ready today for the future of consumer-directed health plan solutions aetna healthfund ® health...

Ready today for the future of consumer-directed health

plan solutions

Aetna HealthFund®

Health Reimbursement Arrangement (HRA)

32.25.102.1 (3/09)

4 ©2009 Aetna

Support member engagement

Help members become better health care consumers

Educate members on the process

Enable behavior change

Support doctor-patient relationships

Provide personalized information

Make connections for optimal health

5 ©2009 Aetna

Aetna HealthFund®

High deductible health plan, Health Reimbursement Arrangement( HRA)*, Health Savings Account (HSA)*, Aetna performance networks

Decision tools for value-based purchasing

Health incentives

Health care transparency

Integrated care management

Effective communications and education

*HRAs and HSAs are currently not available to HMO members in Illinois

6 ©2009 Aetna

Health benefits - current environment

Health care costs continue to rise

Employers looking for solutions and savings

New competitive options emerging

Legislative and political impact

Consumer’s role changing

Result – CDHP (Consumer-Directed Health Plans)

7 ©2009 Aetna

An industry transformation

Greater member responsibility

Promotes consumer engagement

Can improve employee satisfaction

Saves employers money

Drives cost down

8 ©2009 Aetna

The Aetna HealthFund®

Health Reimbursement Arrangement (HRA)*

Fully integrated systems, including Pharmacy

Full product and funding spectrum

Actuarial modeling capabilities

Plan design flexibility

Full medical management services

Personalized Aetna Navigator® consumer decision support tools

Favorable network discounts

Monthly member statements

*HRAs are currently not available to HMO members in Illinois

9 ©2009 Aetna

Aetna HealthFund HRA*

Fund integrated with deductible-based medical plan– Fund

• Established by employer• Notional account / unfunded liability • Pays eligible out-of-pocket expenses• Balances roll over, option to cap• Fund reduces deductible (standard model)

– Medical plan • Deductible• Coinsurance and/or copayments• 100% preventive care, not subject to fund or deductible• Out-of-pocket maximum

Consumer tools and information


10*HRAs are currently not available to HMO members in Illinois.

*

Helps you pay for eligible out-of-pocket expenses……………………….

Employer funded each plan year

11 *HRAs are currently not available to HMO members in Illinois.

*



You pay this amount before your health plan begins to pay for eligible

expenses


*



You pay this amount before your health plan begins to pay for eligible

expenses

Once you meet your deductible, your health plan pays a larger % of eligible costs while you pay a smaller %


*

14 ©2009 Aetna

Employer-established fund

Various fund amounts available Generally half deductible amount Fund rollover options Fund typically forfeited at termination of employment or termination of plan Health fund can be limited to:

– Traditionally covered PPO expenses– IRS Section 213 deductible health expenses (ASC)

Rollover maximum One fund per family, not member Fund-tiering available

15 ©2009 Aetna

HRA* common plan designs

Underlying Plan deductible ranges– Individual range: $500 - $3,000 ($1,000 / $1,500 / $2,000)– Family range: $1,500 - $9,000 ($2,000 / $2,500 / $3,000)

Out-of-Pocket maximum– Individual range: $2,000 - $4,000– Family range: $4,000 - $8,000

Fund ranges– Individual range: $350 - $1,000 ($500 / $750 / $1,000)– Family range: $750 - $3,000 ($1,000 / $1,500 / $2,000)

Underlying plan coinsurance levels: 80/60, 90/70 or 100/70 100% preventive care Tiering

– Standard is 2-tier (Individual or Family)– Each tier has one deductible to meet for the entire group

Note: Effective member responsibility is a result of utilizing many of the plan design components as opposed to each component individually.

* HRAs are currently not available to HMO members in Illinois.

16 ©2009 Aetna

Preventive care coverage

Generally 100% covered for each individual– Does not apply to fund or deductible

Preventive care schedule on Aetna Navigator®

Covers medical services such as routine physicals, immunizations, screening, well-woman exams, well-child visits

Encourages employee to obtain preventive care

17 ©2009 Aetna

HRA* medical plan

Fund deductible coinsurance options– Fund pays member responsibility (deductible and member coinsurance)– Fund pays until exhausted (may or may not reduce deductible)– Before-fund deductible fund coinsurance (ASC only)– Deductible fund deductible coinsurance

Self-funded plans (ASC)– PPO, Aetna Choice® POS II, Open Access Aetna SelectSM

Fully insured plans– PPO, Open Access Managed Choice® (POS) and Aetna Choice POS (HMO)

Optional standalone or integrated pharmacy and dental Flexible plan designs


18 ©2009 Aetna

Additional options & features

Dental integration

Long Term Care premium reimbursement

Chronic & preventive medications

Incentives

Hybrid funding arrangement (insured plan, ASC fund)

Simple Steps To A Healthier Life®

Informed Health® Line

Medical management programs

Aexcel®

19 ©2009 Aetna

Pharmacy integration

Real-time claim adjudication

Discounted cost of prescriptions applied to fund and/or deductible depending upon fund model

Once fund exhausted and deductible met, pharmacy plan can be:– Same or lower coinsurance level as medical, or– Copay plan

Participating pharmacy knows whether to collect anything from member – handled at point of sale with no balance billing

Price-A-DrugSM tool available to assist members

20

Comparing HRA*, HSA*, FSA

Note: HSAs can be purchased with a “limited purpose” HRA/FSA, post deductible HRA/FSA, suspended HRA, retirement HRA

Feature Health Reimbursement Arrangement (HRA* or RRA)

Health Savings Account (HSA*)

Flexible Spending Account (FSA)

Eligibility All eligible employees Individual covered by high deductible health plan (HDHP)

All eligible employees

Contributor Employer only Employer, individual or both

Employer, associate or both

Roll-Over Usually yes, but at employer discretion

Yes No

Tax Advantaged Yes Yes Yes

Portability No, forfeit upon termination Employer has option to roll to RRA on retirement

Yes No

Ability to Earn Investment Income

No Yes No

Rx Integrationfor HDHP

Available Required N/A


21

Aetna HealthFund® HRA* / HSA*

Health Reimbursement Arrangement819 customers

• 133 National• 123 Key• 290 Select• 68 Small Group

52 full replacement plans*

~ 882K members

High-Deductible Health Plan/HSA9,712 customers

• 131 National• 146 Key • 350 Select• 9,085 Small Group

51 full replacement plans*

~401K members HDHP/HSA

~75K members HDHP only

As of 12/2008

Aetna’s HRA/HSA growth1/02 – ~4821/03 – ~39K

1/04 – ~160K 1/05 – ~359K 1/06 – ~463K 1/07 – ~826K

1/08 – ~1.29M

* >1,000 lives


22 ©2009 Aetna

Plan sponsor tools

Cost modeling

Pricing tool

Reporting

23 ©2009 Aetna

Consumer tools

Aetna Navigator®

Plan Selection & Cost Estimator Tool

24 ©2009 Aetna

Consumer tools

DocFind®

Hospital Comparison Tool

Plan Selection & Cost Estimator

Transparency Suite of Tools – Price and Clinical Quality

Cost of Care Tool

Healthwise® Knowledgebase

Informed Health® Line

Aetna InteliHealth®

Simple Steps To A Healthier Life®

25 ©2009 Aetna

Keys to success

Set a strategy Appropriate benefit structure, information and tools A business culture actively communicating health care

engagement concepts

Member responsibility $750 - $1000 bridge between deductible and employer

fund/account contribution with appropriate coinsurance Update benefit offerings regularly to stay in-sync with the overall

strategy

Engagement Multi-year, cost controlling strategies that engage employees in

managing their health Provide information and tools for decisions about health,

spending and overall wellness

26 ©2009 Aetna

Keys to success

Wellness Preventive care covered at 100% In-depth education and communication including completion

of Health Assessments

Steerage to CDHP CDHP as the lowest cost option Lowering the required employee premium contribution

and/or offer higher fund/account contribution

27 ©2009 Aetna

Engaging your employees and enabling behavior

Four phases to an effective communications strategy

Enrollment

Contribution strategy

Educate

Emphasize accountability

2Post-Enrollment

Reinforce

Remind

Update

3 4Pre-Enrollment

Engage Management

Advantages/Features

Employee role

1Ongoing support

Motivate employees Keep them engaged Reintroduce resources

28 ©2009 Aetna

Why Aetna?

Experience

Innovation

Consumer communication and education

Integration

Plan design

Analysis and reporting

29

Healthier employees

Higher levels of engagement

Innovative, client-centered solutions

Lifelong optimal healthLower medical costsHigher productivity

++=

Join the Change

Ready today for the future of health care

30

This material is for information only. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Aetna HealthFund HRAs are subject to employer-defined use and forfeiture rules, and are unfunded liabilities of your employer. Fund balances are not vested benefits. Investment services are independently offered through JPMorgan Institutional Investors, Inc., a subsidiary of JPMorgan Chase Bank. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. 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. Policy forms issued in OK include: HMO OK COC-5 09/07, HMO/OK GA-3 11/01, HMO OK POS RIDER 08/07, GR-23 and/or GR-29/GR-29N.

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Health Inc., Aetna Health of California Inc., Aetna Health of the Carolinas Inc., Aetna Health of Illinois Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 06156. Each insurer has sole financial responsibility for its own products.

©2009 Aetna Inc.

32.25.102.1 (3/09)

http://www.aetna.com/

32

HRA* Workflow (Medical HRA* pays first)

Member sees Provider

- presents ID card (no copay)

- Member pays $0

Provider bills

Aetna.

Aetna adjudicates claim and

determines what the Member

owes.

Is there enough money in the HRA Fund to cover the

Member responsibility?

Aetna pays Provider directly from the Fund.

Member owes $0.

Aetna pays Provider whatever it can, if anything, from the Fund and tells the Provider the exact

amount to bill the Member.

Provider bills Member.

Member pays Provider.

HRA$

Yes

No

*HRAs are currently not available to HMO members in Illinois.

33

HRA* – how it works

The Plan Pays

30%10%


34


Member Responsibility

30%10%


35


The Plan Pays


Fund

30%10%


36


The Plan Pays


Fund

FundHelpsPay

30%10%


37

HRA* example year 1

30%10%*HRAs are currently not available to HMO members in Illinois.

** For illustrative purposes only. Does not reflect events experienced by an actual participant.

**

38

HRA* example year 1



**

39

HRA* example year 1



**

40

HRA* example year 2



**

ready today for the future of consumer-directed health plan solutions aetna healthfund ® health...

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