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Aetna HealthFund
October 2006
What is Aetna HealthFund?
Innovative approach to health benefits that gives you more control over who delivers your care
and how your health care dollars are spent
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You have the flexibility to decide how to spend your benefit dollars and the plan helps you
manage your health care and its associated costs throughout the year
Preventive Care covered at 100%
(in-network only)
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Employee
Employee + 1
Family
The Health Fund
$750*
$1,125*
$1,500*
Annual Deductible**
$1,500
$2,500
$3,000
Traditional Medical Coverage
In-Network Coinsurance Limit
Out-of-Network Coinsurance Limit
Hospital:80% Inova/70% non-Inova in-network/60% out-of-network
Other Services: 80% in-network/60% out-of-network
$2,000 per individual $2,000 per individual
$2,000 per individual
$4,000 per family
$4,000 per family
$4,000 per individual
$4,000 per individual $4,000 per individual
$8,000 per family
$8,000 per family
Depending on whether you are in an employee only, employee +1 or family plan, you are responsible for meeting the Annual Deductible
outlined above. Any dollars you have in your Fund can be used towards meeting this deductible. Once this Annual Deductible has been met,
your medical plan will reimburse benefits based on coinsurance (i.e., 80%). Regardless of whether you are in an employee only, employee
+ 1 or family plan, you are responsible for meeting the coinsurance limits outlined above. The most you will have to pay as an individual in
coinsurance is $2,000 for in-network coverage/$4,000 for out-of network coverage. The most your family will have to pay in coinsurance is
$4,000 for in-network coverage/$8,000 for out-of network coverage. Once your coinsurance limit is met, benefits will be paid at 100% for the
remainder of the year. NOTES: * This amount will be added to your Fund each year. Your beginning Health Fund amount may be more if
you have rollover dollars from the previous year. **This Annual Deductible can be satisfied by one member or any combination of family
members.
Important: Read all details about this plan before you enroll as this is very different from our other plans.
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Aetna HealthFund is Made Up of Three Elements
1.
An underlying deductible-based health insurance plan
2.
A fund or account that you can use to help pay for qualified, out-of-pocket
medical expenses
3.
Interactive tools and information to help you make informed health care decisions
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How Does the Aetna HealthFund Work?
In-Network Preventive Care
Covered at 100 percent
Preventive Services
The Health Fund
Employee
Responsibility
Traditional
Medical Coverage
For out-of-pocket medical and
drug expenses up to Health Fund
amount. Unused portions roll over
to next year.
You pay medical expenses until you
meet deductible. Can be offset by
Health Fund rollover.
Coverage for services and
conditions defined by the plan
design. Takes effect when the
deductible (annual Inova Health
Fund allocation plus the Employee
Responsibility) is satisfied.
Underlying this basic plan design are a variety of on-line tools and other resources
allowing members to take better care of themselves and find help when needed.
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How Does Aetna HealthFund Work for
Prescription Drugs?
The Health Fund
Employee
Responsibility
Traditional
Medical
Coverage
Employee does not pay
at the pharmacy
Employee pays discounted
cost at the pharmacy
Employees pays copays at
the pharmacy (same copays
as the PPO plans)
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Aetna HealthFund Overview
Consumer
Online
Health Tools
• Health Management Tools
Health Care
Marketplace
Seek
Information
Seek
Care
• Hospital Comparison Tool
• Hospitals
• Pharmacy
• Provider Profiles &
Information
• Prescription Drug
Information
• Providers
• Lab/Ancillary
Seek
Help
• Health Library & News
• Financial Tools
• Price-a-medical
procedure
• Price-a-drug
• DocFind
• Price and quality
transparency
Informed Health Line
24/7 Nurse Advice and Proactive
Outreach, Education and Support for
High Risk Individuals
Connect to www.aetna.com for access to Aetna Navigator,
a personalized secure site allowing you to order ID cards,
check the status of your fund, deductible, and gather
health information.
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Aetna HealthFund Example
The Smiths are a family of four. Dwight (43) and Sherrie (38) have two children – Tiffany (12) and Tyler
(7). In the past they have experienced relatively good health. Tiffany is managing diabetes, but her
condition is under control.
Sherrie Smith
Dwight Smith
Tiffany Smith
Tyler Smith
Year 1 and Year 2 in the Aetna HealthFund plan were typical
Year 3 was marked by several serious health concerns including:
• Annual OB/GYN visit
in January
• Found out she was
3-weeks pregnant in
April
• Pre-natal preventive
care from April December
• Normal labor and
delivery in December
• Suffers mild heart
attack in October
• Follow-up office
visits and
prescription drugs
• Managing diabetes
since age 9
• 3 office visits and
lab tests
• Monthly insulin
prescription
• Preventive care doctors
visit
• Prescription drugs for ear
infection
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Year 1
Aetna HealthFund Example (cont’d)
Annual Health Fund allocation from Inova
Expenses:
B1. Preventive Care Services – $500
$1,500
A1
$1,200
B1+C1+D1
C1. Doctor’s Office Visits – $200
Year 2
D1. Prescription Drugs – $500
Amount paid by Inova’s Preventive Care benefit (B1)
$500
Amount paid from Inova’s annual Health Fund allocation (C1+D1)
$700
E1
Fund Rollover to Year 2 (A1-E1)
$800
F1
Health Fund Balance Year 2: $800 from Year 1 (F1), plus $1,500 for Year 2
Expenses:
B2. Preventive Care Services – $500
$2,300
A2
$1,500
B2+C2+D2
C2. Doctor’s Office Visits – $300
D2. Prescription Drugs – $700
Amount paid by Inova’s Preventive Care benefit (B2)
$500
Amount paid from Inova’s annual Health Fund allocation (C2+D2)
$1,000
E2
Fund Rollover to Year 3 (A2-E2)
$1,300
F2
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Aetna HealthFund Example (cont’d)
Year 3
Health Fund Balance Year 3: $1,300 from Year 2 (F2), plus $1,500 for Year 3
Expenses:
B3. Cardiac Procedure – $15,000
$2,800
$26,600
C3. Pregnancy (Normal Delivery) – $8,500
A3
G3=
B3+C3+D3+E3+F3
D3. Preventive Care Services – $900
E3. Doctor’s Office Visits – $600
F3. Prescription drugs – $1,600
Amount paid by Inova’s Preventive Care benefit
$900
D3
Amount paid from Inova’s annual Health Fund allocation
$1,500
Amount paid from Health Fund Carry-Over toward Employee Responsibility
$1,300
F2
$200
H3
Amount paid by You for remainder of your Employee Responsibility ($1,500-F2)
Amount paid by You in Traditional PPO Health Coverage
$4,000
(20% of $22,700* = $4,540) but you pay only up to the $4,000 coinsurance limit
Amount paid by Inova in Traditional PPO Health Coverage
$18,700
(80% of $22,700*) + ($4,540 -$4,000) = $18,160 + $540
Fund Rollover to Year 4
This is the
Traditional
Medical
Coverage
portion of the
Plan.
$0
* $26,600 (G3) - $900 preventive benefit (D3) - $1,500 Inova fund allocation - $1,300 fund carryover (F2) - $200 employee responsibility (H3) = $22,700
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How Does the Health Care Flexible Spending Account
Work with Aetna HealthFund?
 If you enroll in Aetna HealthFund you may also enroll in the Health Care
Flexible Spending Account (FSA)
 Contributions to a FSA could help you meet your out-of-pocket responsibility
 If a service is covered by both the FSA and your HealthFund plan, benefits
would first be paid by your HealthFund plan

Any out-of-pocket amounts (i.e., amounts you are responsible for paying) covered by
but not paid by your HealthFund plan could be automatically paid from your FSA
 Remember, contributions to a FSA are “use-it-or-lose-it” each year

Rollovers are not currently permitted under IRS regulations
 It is important to plan carefully and conservatively
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Is Aetna HealthFund for You?
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Here are some ways to determine if this plan is right for you:
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Review your benefit usage for the past year, using Aetna Navigator or by
reviewing explanation of benefits statements from your previous plan
Determine your medical and prescription drug expenses from last year
Try to account for expected changes in your medical and drug usage in the
coming year
Note the fund amount you will receive when you enroll in the plan
Also note the payroll contribution amount
Compare the fund amount to your expected expenses keeping in mind the
coinsurance amount you will pay if the fund is exhausted and the maximum
amount of coinsurance you will ever have to pay in a given year
Consider enrolling in the Health Care Flexible Spending Account (FSA)
 Note: If you or your spouse is enrolled in another plan, traditional coordination of
benefit rules apply.
To learn more about our 2007 medical plans, estimate personal health care costs and model the
impact under each plan, log on to Inova’s custom Aetna web site at http://custom.aetna.com/Inova
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Post Enrollment Tools and Support
Self-Service
Secure, Personal Website
Aetna Navigator™
Estimate the Cost of Care suite of tools
Health information on conditions & alternative options
Quality of participating providers
24 x 7 availability
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Telephone Self Service
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Aetna Voice AdvantageSM
24 x 7 availability
Check claim status, eligibility and benefits, request ID card
Option to connect to member services during business hours
Personal Touch
Member Services
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Extended hours – 8 a.m. – 6 p.m. eastern time
Toll-free (800) 862-5441
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Post Enrollment Tools and Support
Self-Service
Interactive Online Health and Wellness Program
Personal Touch
Speak to a Registered Nurse
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Simple Steps To A Healthier Life®
Health Risk Assessment Tool
Tailored Health Reports
Personalized Action Plan
Outreach programs
Informed Health® Line*, 24 x 7 Availability
Confidential
Health and wellness information
Promotes healthy lifestyles and disease prevention
Promotes communication with physicians
*While 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.
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