebase  Informed Health ® Line  Aetna InteliHealth ®  Simple Steps To A Healthier Life ®

25. 25©2009 Aetna Keys to success Set a strategy  Appropriate benefit structure, information and tools  A business culture actively communicating health care engagement concepts Member responsibility  $750 - $1000 bridge between deductible and employer fund/account contribution with appropriate coinsurance  Update benefit offerings regularly to stay in-sync with the overall strategy Engagement  Multi-year, cost controlling strategies that engage employees in managing their health  Provide information and tools for decisions about health, spending and overall wellness

26. 26©2009 Aetna Keys to success Wellness  Preventive care covered at 100%  In-depth education and communication including completion of Health Assessments Steerage to CDHP  CDHP as the lowest cost option  Lowering the required employee premium contribution and/or offer higher fund/account contribution

27. 27©2009 Aetna Engaging your employees and enabling behavior Four phases to an effective communications strategy Enrollment  Contribution strategy  Educate  Emphasize accountability 2 Post-Enrollment  Reinforce  Remind  Update 34 Pre-Enrollment  Engage Management  Advantages/Features  Employee role 1 Ongoing support  Motivate employees  Keep them engaged  Reintroduce resources

28. 28©2009 Aetna Why Aetna?  Experience  Innovation  Consumer communication and education  Integration  Plan design  Analysis and reporting

29. 29 Healthier employees Higher levels of engagement Innovative, client-centered solutions Lifelong optimal health Lower medical costs Higher productivity + + = Join the Change Ready today for the future of health care

30. 30 This material is for information only. 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 services. Aetna HealthFund HRAs are subject to employer-defined use and forfeiture rules, and are unfunded liabilities of your employer. Fund balances are not vested benefits. Investment services are independently offered through JPMorgan Institutional Investors, Inc., a subsidiary of JPMorgan Chase Bank. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. 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. Policy forms issued in OK include: HMO OK COC-5 09/07, HMO/OK GA-3 11/01, HMO OK POS RIDER 08/07, GR-23 and/or GR-29/GR-29N.www.aetna.com Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Health Inc., Aetna Health of California Inc., Aetna Health of the Carolinas Inc., Aetna Health of Illinois Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 06156. Each insurer has sole financial responsibility for its own products. ©2009 Aetna Inc. 32.25.102.1 (3/09)

31. 31©2009 Aetna Appendix

32. 32 HRA* Workflow (Medical HRA* pays first) Member sees Provider - presents ID card (no copay) - Member pays $0 Provider bills Aetna. Aetna adjudicates claim and determines what the Member owes. Is there enough money in the HRA Fund to cover the Member responsibility? Aetna pays Provider directly from the Fund. Member owes $0. Aetna pays Provider whatever it can, if anything, from the Fund and tells the Provider the exact amount to bill the Member. Provider bills Member. Member pays Provider. HRA$ Yes No *HRAs are currently not available to HMO members in Illinois.

33. 33 HRA* – how it works The Plan Pays 30% 10% *HRAs are currently not available to HMO members in Illinois.

34. 34 HRA* – how it works The Plan Pays Member Responsibility 30%10% *HRAs are currently not available to HMO members in Illinois.

35. 35 HRA* – how it works The Plan Pays Member Responsibility Fund 30%10% *HRAs are currently not available to HMO members in Illinois.

36. 36 HRA* – how it works The Plan Pays Member Responsibility Fund Helps Pay 30%10% *HRAs are currently not available to HMO members in Illinois.

37. 37 HRA* example year 1 30% 10% *HRAs are currently not available to HMO members in Illinois. ** For illustrative purposes only. Does not reflect events experienced by an actual participant. **

38. 38 HRA* example year 1 30%10% *HRAs are currently not available to HMO members in Illinois. ** For illustrative purposes only. Does not reflect events experienced by an actual participant. **

39. 39 HRA* example year 1 30% 10% *HRAs are currently not available to HMO members in Illinois. ** For illustrative purposes only. Does not reflect events experienced by an actual participant. **

40. 40 HRA* example year 2 30% 10% *HRAs are currently not available to HMO members in Illinois. ** For illustrative purposes only. Does not reflect events experienced by an actual participant. **