Edgewood ISD

1
Edgewood ISD

Benefits 2009
2
Low Alternate-Open Access Managed Choice
EE Only 0.00 Please review the full plan
description.
3
Low Matching -Open Access Managed Choice
EE Only 41.59 Please review the full plan
description.
4
High HMO- PCP Required
EE Only 182.22 Please review the full plan
description.
5
Edgewood ISDMonthly Rates
6
Healthy Beginnings

• High Risk
• (Members with conditions that could lead to
  preterm birth)
• History of Preterm Birth
• Hyperemesis
• Hypertension
• Diabetes
• Multiple Gestation (more than 1 baby)

• At Risk
• (Member has risk factors for preterm delivery)
• Age over 40
• Age under 19
• Smoker
• History of Preterm Labor
• African American

• One-step enrollment process for members call
  1-800-CRADLE-1

7
Natural Alternatives

• No extra cost! Discount services using specific
  providers
• Chiropractic Manipulation
• Acupuncture Therapy
• Massage Therapy
• Nutritional Counseling
• Simply pay the Discounted fee at the providers
  office.
• View the provider list at
• http//www.aetna.com/products/natalt_pdf.html
  
• Over-the-counter vitamins and supplements
• InterNatural - www.internat-aetna.com or
  1-800-643-4221
• WebVitamins, Inc. - www.va.webvitamins.com

8
Eye Med

• No extra cost FREE to all Aetna members DISCOUNTS
  on frames lenses.
• Vendors Pearle Vision, JC Penny, Sears, Target
  Optical, LensCrafters
• Customer Service 1-800-793-8616
• Pricing examples Your portionWOW!
• Your Portion
• Single Vision Lens 40
• Bifocal Lens 60
• Progressive (no line bi-focal lenses) 120
• Frames tier 40 off
• Lasik Discount 10-15 off
• Preferred provider selection
• 1-800-422-6600
• Contact Lens Replacement Program
• 1-800-391-LENS (5367)

9
Consumerism Tools at Work

• Aetna Navigator at www.aetna.com
• Check claims, forms, print temporary ID cards
• Email 24/7 Questions Concerns
• Estimate the cost of care Price a drug
• Hospital comparison tool

• Aetna Docfind
• Evaluate your health care provider
• Aetna InteliHealth- Medical and Dental
  www.intelihealth.com
• Informed Health Line 1-888-416-2277 24 Hour nurse
  line Toll Free

Customer Service OAMC Medical 1-888-416-2277
HMO Medical 1-888-247-1024 Pharmacy
1-800-238-6279
10
Helpful Links

• Aetna DocFind
• http//www.aetna.com/docfind/
• Aetna Navigator- Take a tour
• http//www.aetna.com/members/tour/index.html
• Aetna Forms
• http//www.aetna.com/members/health_coverage/forms
  /forms.html
• Pharmacy Look Up
• http//www.aetna.com/FSE/planType.do
• (Note 3 tiered Open Formulary Guide)
• Coverage Policy Bulletins
• http//www.aetna.com/about/cov_det_policies.html

11
Common QA
?

• Q Open Access Managed Choice plans do I need a
  referral Option 1 or Option 2?
• A No, it is open access plan as long as you do
  check to be sure the specialist or facility is in
  network. Labs and x-ray require a doctor order.
• Q What needs pre-authorization?
• A (1) Mental Health both inpatient and
  outpatient services
• (2)Medical inpatient care within 48 hours
• (3)Certain outpatient surgeries require
  authorization you can view the coverage policy
  bulletins for surgical services online.
• Q How do I access the EyeMed Vision Discounts?
• A Present your Aetna card to the vendor the most
  common are JC Penny, Sears, Pearle, Target
  optical, and LensCrafter locations.
• Q How often can I get my routine eye exam?
• A Every 24 months at the specialist co-pay at in
  network ophthalmologist.
• Q HMO plan (Option 3) do I need to select a
  primary doctor and get referrals?
• A Yes on the HMO a primary doctor (PCP) election
  is required.

12
Enrollment

• How to Enroll
• Acknowledgement form- Mandatory
• Enrollment is ONLINE at www.aetnaess.com
• First time in the website requires registration.
• 1-888-281-9521, Monday through Friday, from 8
  a.m. to 8 p.m. ET for assistance with Enrolling
  Online.
• Changes ONLINE due by
• Tuesday, October 14, 2008