Medicare

With Retiree Health Access^®, you can obtain health coverage regardless of your current health status. You can choose medical and prescription drug plan options to replace the coverage Medicare provides.

You are eligible to enroll in a Retiree Health Access plan if you are at least 55 years of age with five years of service and a former employer that participates in the RHA program. You must also meet the following:

Your former employer's age and years' of service requirements.
You are no longer a full-time or part-time employee.
You are entitled to Medicare Part A.
You are enrolled in and paying for Medicare Part B.
You are otherwise eligible to participate in your former employer's retirement benefits program.

You may also enroll your dependents. If you have eligible dependents that are not eligible to enroll in Medicare, they may be eligible to enroll in a coverage option for those who are not eligible for Medicare. Your Personalized Enrollment Worksheet lists your eligible dependents and coverage options.

You may also get Medicare Part D prescription drug coverage through a Medicare Advantage plan. Log in and register to check your plan options charts and find out what is available to you.

Plan Overviews

The Aetna Medicare^SM Plan (PPO) plan provides benefits beyond those covered in Original Medicare. It includes preventive benefits at no additional cost. You may see a doctor and/or visit a hospital in or out of Aetna’s Medicare network. Services received from participating network providers will generally cost you less.
The Aetna Medicare^SM Plan (PPO) with an Extended Service Area (ESA) provides the freedom to see a doctor and/or visit a hospital in or out of Aetna's Medicare network. If you access care from out-of-network providers, you will receive covered benefits at the in-network level of cost sharing as long as the provider accepts the plan. You also have access to preventive benefits beyond Original Medicare at no additional cost.
The Aetna Medicare^SM Plan (HMO) requires that you select a primary care physician (PCP) and receive referrals for specialty care except in an emergency/urgent care situation or for out-of-area dialysis services. You pay a flat fee (copay) for most covered expenses or pay a percentage of the expense (coinsurance). You can contact us at any time to change your PCP.
Aetna Medicare Rx^® (PDP) helps pay the cost of covered Part D prescription drugs. You must have Medicare Part A and/or be enrolled in Medicare Part B, and live in the plan service area.
Aetna Supplemental Retiree Medical (SRM) Plan* is a traditional plan that’s similar to a non-network supplemental plan. It covers out-of-pocket costs for deductibles, copays and coinsurance not covered by Medicare Parts A or B. Referrals are not required.
Aetna Group Medicare Supplement Insurance Plan insurance policy (for Florida Residents only) is a group Medicare supplement plan. It covers out-of-pocket costs for deductibles, copays and coinsurance not covered by Medicare Parts A and B. Referrals are not required.
Aetna Traditional Choice^® Plan provides coverage for certain amounts of out-of-pocket cost share for deductibles and coinsurance that Medicare Parts A and B do not pay. There are no network restrictions.
Aetna Dental^® PPO Plan provides access to a choice of dental services with no referral required for covered services.
Aetna Dental Preventive Care ^SM PPO provides access to preventive care and diagnostic procedures at no cost when you visit an Aetna Dental Preferred Provider Organization (PPO) Plan dentist.

*Note: In the states of Kentucky and New York the name of this group health product is Aetna Retiree Medical Plan. In the state of Kansas and in Puerto Rico, the name of this group health product is the Aetna Retiree Medical Insurance Plan. In all other states, the name of this group health product is the Aetna Supplemental Retiree Medical Plan.

Aetna Medicare^SM Plan (PPO)

You can choose a PCP from the online provider directory, DocFind^®, for yourself and each covered family member.
You have the freedom to see a licensed provider or visit a hospital out of network as long as they are eligible to receive payment from Medicare and agree to accept your plan. Services received from participating network providers generally will cost less than receiving services from out-of-network providers.
The plan covers preventive benefits beyond Original Medicare at no additional cost, which include routine exams and certain cancer screenings.
Enjoy free health and wellness programs.
Get discounts on vision care, hearing aids, vitamins and more.

Aetna Medicare^SM Plan (PPO) with an Extended Service Area (ESA)

You can choose a PCP from the online provider directory, DocFind^®, for yourself and each covered family member.
You have the freedom to see a doctor and/or visit a hospital out of network.
If you access care from out-of-network providers, you will receive benefits at the in-network level of cost sharing as long as they are eligible to receive payment from Original Medicare and agree to accept your plan.
Enjoy free health and wellness programs.
Get discounts on vision care, hearing aids, vitamins and more.

Aetna Medicare^SM Plan (HMO)

You choose a PCP from the online provider directory, DocFind^®, for yourself and each covered family member.
Your PCP provides routine, basic care and referrals to network specialists when needed.
Benefits are paid only when your PCP provides or refers care except, in an emergency, urgent care situation or out-of-area dialysis.
You share in the cost of your care by paying a flat fee (copay) for most covered services. For some services, you may pay a percentage (coinsurance) of the covered expenses. If you seek care on your own without a referral, neither Aetna nor Medicare will cover the costs.
The plan covers preventive benefits beyond Original Medicare at no additional cost, which include routine exams and certain cancer screenings.

Aetna Medicare Rx^® (PDP)

This is a Medicare Prescription Drug Plan (PDP). It provides coverage to help pay the cost of covered Part D prescription drugs.
You have access to more than 60,000 network pharmacy locations.
Coverage includes a choice of top generic and brand-name Part D prescription drugs used by Medicare members.
This plan includes services that make it easy to get the medications you need, when you need them. They include:

– Aetna Rx Home Delivery^® Service. You can order up to a 90-day supply of medications you use regularly delivered to your home or another location of your choice at no additional cost for standard shipping.

– Aetna's Specialty Pharmacy^®. You can get free, confidential delivery at home or another location of hard-to-fill prescriptions including self-injectable medications and medications that require refrigeration or special handling.

Aetna Supplemental Retiree Medical (SRM) Plan

This is a traditional plan that's similar to how a non-network supplemental plan works. It provides coverage that may include out-of-pocket costs for deductibles, copays and coinsurance not covered by Medicare Parts A and B.
After visiting your doctor or hospital, Medicare will forward claims with remaining balances directly to Aetna for payment according to your plan benefits. You are responsible for any remaining balances.
You have the freedom to choose any licensed doctors and/or hospital.
No referrals are necessary.
Virtually no claim forms to submit for benefits covered by Medicare.

Aetna Group Medicare Supplement Insurance Plan** insurance policy (for Florida Residents only)

This plan covers out-of-pocket costs for deductibles, copays and coinsurance not covered by Medicare Parts A and B.
After visiting your doctor or hospital, Medicare will forward claims with remaining balances to Aetna directly for payment according to your plan benefits. You are responsible for any remaining balances.
You have the freedom to choose any licensed doctors and/or hospital.
No referrals are necessary.
Virtually no claim forms to submit for benefits covered by Medicare.

** Plan High Deductible F and Plan K are not available in the state of Florida.

Aetna Traditional Choice^® Plan

This plan covers certain amounts of out-of-pocket cost share for deductibles and coinsurance that Medicare Parts A and B do not pay.
Medical claims for Medicare covered services are submitted to the federal Medicare program for payment. This plan pays the remaining amount not covered by Medicare. The amount the plan covers depends on the specific plan you choose. Generally, you pay any remaining balances.
You have the freedom to see any licensed doctors and/or visit any hospital.
No referrals are necessary.
Virtually no claim forms to submit for benefits covered by Medicare.
Get discounts on vision care, hearing aids, vitamins and more.

Aetna Dental^® PPO* Plan

Access affordable coverage on dental cleanings, X-rays, restorative work and more.
You can see a dentist in or out of network; you’ll likely save more when your dentist is within our network.
To find a dentist in network, visit DocFind^®, our online directory of providers.

Aetna Dental Preventive Care ^SM PPO*

Pay nothing for preventive care and certain diagnostic procedures when you see an Aetna Dental Preferred Provider Organization (PPO) dentist.
To find a PPO provider, visit DocFind^®, our online directory of providers.
There is no deductible to meet and no copay to pay.

* In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN).

Dental PPO plans are underwritten and/or administered by Aetna Life Insurance Company (Aetna). Policy form numbers in Oklahoma include: GR-9 and/or GR-9N, GR-23, GR-29 and/or GR-29N.

Vital Savings by Aetna^®

Get discounted fees (in most instances) negotiated by Aetna Life Insurance Company for dental care expenses and other health care services.
As a discount program, Vital Savings has no waiting periods, pre-existing exclusions, maximums, claims to file, deductibles or copays.
Your bill to participate in the Vital Savings program will come from Aetna, and you must make your payment to Aetna.
To find out about discounts on dental care and other health care services, call 1-866-36-VITAL (84825) (mention code 882016-020) or visit the Vital Savings by Aetna website http://www.vitalsavingsbyaetna.com/default.aspx.

Note: The Vital Savings by Aetna^® program (the “Program”) is not insurance. The program does not meet the Minimum Creditable Coverage requirements in Massachusetts (MA). It provides Members with access to discounted fees according to schedules negotiated by Aetna Life Insurance Company for the Vital Savings by Aetna discount program. The range of discounts provided under the Program will vary depending on the type of provider and type of service received. The Program does not make payments directly to the participating providers. Each Member must pay for all services or products but will receive a discount from the providers who have contracted with the Discount Medical Plan Organization to participate in the Program. Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, 1-866-368-4825, is the Discount Medical Plan Organization. www.vitalsavingsbyaetna.com.

It is not available in Vermont (VT) and Montana (MT).

Oklahoma form numbers for discount programs are: GR-96402-02 04-09

How Medicare Works

Medicare is a federal health insurance program for individuals age 65 and older. Certain disabled individuals who are under age 65 can also have Medicare insurance. Medicare consists of four different parts. Each part covers specific services and has different costs for the services covered.

Medicare Options

Medicare Service	Coverage	Cost
Part A	Helps cover inpatient care in hospital, skilled nursing facility, hospice and home health care.	Most people don’t need to pay a premium for Medicare Part A because they have contributed the required amount of payroll taxes during their working years. Part A pays benefits once you have met a deductible. The deductible is based upon benefit periods.
Part B	Helps cover doctors’ services, emergency, outpatient care and home health care. Also covers some preventive services.	You pay a monthly premium for Medicare Part B, which is usually deducted from your Social Security check. Medicare Part B pays benefits once you have met an annual deductible.
Part C	If you have Medicare Parts A and B, you can choose to enroll in and receive coverage under Medicare Part C (Medicare Advantage Plan). You may get more benefits than Original Medicare such as health care information and tools and discounts on hearing and vision products. RHA offers this type of plan, partnering with Aetna, a private insurance company approved by Medicare.	You pay a monthly premium to your private insurance company. Medicare Advantage Plans have an approved Medicare contract.
Part D	Helps cover the cost of prescription drugs. Available through a Medicare Advantage plan or through a separate or “standalone” Medicare Prescription Drug Plan.	The premium for Part D depends on where you live, which plan you choose and other eligibility factors. Please check your plan documents for the plans available to you.

Please note that there may be non-Medicare plan(s) available to you that can also coordinate with Original Medicare.

How Medicare Works with Your Retiree Health Access Plan

The Aetna Medicare^SM Plan (PPO), Aetna Medicare^SM Plan (PPO) with an Extended Service Area (ESA), and Aetna Medicare^SM Plan (HMO) provide Medicare Part A and Part B coverage.
The Retiree Health Access prescription drug plans provide Medicare Part D coverage.

For more about your Retiree Health Access plan options:

For more about Medicare

Visit the Medicare website at http://www.medicare.gov/ or call 1-800-MEDICARE.

Prescription Drug Benefits

The Retiree Health Access^® offers Medicare Part D prescription drug plans to help you with the cost of retail and mail order service prescriptions. The plans provide prescription benefits in accordance with coverage options and rules established under the Medicare Modernization Act.

As you review your prescription drug plan options, keep in mind that each option follows the basic structure of Medicare Part D coverage. In addition, when you enroll in a Retiree Health Access prescription drug plan, you can take advantage of certain benefits and services.

How Medicare Part D Works

Medicare Part D has four stages of cost-sharing–deductible, initial coverage, the coverage gap (or ”donut hole”) and catastrophic coverage.

The amount you pay for prescriptions at each stage depends on the plan option you choose and the type of drug used to fill your prescription.

Plan option: Log in and register to check your plan options and see how costs are shared under each option.
Type of drug:
- You pay the least for generic drugs.
- You pay more for brand-name preferred drugs listed on the plan’s formulary.
- You pay the most for brand-name non-preferred drugs–those not listed on the plan’s formulary.

The formulary is a list of preferred, FDA-approved drugs. You can look up your drugs on the list and see whether or not generic equivalents are available.

When you enroll in a Retiree Health Access prescription drug plan, you get Medicare Part D coverage, plus all the benefits and services that come with being an Aetna member.

You can visit any of more than 60,000 pharmacies in Aetna's network to have prescriptions filled.

To find a participating retail pharmacy near you, use the online provider directory, (DocFind^®).

To fill long-term (up to a 90-day supply) prescriptions, you can use the Aetna Rx Home Delivery^® service.

You can use Aetna's Specialty Pharmacy^® for hard-to-fill prescriptions such as injectables and medications that require refrigeration or special handling.

You can look up your drugs on Aetna's formulary. The formulary is a list of preferred medications that are FDA-approved.

Secure Member Website

Once you're enrolled in an Aetna plan, you'll be able to use Aetna Navigator^®, a secure member website that offers self-service convenience, up-to-date health information, consumer tools and much more. You'll need to register first, then you can log on to:

Find Aetna Medicare network doctors, dentists, hospitals, pharmacies and other providers near you.
Get information about your plan's coverage, benefits, programs and special features.
Review claims information, including payments made.
Use cost-of-care tools to check the estimated average costs of medical services and prescription drugs in your area.
Compare local hospitals on the criteria most important to you.
Take care of personal benefits business such as requesting a replacement ID card and printing claim forms.

Find reliable, up-to-date health information on hundreds of topics.

Special Programs and Services

Your RHA plan includes a variety of programs and services that help you get well and stay healthy. They include:

Perfect Aging Program—provides simple, free access to information, resources and support that impact your health and quality of life. As a member, you can access our award-winning website or call our toll-free number to talk to a Perfect Aging Health Advisor, available 24/7.

Health and Wellness Discounts

Aetna Vision^SM discount program—save on routine eye exams and select items and services, including LASIK surgery.

Aetna Hearing^SM discount program—save on hearing aids, comprehensive hearing tests and hearing-aid services from licensed professionals, in certain areas.

Aetna Natural Products and Services^SM discount program—offers reduced rates on acupuncture, chiropractic care, massage therapy and dietetic counseling through American Specialty Health Incorporated (ASH) and its subsidiaries. ASH also offers discounts on over-the-counter vitamins, herbal and nutritional supplements and natural products. Through Vital Health Network, members can receive a discount on online consultations and alternative remedies provided by medical doctors for a variety of conditions.

Aetna Fitness^SM discount program—access preferred rates on gym memberships and discounts on at-home weight-loss programs, home fitness options and one-on-one health coaching services; not available in all states.

Aetna Weight Management^SM discount program—access discounts on eDiets^® diet plans and products, Jenny Craig^® weight-loss programs and products and Nutrisystem^® weight-loss meal plans.*

*Discounts do not apply to some plans, programs, food and/or products.

Note: The products and services described under “Special Programs and Services” are neither offered nor guaranteed under one contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the Aetna Medicare Plan grievance process. Availability may vary by plan.

Wellness Programs

Availability may vary by plan.

Healthy Lifestyle Coaching—speak to a licensed professional by phone to develop a specific program based on your health needs; learn how to manage weight and/or stress, quit smoking and maintain good health.

Fitness Program—enjoy a free fitness center membership at participating locations. Receive a Fitness Home Pak pack upon request. The Pak includes resistance bands, an exercise ball, pedometer and educational materials.

Core Features

Availability may vary by plan.

Aetna Health Connections^SM Disease Management Program—offers educational materials and resources designed to help you live better with conditions such as diabetes, heart problems, asthma or arthritis.

Personal Health Record—keep track of essential health information in a single, secure location online; get tips on alternative therapies; track important health numbers, like blood pressure, weight and other health markers in easy-to-understand graphs and charts.

Annual preventive reminders—can help you remember to get important vaccinations, like flu shots, and colorectal cancer screenings.

Women’s health reminders—receive timely screening reminders for breast and cervical cancers.

Nurse Case Managers—get personalized support for chronic and/or serious health conditions from specially trained medical professionals.

Informed Health^® Line¹—talk directly with our experienced registered nurses about thousands of health topics using our 24-hour toll-free number.

National Medical Excellence Program^®—offers access to our national Institutes of Excellence^TM Transplant Network for transplants and transplant-related services. It includes medical management through the recovery period. Case management is also provided for members with rare or complex conditions requiring specialized treatment.

Patient Safety through Care Considerations—get timely alerts and additional reminders that can help you stay healthy. These messages may warn you of potentially dangerous drug combinations, or remind you of important tests and screenings.

¹While only your doctor can diagnose, prescribe or give medical advice, the Informed Health Nurses can provide information on more than 5,000 health topics. Contact your doctor first with any questions or concerns regarding your health care needs.

This material is for informational purposes only. This communication does not include all provisions of the plans described. Eligibility rules apply for all plans. Retiree Health Access reserves the right to change or terminate benefit plans at any time.

Benefits coverage is provided by Aetna Health Inc., Aetna Health of California Inc., and/or Aetna Life Insurance Company. Benefits, limitations, service areas and premiums are subject to change on January 1, 2012. You must be entitled to Medicare Part A and continue to pay your Part B premium and Part A, if applicable. A Medicare Advantage organization with a Medicare contract. A Medicare approved Part D sponsor.