MANAGED CHOICE® POS PLAN DISCLOSURE FORM Aetna Life Insurance Company This disclosure is not your plan of benefits, but it does describe the main features of the Managed Choice® POS plan. We provide this disclosure in compliance with the laws of the state of Georgia. While this material is believed to be accurate as of the date of publication, it is subject to change without notice. Your plan of benefits will be determined by your employer and underwritten by the Aetna Life Insurance Company, of Hartford, Connecticut (called Aetna). The benefits and main points of the Group Contract for persons covered under your employer’s plan or benefits is detailed in the Booklet-Certificate, which you’ll get at a later date. In case of conflict between the Group Contract and Booklet-Certificate and this disclosure, the Group Contract and Booklet-Certificate will govern. The name and address of the managed care organization is: Aetna Life Insurance Company 151 Farmington Avenue Hartford, CT 06156

MANAGED CHOICE PLAN With the Managed Choice POS plan, you can access benefits in one of two ways: • You can minimize your out-of-pocket costs by visiting

the primary care physician (PCP) you selected and by getting referrals, when necessary, from your PCP.

• You also have the option to access any provider (preferred care or nonpreferred care provider) without a referral, for covered medical expenses. But your out-of-pocket costs will be higher — except for emergency treatment and direct-access benefits.

This section describes benefits for expenses incurred for necessary care and treatment of disease and injury. Not all medical expenses are covered. And some covered medical expenses are not covered in full. All maximums included in this plan are combined between preferred care and nonpreferred care, where applicable, unless stated otherwise.

Direct access to Ob/Gyns If you are a female member, you may go directly to a gynecologist in our network without a referral. You may do this for diagnosis or for treatment, or if you’ve been referred by another doctor for gynecologic problems.

Definitions Preferred care is care provided by: • A primary care physician • A preferred care provider on the referral of the primary

care physician • A nonpreferred care provider on the referral of the

primary care physician, if approved by Aetna • Any health care provider for an emergency condition

when you can’t travel to a preferred care provider or when you can’t get a referral by your primary care physician prior to treatment

Preferred care provider is a provider that has contracted with us to provide services or supplies for a negotiated charge but only if the provider is, with our consent, included in the directory of preferred care providers for: • The service or supply involved • The class of employee of which you are a member

Primary care physician (PCP) is the preferred care provider you selected from the list of primary care physicians in the directory. A PCP is responsible for your ongoing health care. They’re on our records as your primary care physician. Nonpreferred care is care furnished by a health care provider that is not preferred care. Nonpreferred care provider is a provider that has not contracted with us to furnish services or supplies at a negotiated charge. Or it can be a preferred care provider furnishing services or supplies without the referral of a primary care physician. Certification requirements You must obtain certification for certain types of nonpreferred care to avoid a reduction in benefits paid for that care. Read the Patient Management Program section for more details of the types of care affected, how to get certification and how not getting certification could affect your benefits.

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Member deductibles and copays The plan may contain some or all of the following features. Your employer will determine the applicability and amount of each copay and deductible. • Copays — these are fees that you must pay for some

covered medical expenses.• Calendar year deductible — the amount of covered

medical expenses you pay each calendar year beforebenefits are paid. A calendar-year deductible appliesto each person.

• Inpatient hospital deductible — this is the amountfor inpatient hospital charges you pay for each person’shospital stay.A hospital stay for a well newborn child, with coveragein force, starts on the day of birth. The inpatient hospitaldeductible and the inpatient hospital copay will notexceed the hospital’s actual charge for board and roomfor the first day of confinement.This inpatient hospital deductible applies to inpatienthospital expenses incurred for nonpreferred care.

• Emergency room deductible — a separate deductibleapplies to each person’s visit in a hospital emergencyroom. This is true unless the person is admitted tothe hospital within 24 hours after a visit to a hospitalemergency room.

Benefits payable After you’ve paid any applicable deductible or copay amount, the benefits under this plan are paid in a calendar year at the percentage that applies to the type of covered medical expense incurred (this is known as coinsurance). There are exceptions for different benefits levels, as you may see later in this disclosure form. Your benefits may vary if you don’t use a preferred care provider. We will not cover any charge for a service or supply from a preferred care provider above the provider’s negotiated charge. In no event will you or your eligible dependents have to pay any such excess charge. Aetna and the preferred care provider will resolve the amount deemed excess. If any expense is covered under one type of covered medical expense, it cannot be covered under any other type.

Payment percentage Coinsurance percentages will range from 100 percent to 80 percent for preferred care expenses and from 80 percent to 60 percent for nonpreferred care expenses, depending on the plan your employer chose. Generally,

you won’t see more than a 30 percent difference in coinsurance between preferred and nonpreferred care expenses. The payment percentage applies after you have paid any deductible or copay amounts.

Payment limits for nonpreferred care These limits apply to covered medical expenses incurred for nonpreferred care except for expenses: • Applied against any deductible or copay amount• Incurred for the effective treatment of alcoholism and

drug use disorders, and for the treatment of mentaldisorders, while not confined as a full-time inpatient

Covered medical expenses To be covered, the medical expense must be necessary for the diagnosis, care or treatment of the disease or injury as determined by Aetna.

Covered expenses include: • Room and board and other hospital services and

supplies for inpatient hospital stays • Services and supplies for outpatient hospital treatment• Services and supplies for convalescent facilities• Home health care• Routine physical exam• Routine eye exam• Routine ob/gyn exam• Routine hearing exam• Preventive health care services (including child

wellness services)• Mammogram• Lab exams for annual chlamydia screening• Lab exams for routine prostate-specific antigen (PSA) test• Routine Pap test• Skilled nursing care• Hospice care• Short-term rehabilitation• Prescription drugs• Physicians’ services• Diagnostic lab work and X-rays• X-ray, radium and radioactive isotope therapy• Anesthetics and oxygen• Rental of durable medical and surgical equipment

Health benefits and health insurance plans are offered by Aetna Health Inc. and/or Aetna Health Insurance Company (Aetna).

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• Artificial limbs and eyes• Alcoholism or drug use disorders — inpatient and

outpatient treatment• Mental disorders — inpatient and outpatient treatment

Exclusions We will not cover the following: • Services and supplies not necessary, as determined by

Aetna, for the diagnosis, care or treatment of a diseaseor an injury

• Care, treatment, services, or supplies not prescribed,recommended, or approved by the attending physician

• Services or supplies, as determined by Aetna, that areexperimental or investigational

• Services, treatment, educational testing or trainingrelated to learning disabilities or developmental delays

• Care furnished mainly to provide a surrounding freefrom exposure that can worsen the person’s diseaseor injury

• Primal therapy, Rolfing, psychodrama, megavitamintherapy, bioenergetic therapy, vision perception trainingor carbon dioxide therapy

• Treatment from covered health care providers, suchas a resident physician or intern, who specialize in themental health care field and receive treatment as partof their training

• Charges made for services only because there ishealth coverage

• Services for which there is no legal obligation to pay• Custodial care• Services or supplies furnished, paid for, or for which

benefits are provided or required by reason of servicein the armed forces of a government

• Eye surgery mainly to correct refractive errors• Education, special education or job training• Plastic surgery, reconstructive surgery or cosmetic

surgery, except as applied to certain injuries, diseasesor birth defects

• Sexual dysfunctions or inadequacies• Artificial insemination, in vitro fertilization or embryo

transfer procedures• Routine exams, immunizations or preventive care

except as specifically provided for in your Booklet-Certificate

• Marriage, family, child, career, social adjustment,pastoral or financial counseling

• Acupuncture therapy

• Speech therapy, except to restore lost existing speechfunction

• Charges to the extent they are not reasonable charges,as determined by Aetna

• Reversal of a sterilization procedure

Pregnancy coverage We pay benefits for pregnancy-related expenses of female employees and dependents on the same basis as for a disease. For inpatient hospital stays, we’ll pay benefits for care of the covered person and any newborn child for a minimum of: • 48 hours following a vaginal delivery• 96 hours following a cesarean delivery

If a woman is discharged earlier, benefits will be payable for two post-delivery home visits by a health care provider.

Emergency care If you need emergency care, you’re covered, 24/7, anywhere in the world. Call the local emergency hotline (911). Or go to the nearest emergency facility. If a delay would not be detrimental to your health, call your primary care physician. Notify your primary care physician as soon as possible after receiving treatment. An emergency medical condition is “one manifesting itself by acute symptoms of sufficient severity such that a prudent layperson, who possesses average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in serious jeopardy to the person’s health, or with respect to a pregnant woman, the health of the woman and her unborn child.”

Patient Management Program We evaluate and determine the appropriateness of medical care resources used by our members. To accomplish these goals, we’ve developed a comprehensive Patient Management Program. We review the population demographics of the membership and the program’s results to determine the need for changes. Regional medical directors, together with local market medical directors, review this information to initiate program development or enhancement. The Patient Management Program is reviewed annually. Only medical directors make decisions denying coverage for services for reasons of medical necessity. We communicate all patient management decisions both by telephone and in writing. We make timely decisions on appeals as the urgency of the situation dictates.

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Here are the time frames for making our decisions: • Precertification decisions — within two business days• Emergent decisions — immediately• Concurrent decisions — within one business day• Retrospective decisions — within 30 days of when

we receive appropriate information

The focused review process (if subspecialty review is required) takes approximately 10 business days. Procedures that must be performed within this time frame are excluded from the precertification requirement. Coverage denial letters specify any unmet criteria standards and guidelines, and they inform the provider and member of the appeal process.

The Patient Management Program includes the following components: Certification for certain prescription drugs Certification of necessity is required before certain drugs are dispensed by a preferred pharmacy. We’ll cover these prescription drugs at the applicable percentage if certification has been requested and the drug is necessary. Otherwise no benefit will be payable. It is your responsibility to have the prescriber of the drug request certification. They can do that by calling the number on your ID card. They must call as soon as reasonably possible before the drug is dispensed. Written notice of the certification decision will be sent promptly to you. Certification for hospital admissions Certification that a hospital stay is necessary is required if the stay has not been ordered and prescribed by: • Your primary care physician• A preferred care provider upon referral by your primary

care physician

If a stay is certified as necessary, hospital expenses will be payable at the appropriate percentage. If you have requested certification and it was denied, we will not pay benefits for hospital room and board expenses. Benefits for all other hospital expenses will be paid at the appropriate percentage. If certification has not been requested and the hospital stay is not necessary, no benefits will be paid for hospital room and board expenses. If the hospital stay is for a nonurgent admission, you must get the days certified by calling the number on your ID card. This must be done at least 14 days before the scheduled hospitalization.

For an emergency or urgent admission, you, your physician or the hospital must get the days certified by calling the number on your ID card. This must be done before an urgent admission, or not later than 48 hours following an emergency admission. If your physician thinks it’s necessary for you to stay for a longer time than already certified, you, the physician or the hospital may request certification for the additional days by calling the number on your ID card. This must be done no later than on the last day that has already been certified. Certification for convalescent facility admissions, home health care expenses, hospice care expenses and skilled nursing care Certification as necessary is required for: • A stay in a convalescent or hospice facility• Home health care or hospice care while not confined

as an inpatient• Skilled nursing care, if such care has not been ordered

or prescribed by your primary care physician or apreferred care provider upon referral by your primarycare physician

Certification for convalescent and hospice facility stays If a stay is certified as necessary, convalescent and hospice facility expenses will be paid at the appropriate percentage. If you have requested certification and it was denied, we will not pay benefits for convalescent or hospice facility room and board expenses. Benefits for all other convalescent or hospice facility expenses will be paid at the appropriate percentage. If certification has not been requested and the stay is not necessary, no benefits will be paid for convalescent or hospice facility room and board expenses.

Certification for home health care, hospice care and skilled nursing care If care is certified as necessary, home health care, hospice care and skilled nursing care expenses will be paid at the appropriate percentage. If you have requested certification and it was denied, no benefits will be paid. Or, if certification has not been requested and the care is not necessary, no benefits will be paid. To get certification you must call the number on your ID card. You must obtain certification before you receive care. If your physician believes that you need more days of confinement or care beyond those which have already been certified, you must call to certify more days.

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Certification for certain procedures and treatments Certification is required for certain procedures and treatments if they have not been ordered and prescribed by your primary care physician or a preferred care provider upon referral by your primary care physician. The procedures or treatments require certification before they are performed, whether on an inpatient or outpatient basis. You can view the procedures and treatments that require certification at Aetna.com/ Health-Care-Professionals/Precertification/ Precertification-Lists.html. If the procedure or treatment is certified as necessary, expenses will be paid at the appropriate percentage. If the procedure or treatment is not necessary, no benefits will be payable whether or not certification has been requested. If certification has been requested and the procedure or treatment is necessary, benefits will be payable at the appropriate percentage. You or the provider performing the procedure or treatment must call the number on your ID card to request certification. The call must be made at least 14 days before the date of the procedure or treatment unless it’s an emergency. Certification is required for hospital and treatment facility admissions or necessary confinement for alcoholism, drug use disorder or mental disorders. It’s required when the confinement has not been ordered and prescribed by: • Your primary care physician• A preferred care provider upon referral by your primary

care physician

If confinement is certified as necessary, expenses will be paid at the appropriate percentage. If certification has been requested and denied, no benefits will be paid for hospital or treatment facility room and board expenses. Benefits for all other hospital or treatment facility expenses will be paid at the appropriate percentage. If certification has not been requested and the confinement is not necessary, no benefit will be paid for hospital or treatment facility room and board expenses. To get the days certified, you must call the number on your ID card. Certification must be obtained before a stay. Or in an emergency admission, within 48 hours after the start of a confinement, or as soon as reasonably possible. If your physician believes that you need more days of confinement beyond those that have already been certified, the additional days must be certified. This must be done no later than on the last day that has already been certified.

Concurrent review The concurrent review process assesses the necessity for continued stay, level of care and quality of care for members receiving inpatient services. All inpatient services extending beyond the initial certification period will require concurrent review. Discharge planning Discharge planning may be initiated at any stage of the patient management process. It begins upon identification of postdischarge needs during certification or concurrent review. The discharge plan may include services or benefits members can use when they are discharged from an inpatient stay.

Retrospective record review The purpose of these reviews is to retrospectively analyze potential quality and utilization issues, initiate appropriate follow-up action based on quality or utilization issues, and review all appeals of inpatient concurrent review decisions. Managing the services provided to members includes the retrospective review of claims submitted for payment and of medical records submitted for potential quality and utilization concerns.

Appeal procedure An appeal is a written request for a review of a decision to deny, in whole or in part, things like a claim payment, a certification request, a referral or eligibility. • An appeal must be submitted within 180 days of the

date Aetna provides notice of denial.• If your plan provides for a one-level appeal process,

we will send you a response within 30 days of whenwe receive the appeal if your request is regarding apreservice claim (or a service that requires priorapproval). The response will be based on theinformation provided with or subsequent to the appeal.

• If your plan provides for two levels of appeal, you’ll get aresponse within 15 days of when we receive the requestat each level of appeal.

• If your plan provides for a one-level appeal process, we’llsend you a response within 60 days after receipt of theappeal for a postservice issue. The response will be basedon the information provided with or subsequent to theappeal. If your plan provides for two levels of appeal,you’ll get a response within 30 days of our receipt of therequest at each level of appeal.

• For urgent issues, if your plan provides a one-levelappeal process, you’ll get a response within 72 hoursof the request. For a two-level process, you’ll get aresponse within 36 hours at each level of appeal.

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Summary of grievances A summary of the number, nature and outcome of grievances filed in the previous three years is available for inspection. Copies of the summary are available at a reasonable cost.

Specialty referral procedures Except for any applicable direct-access specialists, you can only access specialist benefits with prior approval from your primary care provider.

Provider reimbursement Participating providers are reimbursed on a discounted fee-for-service basis. Where the member is responsible for a coinsurance payment based on a percentage of the bill, the member’s obligation should be based on charges established by contract, if any, and not based on the provider’s billed charges. Aetna Pharmacy Management negotiates discounts from independent pharmacies, chain pharmacies and mail vendors who accept our reimbursement rates for dispensing and ingredient costs in return for volume business. Our negotiated discounts are passed in full to our plan sponsors. The reimbursement formula is based on average wholesale price (AWP) less a negotiated discount, plus a dispensing fee. The dispensing fee is a contractual fee negotiated between Aetna Pharmacy Management and the network pharmacy. The negotiated rate renews each year unless it is changed contractually. Where the member is responsible for a coinsurance payment based on a percentage of the bill, the member’s obligation is determined on the basis of the charges set by contract, if any, rather than on the basis of the provider’s billed charges.

Claims payment for nonpreferred providers and use of claims software If your plan covers services rendered by nonpreferred providers, you should know that we determine the usual, customary and reasonable fee for a provider by referring to commercially available data. This data reflects the customary amount paid to most providers for a given service in that geographic area. If such data is not commercially available, our determination may be based on our own data. We may also use computer software (including ClaimCheck®) and other tools to take into account factors such as the complexity of, amount of time needed for, and manner of billing. You may be responsible for any charges we determine are not covered under the plan.

Limited utilization incentive plans This health plan does not contain any limited utilization incentive plans.

Provider credentialing All prospective participating providers must meet our standards before being accepted into our network. For example, prospective primary care physicians must comply with more than two dozen criteria before they are certified and accepted. These criteria include: • License and malpractice insurance• Hospital privileges• Provision of continuous, comprehensive care• Emergency coverage• Office appearance, cleanliness and equipment• Organization of medical records• Participation in continuing medical education programs

These physicians are evaluated regularly for continued compliance with our criteria. Primary care physicians in our networks are recredentialed about every two years. This process includes a review of: • Provider performance• Office environment• Patient charts• Member surveys and complaints

Results are submitted to a peer committee composed of physicians before participation is continued. Hospitals and ancillary providers are also reviewed for quality and appropriateness of care.

Need to find a health care professional in our network? Our online provider search tool at Aetna.com can help. Click on Find a Doctor anytime, anywhere to find: • Doctors• Dentists• Facilities• Hospitals• EyeMed® locations• Pharmacies• Behavioral health professionals

You can search by: • Name• Specialty• Gender• Hospital affiliation

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We update the information six times a week. The tool allows you to find additional information about your provider, including: • Their board certification• Medical school attended• Year of graduation• Languages spoken• Other office locations

Need maps and driving directions? When you find a doctor using our search tool, you’ll also find a map and driving directions.

Need a paper copy of our provider directory? Although Aetna.com contains the most current information available about participating health care providers, you can ask us for a paper copy of the listing. Just: • Send us a message from your personal member website

at Aetna.com.• Call us anytime at Member Services using the toll-free

number on your ID card. Our automated phoneattendant can help you with your search 24/7.

Use network providers To maximize benefits and reduce out-of-pocket expenses, you should select a preferred provider. You’ll see significant savings when you use preferred providers because they’ve agreed to accept substantially lower rates as payment for their services. Nonpreferred care is subject to reasonable and customary (R&C) charge allowance maximums. Any charges in excess of the R&C allowance are not covered under the plan. Preferred providers are independent contractors and are neither employees nor agents of Aetna.

Summary of agreements between Aetna and preferred providers You can get a summary of any agreement or contract between an Aetna managed care plan and any health care provider by calling 1-800-872-3862 (TTY: 711). The summary will not include financial agreements as to actual rates, reimbursements, charges or fees negotiated by the managed care plan and the provider. The summary will include a category or type of compensation paid by the managed care plan to each class of health care provider under contract with Aetna.

What is the Georgia consumer choice option (“option”)? Georgia law requires that an enrollee (“you” or “member”) of a managed care plan (HMO or PPO plan) must have the opportunity to nominate a provider (PCP, specialist, dentist or hospital) not currently participating in the managed care plan’s network. Under this option, and with certain restrictions required by law, you may nominate a nonparticipating provider. The out-of-network provider you nominate must agree to both: • Provide services covered by the managed care plan at

the plan’s standard reimbursement rates• Follow the plan’s usual rules and procedures

We’ll cover the services you and your dependents receive from this provider at the in-network level. This means we’ll pay your provider as though they were “an accepted provider” in the plan’s network.

When does this option go into effect? Your coverage under the consumer choice option will take effect on whichever one of these two dates is later: • The date your coverage under the plan takes effect• The date the nominated out-of-network provider

becomes an accepted provider

This is called “the effective date.”

Who can be nominated? To be an accepted provider, a nominated provider must: • Be a health care provider as defined by O.C.G.A.

§33-20A-3(3), or a hospital• Be located within and licensed by the state of Georgia• Agree to accept reimbursement by both the plan and

the enrollee at the rates for and on the terms andconditions applicable to similarly situated providers

• Agree to adhere to the plan’s requirements and meetall other reasonable criteria that the plan may requireof its participating providers

How do I nominate a provider? Fill out the Nonparticipating Provider Nomination form. It comes with instructions and conditions. You must fill out one form for each provider you wish to nominate, for yourself and eligible dependents. Give the form to the provider(s) you nominate, for their signature. Then return the form to our consumer choice option unit. There are instructions on how to do that. If you nominate a provider, we won’t necessarily accept them. But we will let you and the provider know our decision, in writing. We’ll do that within three business days of getting your nomination.

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We may cancel our acceptance of (or “deselect”) an accepted provider at any time, if the provider fails to comply with the plan’s generally accepted rules. If we do cancel the acceptance, we’ll let you know in writing. We’ll pay the deselected provider at the in-network level for covered services. We’ll do that until you get our notice of their deselection. Will the provider’s credentials be reviewed? Under the option, the plan will not credential or otherwise review the qualifications of any nonparticipating provider that you may nominate, beyond verifying that the nominated provider is a health care provider as defined by O.C.G.A. § 33-20A-3(3), or a hospital. When you select a nonparticipating provider under this option, you will not have the benefit of the plan’s usual credential verification process.

What are the plan benefits under the option? The benefits provided by your group benefits plan under which this option is exercised will remain in effect, and the benefits and all other requirements under the plan (including precertification, notifications and referrals, when required) will not change because you participated in the consumer choice option. Payment for covered services provided by your accepted provider will be made at the in-network level for you and any of your family members who may enroll in the option with you. How will covered services by a nonparticipating provider be reimbursed under the option? An accepted provider will be eligible for reimbursement of covered services at the in-network benefits level. If you receive covered services from a nonparticipating provider before your option effective date, reimbursement will be at the same level (if at all) as for other nonparticipating providers under the plan. Accepted providers must follow claims procedures described in the Nonparticipating Provider Nomination form instructions and conditions to ensure that claims are paid correctly at the in-network reimbursement rate.

If an accepted provider submits any claims that do not follow these procedures, it may result in an out-of­network claim being paid at the out-of-network reimbursement rate (or denied). Any claims submitted through normal claims channels will be: • Automatically treated as an out-of-network claim• Paid at the out-of-network level of reimbursement

or denied

Consumer choice option claims are not automatically electronically processed the way most in-network claims are. Claims must be prepared for processing by the staff of the consumer choice option unit. Otherwise, HMO claims may be denied outright. PPO claims will be processed at the out-of-network level, which means a higher out-of-pocket expense for the member. When will the option terminate? Coverage under the option is linked to the group benefits plan in which you are enrolled. This option will remain in effect from your date of acceptance through the end of your current plan year, or the end of the plan year under any subsequent annual renewals you may exercise, whichever comes later. The plan will terminate the option coverage: • When your coverage under the plan terminates• If you don’t pay the premium for the option• If the Georgia consumer choice option law (§ 33-20A-9.1,

O.C.G.A.) is repealed

Call 1-800-470-2004 (TTY: 711) for exact pricing and other information. Please have your Aetna member ID card available when you call.

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Aetna complies with applicable Federal civil rights laws and does not unlawfully discriminate, exclude or treat people differently based on their race, color, national origin, sex, age, or disability. We provide free aids/services to people with disabilities and to people who need language assistance. If you need a qualified interpreter, written information in other formats, translation or other services, call the number on your ID card. If you believe we have failed to provide these services or otherwise discriminated based on a protected class noted above, you can also file a grievance with the Civil Rights Coordinator by contacting: Civil Rights Coordinator, P.O. Box 14462, Lexington, KY 40512 (CA HMO customers: PO Box 24030 Fresno, CA 93779), 1-800-648-7817, TTY: 711, Fax: 859-425-3379 (CA HMO customers: 860-262-7705), CRCoordinator@aetna.com. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, or at 1-800-368-1019, 800-537-7697 (TDD).

TTY:711

English To access language services at no cost to you, call the number on your ID card.

Spanish Para acceder a los servicios lingüísticos sin costo alguno, llame al número que figura en su tarjeta de identificación.

Vietnamese Để sử dụng các dịch vụ ngôn ngữ miễn phí, vui lòng gọi số điện thoại ghi trên thẻ ID của quý vị.

Korean 무료 다국어 서비스를 이용하려면 보험 ID 카드에 수록된 번호로 전화해

주십시오.

Chinese Traditional 如欲使用免費語言服務，請撥打您健康保險卡上所列的電話號碼

Gujarati તમારે કોઇ પણ જાતના ખર્ચ વિના ભાષા સેિાઓ મેળિિા માટે, તમારા આઇડી કાડચ પર

રહેલ નબંર પર કૉલ કરિો.

French Pour accéder gratuitement aux services linguistiques, veuillez composer le numéro indiqué sur votre carte d'assurance santé.

Amharic የ ቋን ቋ አ ገ ል ግ ሎቶ ች ን ያ ለ ክ ፍያ ለ ማግ ኘ ት ፣ በ መታወቂ ያ ዎ ት ላይ ያ ለ ውን ቁ ጥር ይ ደ ውሉ፡ ፡

Hindi बिना किसी िीमत िे भाषा सेवाओं िा उपयोग िरने िे लिए, अपने आईडी िाड ड पर दिए नंिर पर िॉि िरें।

French Creole (Haitian)

Pou ou jwenn sèvis gratis nan lang ou, rele nimewo telefòn ki sou kat idantifikasyon asirans sante ou.

Russian Для того чтобы бесплатно получить помощь переводчика, позвоните по телефону, приведенному на вашей идентификационной карте.

Arabic دون أي تكلفة، الرجاء االتصال على الرقم الموجود على بطاقة اشتراككللحصول على الخدمات اللغویة.

Portuguese Para aceder aos serviços linguísticos gratuitamente, ligue para o número indicado no seu cartão de identificação.

Persian Farsi ھ طور رایگان، با شماره قید شده روی کارت شناسایی خود تماس بگیریدبرای دسترسی بھ خدمات زبان ب.

German Um auf den für Sie kostenlosen Sprachservice auf Deutsch zuzugreifen, rufen Sie die Nummer auf Ihrer ID-Karte an.

Japanese 無料の言語サービスは、IDカードにある番号にお電話ください。

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©2020 Aetna Inc. 02.28.318.1-GA B (3/20)