Quality health plans & benefits
Healthier living
Financial well-being
Intelligent solutions
Aetna
Open Access® Managed
Choice® POS for
Our healthy:
Health care built
around people
USA
Networks




Membership


Medical
Management
Health
Information
Technology
International
Presence
Our commitment to the employees and family
members of Great Lakes Behavioral Health is more
access, more choice and more information
concerning their health care benefits.
>Over 1 million health care professionals
>580K primary care doctors & specialists
>5400 hospitals
22.7 Million medical members
14.5 Million dental members
14.1 Million Pharmacy Members

Wellness Programs
Disease Management Programs

Aetna Navigator℠

Aetna Mobile

Medquery Powered by the CareEngine®

Over 71K health care professionals worldwide
More than 445,000 international members
Operations in Europe, Asia, Africa & the Middle East

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2015 Benefit Plan Offerings
Plan Type
Benefit Highlights
Aetna
PPO 1
Aetna
PPO 2
Aetna
PPO 3
Aetna
PPO 4
MC OA $250
MC OA $500
MC OA $1,000
MC OA HDHP
Out-ofNetw ork
In-Netw ork
Lifetime Maximum
Out-ofNetw ork
In-Netw ork
Unlimited
Out-ofNetw ork
In-Netw ork
Unlimited
Unlimited
Out-ofNetw ork
In-Netw ork
Unlimited
Deductible
Individual
$250
$500
$500
$1,000
$1,000
$2,000
$2,000
Family
$500
$1,000
$1,000
$2,000
$2,000
$4,000
$4,000
100% aft Ded
80% aft Ded
90% aft Ded
70% aft Ded
90% aft Ded
70% aft Ded
100% aft Ded
80% aft Ded
$500
$3,000
$1,500
$5,000
$2,000
$6,000
$2,000
$3,500
$1,000
$6,000
$3,000
$10,000
$4,000
$12,000
$4,000
$7,000
Primary
$25
80% aft Ded
$25
70% aft Ded
$25
70% aft Ded
100% aft Ded
80% aft Ded
Specialist
$40
80% aft Ded
$40
70% aft Ded
$40
70% aft Ded
100% aft Ded
80% aft Ded
100% (Not
Subject to Ded)
80% aft Ded
100% (Not
Subject to Ded)
70% aft Ded
100% (Not
Subject to Ded)
70% aft Ded
100% (Not
Subject to Ded)
80% aft Ded
100% aft Ded
80% aft Ded
90% aft Ded
70% aft Ded
90% aft Ded
70% aft Ded
100% aft Ded
80% aft Ded
Coinsurance
Maximum Out-of-Pocket
Individual
Family
Office Visits
Preventive Care
Hospitalization Services
Emergency Room
$150 (Waived if Admitted)
$150 (Waived if Admitted)
$150 (Waived if Admitted)
Generic
$10
$10
$10
Preferred Brand
$25
$25
$25
Non-Preferred Brand
$40
$40
$40
Mail Order
2 X
2 X
2 X
100% aft Ded
Prescription Drugs
100% aft Ded
3
Network
Provider collaboration and network
contracting Nationally and in Western
Pennsylvania
4
Network
Our network strategy offers choice, while
driving the outcomes you need.
Broad
national
network
Complete
Western PA
network
Efficiency
Quality
Savings
5
Transforming the market – complete provider
access with more choice for Aetna members
Inpatient
Outpatient
Inpatient
Allegheny
Health
Network
Professional
Allegheny Health Network
Ongoing long term contract until Oct 1,2017
UPMC
Health
System
Outpatient
Professional
UPMC
Available in-network July 1, 2011
Contract through December 31, 2017
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Information is Power
Consumer Tools and Member Experience
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Aetna Navigator®
With Aetna’s secure member website*, members can
better manage their health and benefits with easy online
access to:
 Claims, Balances, and eligibility information
®
 Find a Doctor with DocFind www.aetna.com/docfind
 Personal Health Record and Health History Report
 Health Assessments through Simple Steps To A Healthier Life
®**
 Doctors’ Rates, Medical Procedure by Facility Cost Tool,
Estimate the Cost of Care
 Hospital Comparison Tool
 Price-A-Drug***
®
 Health information with SmartSource** and Aetna InteliHealth
* Available to members with Aetna benefits. An Aetna medical or Aetna dental plan is not required.
** Availability varies by plan
*** Aetna pharmacy required
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Innovative online tools
Meet your employees at teachable moments
 We provide your employees with the
online tools they need to shop around,
make informed decisions and become
smarter consumers
Aetna Navigator
 Our transparency tools are the first in
the industry to:
Ask Ann
Price A Drug
MPE
SmartSource
 calculate personalized cost
estimates based on claim
adjudication logic
(Member Payment Estimator)
 provide physician price, clinical
quality and efficiency information
 offer site-specific cost information
for hospitals and other facilities
DocFind
PHR
www.aetnatools.com
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10
Estimate the Cost of Care tool
•
Available to all Aetna Navigator®
registered subscribers
•
Provides average costs for
approximately 200 medical and
dental procedures, tests, office
visits, diseases and conditions
•
Access to Price-A-DrugSM with costs
for approximately 9,000 prescription
drugs
•
Illustrates potential cost advantage
of using in-network providers
•
Uses data sourced directly from
Aetna’s systems
•
Available at no additional cost to
members or plan sponsors
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Net cost is really what matters
Pittsburgh market examples
Facility
Allowed
charges
Example:
Facility A
$896
MRI of the
lower back
Facility B
$699
Freestanding site C
$336
Freestanding site D
$425
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Putting employees in the driver’s seat of
their health journey
Aetna
Mobile
Assessing symptoms to
make better care choices
with iTriage®
An easy-to-use secure tool that
provides members with access
to valuable tools and
information about their health
with Aetna Navigator℠
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Simple Steps To A
Healthier Life Program
Online programs* to help you reach your health
goals
•
Manage your weight: Reach your goal weight, and boost
how active you are with HealthMedia® BALANCE™.
•
Deal with stress: Find out where your tension comes
from, and get proven strategies to stay calm under
pressure with HealthMedia® RELAX™.
•
Eat healthier: Learn better eating habits for life with
HealthMedia® NOURISH™.
•
Sleep better: Beat sleepless nights with strategies from
HealthMedia® OVERCOMING™ Insomnia.
•
Quit smoking: Get a quit plan that uses your strengths to
help you get past old roadblocks with HealthMedia®
BREATHE™.
•
Be happier: Everyone gets the blues at one time or
another. Sometimes it’s more serious. Get the confidential
support you need with HealthMedia® OVERCOMING™
Depression.
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Aetna Health ConnectionsSM Disease Management
Focus on 35 Chronic Conditions
Vascular
Orthopedic / Rheumatologic
Neuro-Geriatric
Renal
 Heart failure
 Osteopenia*
 Geriatrics
 Diabetes – adult & pediatric
 Osteoporosis
 Migraines
 Chronic kidney
disease
 Coronary artery disease (CAD)
 Osteoarthritis* (OA)
 Peripheral artery disease (PAD)
 Seizures
 Rheumatoid arthritis (RA)
 Hypertension – adult &
pediatric (high blood pressure)
 Chronic lower back pain
 Cerebrovascular disease/stroke
(CVA)
Gastrointestinal
 Hyperlipidemia (high
cholesterol)
Pulmonary
 Asthma – adult & pediatric
 Chronic obstructive pulmonary
disease (COPD)
 Gastro esophageal reflux
disease (GERD)
 Parkinsonism
Cancer
 General cancer*
 Breast cancer
 Peptic ulcer disease
 Lung cancer
 Inflammatory bowel disease
(IBD) (Crohn’s disease)
 Lymphoma/
leukemia
 Chronic hepatitis
 Prostate cancer
 Colorectal cancer
 End stage renal
failure
Other
 Weight
management –
adult & pediatric
 Cystic Fibrosis –
adult & pediatric
 HIV
 Hypercoagulable
state
 Sickle cell disease
– adult & pediatric
 Depression*
* Addressed as a comorbid
condition
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Questions?
15
Sources
1 “Kaiser/HRET
Survey of Employer-Sponsored Health Benefits, 1999-2012,” The Kaiser Family Foundation and the Health Research & Educational
Trust, November 2012.
2 ”Roundtable on Value & Science-Driven Health Care,” Institute of Medicine of the National Academies, September 2012.
3 “Employer Survey on Purchasing Value in Health Care,” Towers Watson/National Business Group on Health, March 2012.
4 Troost JP, Rafferty AP, Luo Z, Reeves MJ. Temporal and regional trends in the prevalence of healthy lifestyle characteristics: United States, 1994-2007.
Am J Pub Health. 2012; 102(7):1392-1398.
5 Sharon Begley, “As America’s Waistline Expands, Costs Soar,” Reuters, April 2012.
6 Based on the 2013 national average annual premiums for covered workers ($5,884, single; $16,361, family).
7 Sherman BW, Lynch WD. Connecting the dots: Examining the link between workforce health and business performance. Am J Man Care. 2013
(in press).
8 “Accountable Care Payers: Partners in a Changing Paradigm,” KLAS, June 2013.
9 Claffey TF, Agostini JV, Collet EN, Reisman L, Krakauer R. Payer-provider collaboration in accountable care reduced use and improved quality in Maine
Medicare Advantage plan. Health Aff. 2012; 31(9):2074-2083.
10 Medical results are generated by the Pioneer Medicare population from Banner Health Network.
11 Results are from Aetna’s generic prescription program with Optimus.
12 Aetna One℠ Premier Health Concierge reports.
13 Results based on Aetna In Touch Care report findings, 2012.
14 “Metabolic Syndrome and Employer Sponsored Medical Benefits: An Actuarial Analysis,” Milliman, March 2006.
15 Aetna disease management program dashboards (initial engagement vs. step-downs), February 2012.
16 Based on historical data from July 1, 2011, to June 30, 2012, comparing the cost of cases performed at Institutes of Quality® (IOQ) facilities with that
of cases performed at non-IOQ facilities (specific customer savings will vary).
17 Health economic savings model, Aetna book of business, 2011.
18 Aexcel book of business study, 2012.
19 “Health Information Exchanges: Rapid Growth in an Evolving Market,” performance report, KLAS, June 2011.
20 “Metabolic Syndrome and Employer Sponsored Medical Benefits: An Actuarial Analysis,” Milliman, March 2006.
21 “What Is Metabolic Syndrome,” American Heart Association, May 2012.
22 Aetna committed to a 25 percent metabolic syndrome reduction. Guarantee population defined as individuals who complete a baseline metabolic
syndrome screening in year one and a follow-up screening in year two (minimum 12 months apart). Receive the guarantee by achieving at least 50
percent participation in both year one and year two screenings. Available to groups with a minimum of 300 eligible employees. Not available on a
fully insured basis in all states. Please contact your broker or Aetna representative for additional details on state availability.
23 Sherman BW, Lynch WD. Connecting the dots: Examining the link between workforce health and business performance. Am J Man Care. 2013
(in press).
24 Wei HG, Rosenberg S, Shnaiden T, Jacques J, Steinberg G, Reisman L. Clinical validity of alerts generated by the CareEngine claims-driven decision
support engine. AMIA Annu Symp Proc. 2008 Nov 6:1171.
25 “Accountable Care Payers: Partners in a Changing Paradigm,” KLAS, June 2013.
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Thank you
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies,
including Aetna Life Insurance Company and its affiliates (Aetna).
This material is for information only. Health benefits and insurance plans contain exclusions and limitations. Health information
programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health
care professional. The CareEngine is a proprietary technology platform developed by ActiveHealth Management, an Aetna
company. In conjunction with clinicians, the CareEngine continuously analyzes claims and other data against evidenced-based
best practices and alerts the members and their physicians about possible care gaps and other inconsistencies. Information is
not a substitute for diagnosis or treatment by a physician or other health care professional. The Aetna Personal Health Record
should not be used as the sole source of information about the member’s medical history. 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 We are located at 151 Farmington Ave., Hartford, Connecticut 06156.
The Aetna name and logo are registered trademarks.
Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark
of Apple Inc.
©2013 Aetna Inc.
00.25.281.1 (11/13)
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