Aetna Health Insurance Plan Options - Pre-65 Dependents Plan

Pre-65 Dependents Coverage

Your spouse (or domestic partner if permitted under the institution's plan) can be enrolled in Emeriti insurance at the same time you enroll. If your spouse is over 65, he/she must be enrolled in Medicare Parts A and B, and must be enrolled in the same Emeriti Health Insurance Plan Options as you. If you have a spouse (or domestic partner if permitted under the institution's plan) who is under age 65, or if you have children who qualify as dependents under federal law and are under age 19 (or under age 24* if full-time students), you can enroll them in a separate pre-65 Emeriti insurance plan, underwritten by Aetna. When your spouse reaches age 65 and enrolls in Medicare Parts A and B, he/she can switch to the Emeriti Health Insurance Plan that you have chosen. Special rules apply for permanently disabled family members. Call 1-866-EMERITI (1-866-363-7484) for more information about who may qualify as eligible dependents.

*restrictions apply

The Pre-65 Dependents Plan Provisions

For detailed information about the Pre-65 plan provisions, please review the Pre-65 Dependents Summary of Benefits.

How the Pre-65 Dependents Plan Works

The Pre-65 Dependents Plan is an Aetna Open Choice PPO/Indemnity Plan, that works differently depending on where you live.

• If you live in an Aetna PPO service area, the plan pays benefits according to a preferred provider arrangement. You may receive care from any licensed provider, but when you choose a provider who belongs to Aetna's network (a preferred provider), the plan pays a higher level of benefits. In addition, the preferred provider files claims for you. If you choose a non-preferred provider, the plan pays a lower level of benefits and you must file your own claims. The Summary of Benefits chart compares preferred and non-preferred provider benefits.
  
  
• If you live outside Aetna's PPO service area, the plan pays benefits according to an indemnity arrangement. That is, there's a single level of benefits regardless of who provides your care. This level of benefits that correspond to the Indemnity plan are equal to the preferred level "In network" shown on the Pre-65 Dependents Summary of Benefits, but without a panel of providers you need to use to get this level of benefits. In most situations, you will need to pay for your care at the time you receive it and then file a claim for reimbursement with Aetna. In some cases, the provider may be willing to file a claim with Aetna on your behalf.

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Sharing the Cost

You share in the cost of your care by paying a calendar year deductible and a percentage of your covered expenses.

• The calendar year deductible is the amount of covered expenses you must pay each calendar year before the plan starts to pay benefits. A calendar year starts on January 1 and ends on December 31. Both medical and prescription drug expenses apply toward the plan's deductible. Note that the calendar year deductible does not apply to certain preventive care services, shown on the Pre-65 Dependents Summary of Benefits.
• Once you meet the deductible, you pay a percentage of your remaining expense(s) and the plan pays the rest. The part you pay is called your coinsurance. The plan pays 80% for most covered expenses when you use a preferred provider, so your coinsurance is 20%.
• The plan places a limit on what you must pay out of pocket for your care. When your out-of-pocket costs reach the coinsurance limit, the plan pays 100% of your covered expenses for the rest of the calendar year. Both medical and prescription drug expenses apply toward the plan's coinsurance limit.
• The plan also has a lifetime maximum benefit. This is the most the plan will pay in benefits over a covered person's lifetime.

The dollar amounts of the plan's deductible, coinsurance limit and lifetime maximum benefit are shown in the Summary of Benefits chart. You'll see that the coinsurance limit is lower when you use preferred providers, and higher when you use non-preferred providers.

Calculate Your Monthly Premiums

To calculate the monthly premiums for the different 2008 Emeriti Health Insurance Plan Options, including pre-65 dependent coverage, use the Emeriti Online Premium Rate Guide.

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Aetna Special Programs

As Aetna members, you and your covered dependents may take advantage of special programs that address specific health conditions and needs. Click here to learn more about the other Aetna benefits, listed below.

• Alternative Health Care Program
• Fitness Program
• Healthy Outlook Program®
• Informed Health® Line
• National Medical Excellence Program®
• National Advantage Program
• Vision One® Discount Program
• Women's Health Program

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Aetna provides all coverage for institutions and their retirees in 48 states and the District of Columbia. For institutions and their retirees in Minnesota, HealthPartners provides comprehensive coverage, and Aetna provides prescription drug only plans. For institutions in Minnesota, and their retirees residing in Minnesota, HealthPartners provides comprehensive coverage, and Aetna provides a prescription drug-only plan. Click here to see the HealthPartners Freedom Plans available in Minnesota. If your institution has fewer than 50 employees, your Emeriti insurance option will be limited to a separate insurance offering mandated by your state insurance department as part of small group insurance reform. Please call an Emeriti Specialist from Aetna to find out what insurance coverage is available to you.