EMPLOYEE BENEFITS

The Benefits Section of Human Resources & Risk Management is a customer service and benefits processing operation. We handle the daily activities of managing your benefits, design communications to keep you apprised of changes, prepare you for retirement, conduct data analysis, provide training on our technology-based benefits and new employee orientation. Our staff continuously strives to provide comprehensive benefits to employees, dependents and retirees while maintaining reasonable costs and a high level of service.   
 
We recognize each employee has different needs and since time is of the essence, technology and convenience are the key factors in conducting business. Plan participants may log on to http://www.aetna.com/ to check claims payment status, eligibility, order an ID card, Price A Procedure, Price A Drug, print your Explanation of Benefits (EOB) statements, check out the Clinical Policy Bulletins, refill mail order prescriptions, monitor Flexible Spending Account (FSA) balances, query for medical information or just search for a provider anywhere in the country. Utilizing the Aetna tools enables you to get the most value out of your plan and saves time!

Those who prefer personal contact may call Aetna’s Harris County dedicated customer service line at (800) 279-2401 or the Harris County Benefits staff at (713) 755-5117, toll free (866) 474-7475.

Benefits Comparison for Plan Year 3/1/12 – 2/28/13

Aetna Choice POS II Plan Design - Plan Highlights
	BASE PLAN In-Network	BASE PLAN Out-of-Network
Annual Deductible (per calendar year)	$   500 Individual $1,500 Family	$1,000 Individual $3,000 Family
Coinsurance Limit	$2,500 Individual (plus deductible) $7,500 Family (plus deductible)	$8,000 Individual (plus deductible) $24,000 Family (plus deductible)
Lifetime Maximum Benefit	Unlimited except where otherwise indicated	$1,000,000
Physician's Office Copay Primary Care Specialist (Aexcel provider) Specialist (non-Aexcel prov)	100% after $25 copay 100% after $40 copay 100% after $50 copay	50% after deductible
Preventive Care	100% coverage	50% after deductible
Allergy Services (includes testing, serum and injections)	100% after $40  copay	50% after deductible
Maternity Care   Physician's Office    (prenatal & post natal)    In the Hospital    (for mother & newborn)	$40 for first visit only 80% after deductible	50% after deductible 50% after deductible
Diagnostic Laboratory & Radiology Services	100% coverage	50% after deductible
Complex Imaging/High Tech Radiology	90% after deductible (requires precertification)	50% after deductiible
Rehabilitation, Speech, Occupational and Physical Therapy	100% after a $25 copay, up to 60 visits per calendar year*	50% after deductible, up to 60 visits per calendar year*
Walk-In Clinic	100% after a $25 copay	50% after deductible
Urgent Care Facility	100% after a $50 copay	50% after deductible
Emergency Room	$300 copay; waived if confined, 80% after deductible if admitted	$300 copay; waived if confined, 50% after deductible if admitted
Outpatient Surgery	80% after deductible	50% after deductible
Inpatient Services	80% after deductible	50% after deductible
Home Health Care	90% after deductible, up to 100 visits per calendar year*	50% after deductible, up 100 visits per calendar year*
International care	n/a	50% after deductible
Mental Health    Outpatient Visits    Inpatient Services	100% after $30 copay 80% after deductible	50% after deductible 50% after deductible
Chemical Dependency     Outpatient Visits     Inpatient Services	100% after $30 copay 80% after deductible	50% after deductible 50% after deductible
	BASE PLUS PLAN In-Network	BASE PLUS PLAN Out-of-Network
Annual Deductible (per calendar year)	None	$1,000 Individual $3,000 Family
Coinsurance Limit	None	$8,000 Individual (plus deductible) $24,000 Family (plus deductible)
Lifetime Maximum Benefit	Unlimited except where otherwise indicated	$1,000,000
Physician's Office Copay Primary Care Specialist (Aexcel provider) Specialist (non-Aexcel prov)	100% after $20 copay 100% after $30 copay 100% after $40 copay	60% after deductible
Preventive Care	100% coverage	60% after deductible
Allergy Services (includes testing, serum and injections)	100% after $40 copay	60% after deductible
Maternity Care   Physician's Office    (prenatal & post natal)    In the Hospital    (for mother & newborn)	$30 for first visit only $500 per confinement copay for mother $500 copay for each newborn	60% after deductible 60% after deductible
Diagnostic Laboratory & Radiology Services	100% coverage	60% after deductible
Complex Imaging/High Tech Radiology	100% coverage (requires precertification)	60% after deductiible
Rehabilitation, Speech, Occupational and Physical Therapy	100% after a $20 copay, up to 60 visits per calendar year*	60% after deductible, up to 60 visits per calendar year*
Walk-In Clinic	100% after a $20 copay	60% after deductible
Urgent Care Facility	100% after a $50 copay	60% after deductible
Emergency Room	$300 copay; waived if confined, 80% after deductible if admitted	$300 copay; waived if confined, 60% after deductible if admitted
Outpatient Surgery	100% after $300 copay for surgical procedures, 100% coverage for non-surgical	60% after deductible
Inpatient Services	$500 per confinement copay*	60% after deductible
Home Health Care	100% coverage, up to 100 visits per calendar year*	60% after deductible, up 100 visits per calendar year*
International care	n/a	60% after deductible
Mental Health    Outpatient Visits    Inpatient Services	100% after $30 copay $500 per confinement copay*	60% after deductible 60% after deductible
Chemical Dependency     Outpatient Visits     Inpatient Services	100% after $30 copay $500 per confinement copay*	60% after deductible 60% after deductible
* Maximums are a combined limit for in-network and out-of-network services.