Small Business Solutions - Health, Dental, Vision, Pharmacy, Life and Disability New Jersey

 
Small Business Solutions - Health, Dental, Vision, Pharmacy, Life and Disability New Jersey
Health, Dental,
Small Business Solutions   Vision, Pharmacy,
                           Life and Disability
                           New Jersey

                           FOR BUSINESSES WITH 2 – 50
                           ELIGIBLE EMPLOYEES

14.02.922.1-NJ (2/05)
Small Business Solutions - Health, Dental, Vision, Pharmacy, Life and Disability New Jersey
Recently there’s been significant
publicity about “consumer-directed”
health plans. At Aetna, we believe
these plans are defined by putting
consumers in the center of the
health care equation, with the insur-
er and health care practitioner play-
ing the supporting roles.

Consumer-directed plans increase
flexibility, control and choice for the
employer and the employee. Aetna
recognizes the challenges of rising
healthcare costs and the demands of
running a successful small business.
We are working with small businesses
to establish innovative, realistic and
practical ways to continue providing
quality coverage at affordable prices.

At Aetna Small Group*, we are bet-
ting heavily on the consumer, which
is why we offer easy-to-understand,
flexible, affordable consumer choice
plans. We’re committed to investing
in tools, education and technology
to help consumers make clear,
informed decisions.

Bill Roth, Senior Vice President
Aetna Small Group

Our portfolio of health,
dental, vision, pharmacy,
life and disability insurance
products is designed to
help your employees stay
healthy and productive
through all stages of life.

*Aetna Small Group refers to an internal
 business unit of Aetna.
Small Business Solutions - Health, Dental, Vision, Pharmacy, Life and Disability New Jersey
Choice. Simplicity. Affordability.
With Aetna. It’s Yours.

                                           Our portfolio of health, dental,
                                           pharmacy, life and disability
  In the world of small business,          products is designed to help
                                           your employees stay healthy and
  there’s nothing more critical to your    productive through all stages
  company’s success than the health        of life.
                                           From the National Medical Excellence
  and well-being of your employees.        Program®, our transplant and complex
  At Aetna*, we are committed to           care program, to our disease manage-
                                           ment and vision programs, Aetna offers
  putting the member at the center         solutions for your small business.

  of everything we do — with a new         *The Aetna companies that offer, underwrite or

  generation of consumer-friendly           administer benefits coverage include Aetna
                                            Health Inc., Aetna Life Insurance Company
                                            and/or Aetna Dental Inc. For the Aetna Golden
  health care benefits and related          Choice Plan, Corporate Health Insurance
                                            Company also offers, underwrites or adminis-
                                            ters benefits.
  programs designed to give your
  employees the product choices,
  tools and information they need to
  lead healthier, more productive lives.

                                           Technology Solutions                        3

                                           Special Programs                            4

                                           Provider Networks                           5

                                           Product Overview                          6-8

                                           Dental Plans                            9-11

                                           Life and Disability                    12-15

                                           Limitations and Exclusions                 16
Small Business Solutions - Health, Dental, Vision, Pharmacy, Life and Disability New Jersey
Designed with small           Choice. Simplicity. Affordability.
    businesses in mind, Aetna
    is proud to offer its Aetna
                                  With Aetna. It’s Yours.
    Product Suite, providing
    choice, simplicity and
    affordability.

                                  Aetna understands small business —           Simplicity
                                  especially when it comes to the daily
                                  challenges of controlling costs, keeping     Straightforward and easy-to-understand
                                  things simple and providing employee         benefits. That’s what Aetna provides to
                                  choice in health care benefits.              small employers and their employees.
                                                                               Member experiences will be enriched
                                  Employers and their employees have           through user-friendly technology
                                  been depending on Aetna for years.           and online tools such as the Aetna
                                  Now we’re offering the next generation       NavigatorTM self-service website and our
                                  of consumer choice products that address     DocFind® online provider directory.
                                  small business challenges for providing
                                  choice, simplicity and affordability.        Affordability
                                                                               With Aetna’s consumer choice plan
                                  Choice                                       designs, employers and their employees
                                  In addition to the standard health bene-     now have the option of how much
                                  fits plans, Aetna offers health plan         to invest in monthly premiums versus
                                  designs with a large network for small       out-of-pocket expenses. This puts
                                  employers in New Jersey. Employers can       consumers in the center of the health
                                  now empower employees by giving them         care equation.
                                  a choice in their health care benefits and
                                  freedom that aligns with their individual
                                  lifestyles.

2
Technology Solutions                                                                             zip code, miles willing to travel, city and
                                                                                                 state, or county and state. Narrow the
                                                                                                 search by specialty, hospital affiliation
                                                                                                 and/or languages spoken — all with a
                                                                                                 few clicks of a mouse.
                                                                                                 When members find the provider they
                                                                                                 want, we can also help them get there
                                                                                                 with a map and driving directions from
                                                                                                 Maps On Us®. Best of all, DocFind is
                                                                                                 updated regularly and is available 24
                                                                                                 hours a day, 7 days a week.
                                                                                                 To request a paper directory, contact
                                                                                                 your broker or Aetna.

Through Aetna’s website                                                                          Aetna InteliHealth® Website
(www.aetna.com)
                                               ■   Research the price of a drug and learn if
members have access                                there are less-costly alternatives.*          Our award-winning health information
to health information                                                                            website, www.intelihealth.com, is a pre-
                                               ■   Find health care professionals and
resources and services                                                                           mier provider of online consumer-based
                                                   facilities that participate in their plan.
designed to help them                                                                            health, wellness and disease-specific infor-
better manage their health.
                                               ■   Request member ID cards.                      mation. In addition, members can search
                                                                                                 a drug database and register for condi-
                                               ■   Print temporary member identification
                                                                                                 tion-specific e-mails.
                                                   information needed for a health care visit.
                                               ■   View the latest health information and        Aetna Voice Advantage®
                                                   news, and more!
                                                                                                 The system enables employees to
                                                                                                 conduct many tasks by phone, such as
                                               Estimate the Cost of Care Tools
                                                                                                 checking claims, changing doctors and
                                               Aetna’s suite of interactive Web-based cost       requesting ID cards.
                                               tools is designed to help members estimate
 Aetna Navigator™ — The                        the costs of health care services so they can     Plan for Your Health
 Power to Help Members                         plan for and take better charge of their
 Manage Their Health                           health care expenses. Members have access
                                                                                                 Plan for Your Health is a public
                                                                                                 education campaign focused on
 It’s easy and convenient for Aetna            to cost estimates for medical procedures,
                                                                                                 helping consumers understand the
 members to manage their health bene-          office visits, medical tests, and diseases and
                                                                                                 connection between health benefits
 fits. Anytime — day or night — wher-          conditions. They may also have access
                                                                                                 and financial planning — particularly
 ever they have Internet access, mem-          to two other cost tools depending on their
                                                                                                 for women. The campaign’s website,
 bers can log in to Aetna Navigator,           Aetna coverage. Members enrolled in an
                                                                                                 PlanforYourHealth.com, makes it easy
 Aetna’s secure member website.                Aetna Dental PPO or PPO Max Plan can
                                                                                                 for consumers to access credible tools
 Members who register on the site can          access the dental procedures cost tool.
                                                                                                 and information, empowering them
 check the status of their claims, con-        Those with prescription drug coverage can
                                                                                                 to make better health benefits and
 tact Aetna Member Services, estimate          use the prescription drugs cost tool.
                                                                                                 financial decisions to meet their present
 the costs of health care services, and        Aetna Navigator is ready 24/7! Aetna              and future needs. The site includes:
 much more!                                    members can go to www.aetna.com and
                                                                                                 ■   Useful tips on navigating health
 Aetna Navigator is a valuable online          select Aetna Navigator. If they haven’t
                                                                                                     benefits in relation to overall
 resource for personalized benefits and        already, encourage them to register today             financial well-being.
 health information. Once registered for       by clicking on the Register Now! link.
 Aetna Navigator, members can:
                                                                                                 ■   Tools to figure out how important
                                               DocFind®                                              life changes will affect health benefits
 ■   Review who is covered under                                                                     options.
     their plan.                               Finding a participating doctor has never been
                                                                                                 ■   Information on choosing the best
                                               easier with our DocFind online provider
 ■   Check claim status and view Claim                                                               health benefits options for women
                                               directory. Members can search
     Explanation of Benefits (EOB)                                                                   and their families.
                                               for participating physicians, hospitals, phar-
     statements.                               macies, dentists and eyewear providers.           *If offered by their plan.
 ■   Estimate the costs of health care         DocFind also allows members to search by
     services to better plan their expenses.
                                                                                                                                                3
Special Programs                                                                                   Check out our website
                                                                                                   at www.aetna.com
                                                                                                   today. With just a
                                                                                                   few clicks, you can
                                                                                                   receive additional
                                                                                                   product information,
                                                                                                   download brochures,
                                                                                                   and more.

Our special programs* offer a wealth           Alternative Health Care Programs —            Informed Health® Line — members can
of features that complement our                reduced rates on alternative therapies for    get answers to their health questions
standard medical and dental                    members including visits to acupuncturists,   anytime … day or night. Our 24-hour,
coverage — including substantial
                                               chiropractors, massage therapists and         toll-free Informed Health Line offers
savings on products and educational
materials geared toward employees’             nutritional counselors. Save on many          access to a team of registered nurses who
special health needs. Read on to               health-related products, including            can provide information on a variety of
discover the many ways we can                  aromatherapy and natural body care,           health issues. Members can also listen to
help you and your employees                    through the National Products Program.        our audio Health Library, a recorded col-
stay healthy.                                  Plus, you can also save on over-the-counter   lection of more than 2,000 health topics
Fitness Program — members can enjoy            vitamins and nutritional supplements          in English and Spanish.
special membership rates at participating      through the Vitamin Advantage™
                                                                                             Healthy Outlook Program® — Our
fitness clubs contracted with GlobalFit        Program.
                                                                                             disease management programs offer
and discounts on certain home exercise         National Medical Excellence Program® —        access to case management, education
equipment. Plus, members may even try          when Aetna members face difficult or life-    and other services for members with
out the facility before joining.**             threatening situations such as organ trans-   chronic health conditions such as
Eye Care Savings Program                       plants, Aetna’s National Medical Excellence   asthma, diabetes, chronic heart failure
The Vision One®*** discount program            Program (NME) coordinates care and pro-       and coronary artery disease.
gives your employees’ special savings on       vides access to covered treatment through
                                                                                             Women’s Health Programs — focus
eye exams (not covered under your base         our Institutes of Excellence™ network.
                                                                                             specifically on the health care needs of
medical plan), contacts, frames, lenses        The program also coordinates specialized
                                                                                             women. Programs include:
and other eye care accessories. They’ll        treatment for members with certain rare or
have many locations to choose from,            complicated conditions, and assists           ■   Our Moms-to-Babies® Maternity
such as Sears Optical, JCPenney Optical,       members who are admitted to the                   Management Program, which offers
Target Optical, participating Pearle           hospital for emergency medical care when          information and services to expectant
Vision Centers, and other participating        they are traveling temporarily                    mothers including care coordination
vision professionals.                          outside of the United States. Except for          by obstetrical nurses experienced in
                                               emergency medical care as described above,        preterm labor education, breastfeeding
Your employees also receive:                   services under this program must be preau-        support and more.
■   A contact lens mail-order replacement      thorized. A listing of facilities in our
                                                                                             ■   Our Breast Health Education Center,
    service through Contacts Direct.           Institutes of Excellence network can be
                                                                                                 which offers information and services
                                               found in DocFind at www.aetna.com.
■   Discount off the surgeon’s fees for                                                          dedicated to breast health, including
    LASIK eye surgery.                         Cancer Screening Programs — remind                our Breast Cancer Case Management
                                               age-eligible HMO and POS members                  Program, confidential genetic testing
■   20-percent discount off retail prices on   to schedule periodic cancer screenings.           for breast and ovarian cancer, our
    vision-related items when purchased at     Reminders are for breast and cervical             Breast Health website and more.
    a Cole Managed Vision provider.            cancer screenings, as well as colorectal
                                                                                             ■   Infertility case management and
■   Access to Aetna Navigator, our online      cancer screenings.
                                                                                                 education.
    resource for checking claims status,
    ordering ID cards and locating eye care                                                    *Availability varies by plan. Talk with your Aetna
    professionals quickly … and easily.                                                         representative for details.
                                                                                              **Not available at all clubs.
                                                                                             ***Vision One is a registered trademark of Cole
                                                                                                Managed Vision.
4
Provider Network

                   New Jersey Network*
                   Map Key
                   All plans are available in all
                   New Jersey counties.

                   Contact Information by County
                   Northeast Region Small Group Sales
                   Support Center: 1-888-277-1053

                   Bergen          Monmouth      Sussex
                   Essex           Morris        Union
                   Hudson          Ocean         Warren
                   Hunterdon       Passaic
                   Middlesex       Somerset

                   Mid-Atlantic Small Group Sales Support
                   Center: 1-877-28-AETNA

                   Atlantic        Cape May      Mercer
                   Burlington      Cumberland    Salem
                   Camden          Gloucester

                   *Network subject to change.

                                                          5
Product Overview*

Aetna Primary Care® Plan HMO                     Members never need a referral when visiting        Aetna Choice® Plan POS —
                                                 a participating specialist for covered services.   No Referrals
Members access care through Primary
Care Physicians.                                 The Primary Care Plan HMO —                        No need for referrals; freedom to select
With this health benefit plan, members           No Referrals provides:                             provider of choice.
                                                 ■ Flexibility — there’s no referral needed
begin by selecting a Primary Care                                                                   Aetna Choice POS — No Referrals
Physician (PCP) from Aetna’s participating         from PCP to visit participating providers.       offers all the health plan benefits of a
network of providers. A member selects a                                                            point-of-service plan with two easy ways
                                                 ■   Emergency care coverage anywhere,
PCP who will coordinate their health care                                                           to access care when members need it.
                                                     anytime, 24 hrs a day
needs for covered benefits or services. Each                                                        Members have the freedom to visit the
covered member of the family may choose          ■   No claim forms.                                participating doctor or hospital of their
their own PCP.                                                                                      choice for covered services. Best of all,
                                                 ■   No lifetime dollar maximums.
                                                                                                    members do not need referrals. This
The Primary Care Plan HMO provides:              ■   Large provider networks.                       plan allows members to:
■ Large provider networks.

                                                                                                    ■   Select and visit their participating
■   Low out-of-pocket costs.                     Aetna Choice® Plan POS
                                                                                                        PCP and pay the plan’s copayment
■   No claim forms.                              Freedom to select providers.                           for covered benefits.
                                                 This health benefit plan values the role of
■   Member’s PCP coordinates their                                                                  ■   Go directly to any network physician
                                                 the PCP to serve as the coordinator of the
    covered health care services.                                                                       from within Aetna’s network of
                                                 member’s health care. Members seeking
                                                                                                        providers and pay the applicable spe-
■   Emergency care coverage anywhere,            health care have the flexibility to access care
                                                                                                        cialist copayment for covered benefits.
    anytime, 24 hrs a day                        in or out of the network. For this flexibility,
                                                 self-referring members share more of the           ■   Go directly to any licensed out-of-
■   No lifetime dollar maximums.
                                                 cost of care through a deductible and coin-            network physician, subject to payment
■   Referral is required for most services not   surance.                                               of a deductible and coinsurance.
    administered by the PCP and
                                                 The Aetna Choice Plan POS provides:                ■   No lifetime dollar maximums
    inpatient hospital care.                     ■ Flexibility to self-refer.
                                                                                                        in-network.
■   Direct access to some specialists,           ■   No lifetime dollar maximums in network.        ■   Large provider networks.
    like Ob/Gyn.
                                                 ■   Large provider networks.
Aetna Primary Care® Plan HMO                     ■   Member encouraged to choose a PCP from
                                                                                                     *This is an overview of Aetna’s packaged product
                                                                                                      offerings and is not intended to be an exhaus-
— No Referrals                                       Aetna’s network of participating providers.      tive list of plan offerings or options available.
                                                                                                      Aetna also offers standard health benefit plans
Flexibility and no referrals needed                                                                   in New Jersey.
                                                 ■   Member visits PCP for routine care or for      **A copayment can be either a flat dollar amount
for participating providers.
                                                     injury or illness; member pays applicable        or a percentage of covered services.
With this health benefit plan, members
                                                     copay each time covered benefits are
may choose how they access covered bene-
                                                     accessed within the network with PCP
fits. Members can visit a PCP and pay a
                                                     referral.
lower copay** or go directly to any partici-
pating physician and pay a higher copay.         ■   Member may visit any out-of-network
                                                     licensed provider, without PCP referral
                                                     for a covered benefit; member shares the
6                                                    cost of care through deductible/coinsurance.
Aetna First Dollar Plan                       owners that have not offered coverage to       provide more health care benefits than
                                              their employees in the past, because of        the Original Medicare plan.
The First Dollar Plan is a high
                                              price, now have a plan option that provides
deductible PPO insurance plan with a                                                         Members access care through Primary
                                              basic affordable coverage.
special benefit feature allowing a limited                                                   Care Physicians.
dollar amount of services prior to the        NOTE: This plan provides limited benefits      Members of the Aetna Golden
deductible coming into play.                  only and does not constitute a comprehen-      Medicare Plan must select a network
                                              sive health insurance plan. As such, it may    primary care doctor to coordinate all
Here’s how it works: the First Dollar
                                              not cover all the expenses associated with     covered care, including:
Plan offers the first $500 individ-
                                              your health care needs.
ual/$1,000 family in covered medical                                                         ■   Routine and preventive care.
expenses (excludes RX) to be paid at
                                              Out-of-State/Situs Employee                    ■   Treatment of illness and injuries.
100% NOT subject to the deductible.
                                              Plan Open Choice® PPO
Once the available first dollars funds are                                                   ■   Referrals to network specialists and
                                              Coverage
exhausted, a deductible must be met for                                                          facilities for certain services, if
all covered medical services (excludes Rx     Coverage available only for eligible               required.
and certain state-mandated benefits).         employees who live outside of
                                                                                             Other Aetna Golden Medicare Plan
Once the deductible is satisfied, the         Connecticut, Delaware, Maryland,
                                                                                             features include:
member will then be responsible for the       New Jersey, New York, Pennsylvania,
cost sharing amounts as indicated in the      Virginia and Washington, D.C.                  ■   Large networks of doctors and hospitals.
plan documents.                               Open Choice gives members the freedom          ■   Referrals to specialist and inpatient
                                              to choose any licensed physician or hospital
                                                                                                 hospital services, if needed.
The Basic Hospital Plan                       whenever they need medical treatment.
                                              Whether the member is at home or away,         ■   Direct access to some specialists,
The Basic Hospital Plan is ideal for                                                             like Ob/Gyn.
                                              members have access to covered services
small business owners that are primarily
                                              with no referrals. Members may pay less        ■   Low or no monthly premiums.
looking for affordability when selecting a
                                              out-of-pocket when they visit an in-net-
coverage option. This high-deductible                                                        ■   Fixed out-of-pocket costs for covered
                                              work physician than if they visit a provider
insurance plan provides inpatient hospi-                                                         services.
                                              not in the network.
tal coverage coupled with limited bene-
                                                                                             ■   No lifetime dollar maximums.
fits for outpatient surgery, skilled nurs-
                                              The Aetna Golden
ing or home health care charges in lieu                                                      ■   No copays for select preventive services.
                                              Medicare Plan® (HMO)
of hospitalization. In addition, this plan                                                   ■   Multiple options to save money
includes three office visits per member       This is a Medicare Advantage HMO plan
                                                                                                 on prescription drugs.
per calendar year for acute and preven-       which provides health care benefits for
tive care and a fixed benefit allowance       Medicare beneficiaries through our con-        ■   Worldwide emergency care.
for lab and x-ray services.                   tract with the federal government. When a      ■   Access to benefits when traveling to
                                              Medicare beneficiary enrolls                       plan-approved service areas through
The deductible on the Basic Hospital
                                              in our Medicare Advantage plan, the feder-                                    ®
                                                                                                 the U.S. Travel Advantage program
Plan applies to all covered expenses,
                                              al government pays us a set amount of              (available in limited service areas).
except certain state-mandated benefits,
                                              money for their covered care every month.
allowed acute/preventive care office visits
                                              In return, we manage their Medicare cover-
and lab-and x-ray services covered by the
                                              age. This funding arrangement allows us to
fixed benefit allowance. Small business
                                                                                                                                         7
■   Automatic claims filing when using
                                                                                                      network doctors and hospitals.
                                                                                                  Enrollee must be entitled to Medicare
                                                                                                  Part A and continue to pay the part B
                                                                                                  premium and Part A, if applicable.
                                                                                                  Higher costs apply for out-of-network
                                                                                                  services. Certain services require pre-
                                                                                                  certification or prior approval of cover-
                                                                                                  age. Providers must be licensed and eli-
                                                                                                  gible to receive payment under the fed-
                                                                                                  eral Medicare program. Coverage is pro-
                                                                                                  vided through a Medicare Advantage
                                                                                                  organization with a Medicare contract
                                                                                                  and benefits, limitations, service areas
                                                                                                  and premiums are subject to change on
■   Access to preventive health and wellness    Members can access care in three                  January 1 of each year.
    programs at no additional cost.             easy ways:
                                                ■ Go directly to any licensed out-of-network      Aetna Dental® Plans
■   Toll-free phone and online resources
                                                  doctor who accepts Medicare for most
    for instant access to health information.                                                     Small business decision makers can
                                                  covered services, subject to payment of an
■   Money-saving services, including                                                              choose from a variety of plan design
                                                  applicable deductible and coinsurance –
    reduced-rate eyewear and vitamins.                                                            options that help you offer a dental plan
                                                  no referrals needed!
                                                                                                  that’s just right for your employees. Aetna
■   Automatic claims filing.                    ■   Go directly to any in-network physician       offers a range of dental benefits plans,
Enrollee must be entitled to Medicare               and pay the applicable specialist copay –     including our Preferred Provider
Part A and continue to pay the part B               no referrals needed!                          Organization (PPO) and Dental
premium and Part A, if applicable.              ■   Go to a primary care doctor and pay the       Maintenance Organization (DMO®)
Enrollee must use network providers                 applicable copay.                             plans. With our dental PPO plans, mem-
except for emergency care or out-of-area                                                          bers have the option to use a participat-
                                                Other Aetna Golden Choice Plan                    ing network dentist or a licensed dentist
urgent care/renal dialysis. Coverage is
                                                features include:                                 who is not in the network. With our
provided through a Medicare Advantage
                                                ■ Flexibility to visit doctors and hospitals in
organization with a Medicare contract                                                             DMO plans, members select a participat-
                                                  or out of network. (Certain services are        ing primary care dentist who coordinates
and benefits, limitations, service areas
                                                  only available in-network for coverage to       their dental care, including referrals to net-
and premiums are subject to change on
                                                  apply).                                         work specialists as needed. Both plans offer
January 1 of each year.
                                                   > Coordinate care through a network            members access to large networks of partic-
The Aetna Golden Choice™                             primary care doctor for fixed copays.        ipating dentists and dental specialists.
Plan (POS)                                         > Go out of network and pay a low              Aetna’s Freedom-of-Choice plan design
                                                     deductible and coinsurance.                  offers two plans in one. Your employee
This is a Medicare Advantage POS plan           ■ Large networks of doctors and hospitals.
which provides health care benefits for                                                           can choose between the Dental PPO and
Medicare beneficiaries through our con-         ■   No annual or lifetime dollar maximums         the DMO. They can switch between
tract with the federal government. When             in network.                                   plans each month or stay with the plan
a Medicare beneficiary enrolls in the                                                             they originally selected … the choice is
                                                ■   No copays for select preventive services.     always theirs!
plan, the federal government pays us a
set amount of money for their covered           ■   Multiple options to save money on pre-
care every month. In return, we manage              scription drugs.                              Aetna Life and Disability
their Medicare coverage. This funding                                                             Plans
                                                ■   Worldwide emergency care.
arrangement allows us to provide more                                                             Aetna offers a wide range of flat dollar
health care benefits than the Original
                                                ■   Access to preventive health and wellness
                                                                                                  insurance options for basic employee
Medicare plan.                                      programs at no additional cost.
                                                                                                  term life insurance as well as disability
                                                ■   Toll-free phone and online resources for      health plan benefit solutions. Aetna’s
                                                    instant access to health information.         affordable life insurance options enable
                                                ■   Money-saving services, including reduced-     members to establish financial protec-
                                                    rate eyewear and vitamins.                    tion for themselves and their families.
                                                                                                  Members can also benefit from Aetna’s
                                                                                                  Packaged Life and Disability product.
                                                                                                  See pages 12-15 for more details.
8
NEW JERSEY AETNA SMALL GROUP DENTAL PLANS
DENTAL PLAN OPTIONS
   Available With an Aetna Medical
   Plan (2 – 50 Eligible Employees)                                         Option 1                        Option 2                                     Option 3                                                Option 4
   Available Without Medical Plan (Dental                                  HMO Rider                         DMO                                    Freedom of Choice                                            PPO Max
                                                                                                                                                 Monthly selection between the
   Standalone) to Groups                                                                                                                             DMO and PPO Max
   with 10 - 50 Eligible Employees

  MEMBER BENEFITS                                                        Basic Dental                 DMO Plan                        DMO Plan                         PPO Max Plan                       PPO Max Plan
                                                                         Rider to HMO-                100/80/50                       100/90/60                        100/70/40                          100/80/50
                                                                         based Medical
  Office Visit Copay                                                     $2                           $5                              $5                               None                               None
  Dental Fund                                                            N/A                          N/A                             N/A                              N/A                                N/A
  Annual Deductible per Member                                           None                         None                            None                             $50; 3X                            $50; 3X
  (does not apply to Diagnostic &                                                                                                                                      Family Maximum                     Family Maximum
  Preventive Services)
  Annual Maximum Benefit                                                 None                         None                            None                             $1,000                             $1,500
  DIAGNOSTIC SERVICES
  Oral Exams
  Periodic oral exam                                                     100%                         100%                            100%                             100%                               100%
  Comprehensive oral exam                                                100%                         100%                            100%                             100%                               100%
  Problem-focused oral exam                                              100%                         100%                            100%                             100%                               100%
  X-rays
  Bitewing — single film                                                 100%                         100%                            100%                             100%                               100%
  Complete series                                                        100%                         100%                            100%                             100%                               100%
  PREVENTIVE SERVICES
  Adult cleaning                                                         100%                         100%                            100%                             100%                               100%
  Child cleaning                                                         100%                         100%                            100%                             100%                               100%
  Sealants — per tooth                                                   Discounted Fee               100%                            100%                             100%                               100%
  Fluoride application — with cleaning                                   100%                         100%                            100%                             100%                               100%
  Space maintainers                                                      Discounted Fee               100%                            100%                             100%                               100%
  BASIC SERVICES
  Amalgam filling — 2 surfaces                                           100%                         80%                             90%                              70%                                80%
  Resin filling — 2 surfaces anterior                                    Discounted Fee               80%                             90%                              70%                                80%
  Oral Surgery
  Extraction – exposed root or erupted tooth                             Discounted Fee               80%                             90%                              70%                                80%
  Extraction of impacted tooth —                                         Discounted Fee               80%                             90%                              70%                                80%
  soft tissue
  MAJOR SERVICES*
  Complete upper denture                                                 Discounted Fee               50%                             60%                              40%                                50%
  Partial upper denture (resin base)                                     Discounted Fee               50%                             60%                              40%                                50%
  Crown — Porcelain with noble metal                                     Discounted Fee               50%                             60%                              40%                                50%
  Pontic — Porcelain with noble metal                                    Discounted Fee               50%                             60%                              40%                                50%
  Inlay — Metallic (3 or more surfaces)                                  Discounted Fee               50%                             60%                              40%                                50%
  Oral Surgery
  Removal of impacted tooth —                                            Discounted Fee               50%                             60%                              40%                                50%
  partially bony
  Endodontic Services
  Bicuspid root canal therapy                                            Discounted Fee               80%                             90%                              40%                                50%
  Molar root canal therapy                                               Discounted Fee               50%                             60%                              40%                                50%
  Periodontic Services
  Scaling & root planing — per quadrant                                  Discounted Fee               80%                             90%                              40%                                50%
  Osseous surgery — per quadrant                                         Discounted Fee               50%                             60%                              40%                                50%
  Orthodontic Services*                                                  Discounted Fee               $2300 copay                     $2300 copay                      Not covered                        Not covered
  Orthodontic Lifetime Maximum                                           Does not apply               Does not apply                  Does not apply                   Does not apply                     Does not apply

Note: For New Jersey groups with 25 or more eligible employees, the DMO in Plan Option 2 cannot be sold on a standalone basis to a customer with primary business location in New Jersey. It must be part of a Dual Option sale packaged
with either one of the PPO plans in Plan Options 4 - 6.
The DentalFund in Plan Option 7 can be used to pay for any non-covered service. Any unused portion of the Fund will roll over to the next calendar year.
*Coverage Waiting Period: Must be an enrolled member of the Plan for 12 months before becoming eligible for coverage of any Major Service including Orthodontic Services. Does not apply to the Basic Dental Rider in Plan Option 1;
 DMO in Plan Options 2 & 3 or the DentalFund in Plan Option 7.
Access to negotiated discounts; On the PPO plans in Plan Options 3-7, members are eligible to receive non-covered services at the PPO negotiated rate when visiting a participating PPO dentist at any time, including during the Coverage
Waiting Period.
The DMO in Plan Option 2 can be offered with any of the PPO plans in Plan Options 4 - 6 in a Dual Option package.
Most Oral Surgery, Endodontic and Periodontic services are covered as Basic Services on the DMO in Plan Options 2 & 3 and the PPO in Plan Option 5 and are not subject to the coverage waiting period.
Plan Options 3, 4 & 7; PPO Max Non-Preferred (Out-of-Network) Coverage is limited to a maximum of the Plan’s payment, which is based on the contracted maximum fee for participating providers in the particular geographic area.
Orthodontic coverage is available only to groups with 10 or more eligibles and for dependent children only.
Above list of covered services is representative. Full list with limitations as determined by Aetna appears on the plan booklet/certificate. For a summary list of Limitations and Exclusions, refer to page 16.                           9
NEW JERSEY AETNA SMALL GROUP DENTAL PLANS
DENTAL PLAN OPTIONS
   Available With an Aetna Medical
   Plan to Groups with 2 - 50 Eligible                                            Option 5                                                Option 6                       Option 7
   Employees Available Without Medical                                   Active PPO High-Option Plan                                       Passive                       Consumer
   Plan (Dental Standalone) to Groups                                                                                                     PPO 1500                        Directed
   with 10 - 50 Eligible Employees

  MEMBER BENEFITS                                                        Preferred Plan               Non-Preferred                   PPO 1500 Plan                    DentalFund/
                                                                         100/80/50                    Plan 80/60/40                   100/80/50                        PPO Max
                                                                                                                                                                       100/0/0
  Office Visit Copay                                                     None                         None                            None                             None
  Dental Fund                                                            N/A                          N/A                             N/A                              $50 Single;
                                                                                                                                                                       $100 Family
  Annual Deductible per Member                                           $50; 3X Family               $50; 3X Family                  $50; 3X Family                   None
  (does not apply to Diagnostic &                                        Maximum                      Maximum                         Maximum
  Preventive Services)
  Annual Maximum Benefit                                                 $1,500                       $1,000                          $1,500                           None
  DIAGNOSTIC SERVICES
  Oral Exams
  Periodic oral exam                                                     100%                         80%                             100%                             100%
  Comprehensive oral exam                                                100%                         80%                             100%                             100%
  Problem-focused oral exam                                              100%                         80%                             100%                             100%
  X-rays
  Bitewing — single film                                                 100%                         80%                             100%                             100%
  Complete series                                                        100%                         80%                             100%                             100%
  PREVENTIVE SERVICES
  Adult cleaning                                                         100%                         80%                             100%                             100%
  Child cleaning                                                         100%                         80%                             100%                             100%
  Sealants — per tooth                                                   100%                         80%                             100%                             100%
  Fluoride application — with cleaning                                   100%                         80%                             100%                             100%
  Space maintainers                                                      100%                         80%                             100%                             100%
  BASIC SERVICES
  Amalgam filling — 2 surfaces                                           80%                          60%                             80%                              Discounted Fee
  Resin filling — 2 surfaces anterior                                    80%                          60%                             80%                              Discounted Fee
  Oral Surgery
  Extraction – exposed root or erupted tooth                             80%                          60%                             80%                              Discounted Fee
  Extraction of impacted tooth —                                         80%                          60%                             80%                              Discounted Fee
  soft tissue
  MAJOR SERVICES*
  Complete upper denture                                                 50%                          40%                             50%                              Discounted        Fee
  Partial upper denture (resin base)                                     50%                          40%                             50%                              Discounted        Fee
  Crown — Porcelain with noble metal                                     50%                          40%                             50%                              Discounted        Fee
  Pontic — Porcelain with noble metal                                    50%                          40%                             50%                              Discounted        Fee
  Inlay — Metallic (3 or more surfaces)                                  50%                          40%                             50%                              Discounted        Fee
  Oral Surgery
  Removal of impacted tooth —                                            50%                          40%                             50%                              Discounted Fee
  partially bony
  Endodontic Services
  Bicuspid root canal therapy                                            80%                          60%                             50%                              Discounted Fee
  Molar root canal therapy                                               50%                          40%                             50%                              Discounted Fee
  Periodontic Services
  Scaling & root planing — per quadrant                                  80%                          60%                             50%                              Discounted Fee
  Osseous surgery — per quadrant                                         50%                          40%                             50%                              Discounted Fee
  Orthodontic Services*                                                   50%                         40%                             50%                              Discounted Fee
  Orthodontic Lifetime Maximum                                            $1,000                      $1,000                          $1,000                           Does not apply
Note: For New Jersey groups with 25 or more eligible employees, the DMO in Plan Option 2 cannot be sold on a standalone basis to a customer with primary business location in New Jersey. It must be part of a Dual Option sale packaged with
either one of the PPO plans in Plan Options 4 - 6.
The DentalFund in Plan Option 7 can be used to pay for any non-covered service. Any unused portion of the Fund will roll over to the next calendar year.
*Coverage Waiting Period: Must be an enrolled member of the Plan for 12 months before becoming eligible for coverage of any Major Service including Orthodontic Services. Does not apply to the Basic Dental Rider in Plan Option 1; DMO
 in Plan Options 2 & 3 or the DentalFund in Plan Option 7.
Access to negotiated discounts; On the PPO plans in Plan Options 3-7, members are eligible to receive non-covered services at the PPO negotiated rate when visiting a participating PPO dentist at any time, including during the Coverage
Waiting Period.
The DMO in Plan Option 2 can be offered with any of the PPO plans in Plan Options 4 - 6 in a Dual Option package.
Most Oral Surgery, Endodontic and Periodontic services are covered as Basic Services on the DMO in Plan Options 2 & 3 and the PPO in Plan Option 5 and are not subject to the coverage waiting period.
Plan Options 3, 4 & 7; PPO Max Non-Preferred (Out-of-Network) Coverage is limited to a maximum of the Plan’s payment, which is based on the contracted maximum fee for participating providers in the particular geographic area.
Orthodontic coverage is available only to groups with 10 or more eligibles and for dependent children only.
Above list of covered services is representative. Full list with limitations as determined by Aetna appears on the plan booklet/certificate. For a summary list of Limitations and Exclusions, refer to page 16.

10
NEW JERSEY AETNA SMALL GROUP DENTAL PLANS
OUT-OF-STATE/SITUS PPO PLAN OPTIONS
   Available With an Aetna Medical
   Plan (2 – 50 Eligible Employees)
                                                                            Low Option                               Low Option                           Medium Option                         Medium Option
   Available Without Medical Plan
                                                                             No Ortho*                                 Ortho*                               No Ortho*                              Ortho*
   (Dental Standalone) to Groups with
   10 - 50 Eligible Employees

  MEMBER BENEFITS                                                     PPO Max Plan                              PPO Max Plan                             PPO Max Plan                             PPO Max Plan
                                                                      100/80/50                                 100/80/50                                100/80/50                                100/80/50
 Office Visit Copay                                                   N/A                                       N/A                                      N/A                                      N/A
 Annual Deductible per Member                                         $50; 3X Family                            $50; 3X Family                           $50; 3X Family                           $50; 3X Family
 (does not apply to Diagnostic &                                      Maximum                                   Maximum                                  Maximum                                  Maximum
 Preventive Services)
 Annual Maximum Benefit                                               $1,000                                    $1,000                                   $1,500                                   $1,500
  DIAGNOSTIC SERVICES
  Oral Exams
 Periodic oral exam                                                   100%                                      100%                                     100%                                     100%
 Comprehensive oral exam                                              100%                                      100%                                     100%                                     100%
 Problem-focused oral exam                                            100%                                      100%                                     100%                                     100%
  X-rays
 Bitewing — single film                                               100%                                      100%                                     100%                                     100%
 Complete series                                                      100%                                      100%                                     100%                                     100%
  PREVENTIVE SERVICES
 Adult cleaning                                                       100%                                      100%                                     100%                                     100%
 Child cleaning                                                       100%                                      100%                                     100%                                     100%
 Sealants — per tooth                                                 100%                                      100%                                     100%                                     100%
 Fluoride application — with cleaning                                 100%                                      100%                                     100%                                     100%
 Space maintainers                                                    100%                                      100%                                     100%                                     100%
  BASIC SERVICES
 Amalgam filling — 2 surfaces                                         80%                                       80%                                      80%                                      80%
 Resin filling — 2 surfaces anterior                                  80%                                       80%                                      80%                                      80%
  Oral Surgery
 Extraction – exposed root or erupted tooth                           80%                                       80%                                      80%                                      80%
 Extraction of impacted tooth —                                       80%                                       80%                                      80%                                      80%
 soft tissue
  MAJOR SERVICES**
 Complete upper denture                                               50%                                       50%                                      50%                                      50%
 Partial upper denture (resin base)                                   50%                                       50%                                      50%                                      50%
 Crown — Porcelain with noble metal                                   50%                                       50%                                      50%                                      50%
 Pontic — Porcelain with noble metal                                  50%                                       50%                                      50%                                      50%
 Inlay — Metallic (3 or more surfaces)                                50%                                       50%                                      50%                                      50%
  Oral Surgery
 Removal of impacted tooth —                                          50%                                       50%                                      50%                                      50%
 partially bony
  Endodontic Services
 Bicuspid root canal therapy                                          50%                                       50%                                      50%                                      50%
 Molar root canal therapy                                             50%                                       50%                                      50%                                      50%
  Periodontic Services
 Scaling & root planing — per quadrant                                50%                                       50%                                      50%                                      50%
 Osseous surgery — per quadrant                                       50%                                       50%                                      50%                                      50%
  Orthodontic Services**                                              Not covered                               50%                                      Not covered                              50%
 Orthodontic Lifetime Maximum                                         Does not apply                            $1,000                                   Does not apply                           $1,000

 *Employees inside of the situs rating area are: Connecticut, Delaware, Maryland, New Jersey, New York, Pennsylvania, Virginia and Washington, D.C. where Aetna has an HMO and/or PPO network. Out-of-State/Situs PPO plans
   are not available in some states. The Out-of-State/Situs Traditional plan is offered in Arkansas, Alaska, Hawaii, Idaho, Maine, Montana, North Dakota, New Hampshire, New Mexico, South Dakota, Vermont and Wyoming.
**Coverage Waiting Period: Must be an enrolled member of the Plan for 12 months before becoming eligible for coverage of any Major Service including Orthodontic Services.
Access to negotiated discounts; On all PPO Max plans, members are eligible to receive non-covered services at the PPO negotiated rate when visiting a participating PPO dentist at any time, including during the Coverage Waiting
Period.
PPO Max Non-Preferred (Out-of-Network) Coverage is limited to a maximum of the Plan’s payment, which is based on the contracted maximum fee for participating providers in the particular geographic area.
Orthodontic coverage is available only to groups with 10 or more eligibles and for dependent children only.
Above list of covered services is representative. Full list with limitations as determined by Aetna appears on the plan booklet/certificate. For a summary list of Limitations and Exclusions, refer to page 16.
                                                                                                                                                                                                                              11
Small Business decision makers
can choose from a selection of                              Aetna Life and Disability
affordable life and disability
benefit solutions to meet your
employees’ needs. We also provide
extra value through a variety of
services for your employees.

  The streamlined Life and Disability                       Life Insurance                                 ■   Premium Waiver Provision —
  package includes a range of flat
                                                                                                               Employee coverage may stay in effect
  dollar insurance options bundled                          Life insurance is an inexpensive way to
  together in one monthly per                                                                                  up to age 65 without premium pay-
                                                            provide a death benefit for employees that
  employee rate — resulting in a                                                                               ments if an employee is permanently
                                                            will help them establish essential financial
  simplified quotation process. These                                                                          and totally disabled while insured
  products are easy to understand,
                                                            protection for themselves and their fami-
                                                                                                               because of an illness or injury prior to
  and offer affordable benefits                             lies. Aetna offers a wide range of flat dol-
                                                                                                               age 60.
  together with valuable services                           lar insurance options for basic employee
  at no additional cost. Plan sponsors                      term life insurance with rates guaranteed      ■   Guaranteed Issue — For Basic Term
  will also benefit from streamlined                        not to increase for a period of two years          Life, coverage is individually “guaran-
  plan installation, administration
                                                            from your policy’s effective date. Aetna           teed issue” up to $20,000 for groups
  and claims processing. Or, if a Life
  solution is all you’re looking for,
                                                            Small Group life insurance plans auto-             with 2-9 eligible employees, $75,000
  you may also just simply choose                           matically come with many value-added               for groups of 10-25 eligible employees,
  from our portfolio of Group Basic                         features, including:                               and $100,000 for groups of 26-50
  Term Life plans.                                                                                             eligible employees. For Packaged
                                                            ■   AD&D Ultra® — Automatically
  Life insurance customers have
                                                                                                               Life/Disability, the guaranteed issue
                                                                included in all employee term life plans
  access to free investment planning                                                                           amounts for groups of 2-50 eligible
                                                                is an Accidental Death and Personal
  services through an arrangement                                                                              employees are $10,000 for the Low
                                                                Loss benefit called AD&D Ultra.
  with Chase Investment Services                                                                               Option and $20,000 for the Medium
  Corp. (CISC)*, an affiliate of J.P.                           AD&D Ultra provides a benefit up to
                                                                                                               Option. For the High Option, the
  Morgan Chase & Co. The program                                the amount of group life insurance for
                                                                                                               guaranteed issue amount is $20,000
  is available to all beneficiaries                             certain accidental losses. Aetna calls
  regardless of their benefit payout
                                                                                                               for groups of 2-9 eligible employees
                                                                it AD&D Ultra because it includes
  and provides investment planning                                                                             and $50,000 for groups of 10-50 eligi-
                                                                seven benefits that set the standard
  from a CISC Financial Consultant                                                                             ble employees.
                                                                for accidental loss protection. These
  through a toll-free number.
                                                                benefits include:                          ■   Optional Dependent Life Insurance
  Aetna’s Legal Reference Program*                                                                             — Ability to add optional additional
  offers free information, as well as
                                                                > Passenger Restraint & Airbag
                                                                                                               coverage for eligible spouses and
  discounted legal services to plan                             > Education Benefit for Dependent              children for employers with 10 or
  members through Advisory                                        Child and/or Spouse
  Communications Systems, Inc.                                                                                 more employees. This benefit enables
                                                                > Child Care Benefit                           employees to protect their spouses and
  * For the Aetna Beneficiary Solutions Program, secu-          > Repatriation of Remains Benefit              dependent children in flat amounts
    rities and investment advisory services are inde-                                                          at employee expense.
    pendently offered through Chase Investment
    Services Corp. (CISC). A member of NASD/SIPC                > Coma Benefit
    and a subsidiary of J.P. Morgan Chase Bank, CISC                                                       ■   Aetna Beneficiary SolutionsTM
    is a full-service broker-dealer and Registered              > Total Disability Benefit
    Investment Advisor. Aetna does not warrant or                                                              Program* — A program that provides
    guarantee and makes no representations as to the
    quality of services offered by CISC. The Legal              > 365-Day Covered Loss Period                  an interest-bearing account, cus-
    Reference Program is independently offered and
    administered by Advisory Communications                 ■   Accelerated Death Benefits — Also              tomized investment programs with
    Systems, Inc. (ACS). Aetna does not participate in
    attorney selection or review, and does not monitor          called the “living benefit,” provides          confidential, free financial counseling
    ACS services, content or network. Aetna does not                                                           through Chase Investment Services
    provide legal services and makes no representa-             payment to terminally ill employees or
    tions or warranties as to the quality of the services
                                                                spouses. The payment can be up to              Corp., as well as Aetna’s Legal
    of ACS or of any attorney in the ACS network.
                                                                50% of the life insurance benefit              Reference Program for all beneficiaries.
                                                                (minimum of $5,000).
 12
Disability                                         ■   We align clinical and claim management       ■   Simplified quotation process — no extra
                                                       experience with the nature and complexity        information is needed and rates are set.
Disability insurance provides a partial                of each claim to provide the right touch
replacement of lost income for the                                                                  ■   Streamlined plan installation,
                                                       at the right time™ for you and your ill or
employee, and helps reduce employer                                                                     administration and claims processing.
                                                       injured employees.
costs compared to the cost of carrying                                                              ■   Specially designed Disability product,
disabled employees on the payroll while            Packaged Life and Disability                         which is a combination of Short and
also paying overtime to other employees
                                                                                                        Long Term Disability benefits that —
or hiring replacements.                            Aetna offers a streamlined product that
                                                                                                        at a crucial time — helps employees
                                                   combines basic life, AD&D, dependent
Through Aetna Disability Services®, plan                                                                bridge from most employer-sponsored
                                                   life, and disability insurance coverages in
administration is easy and dependable:                                                                  salary continuation to Social Security.
                                                   one convenient package. To make it easy to
■   Fast, accurate claim payments from our         choose, we’ve designed three alternatives        ■   The Disability portion of this product
    dedicated disability benefit system that       that provide different levels of life and dis-       offers coverage for occupational and
    automates benefit calculations, claim          ability coverage for a set price — Low,              non-occupational injuries and illnesses.
    histories, and audit and security features.    Medium and High plans. These plans offer
                                                   a range of flat dollar insurance options         NOTE: For a summary list of AD&D Ultra
■   Designated claim analysts who serve as         bundled together in one monthly per              and Disability Limitations and Exclusions, refer
    the employee’s single point of contact to      employee rate.
                                                                                                    to page 16.
    our team of claim and clinical profes-
    sionals. Nurse case managers and voca-         There are several advantages to choosing
    tional rehabilitation specialists are avail-   these options:
    able to work with employees facing             ■   One-stop shopping
    complex clinical and functional chal-
    lenges to help achieve a positive out-         ■   Plans are designed to meet the business
    come for the employee and cost-effec-              needs of small business owners.
    tive claim management for you.

                                                                                                                                                       13
LIFE AND DISABILITY BENEFITS
A E T N A S M A L L G R O U P PA C K A G E D L I F E & D I S A B I L I T Y P L A N O P T I O N S

  Packaged Life                             Low                                     Medium                                    High
  & Disability Benefits                     Option                                  Option                                    Option
  BASIC LIFE PLAN DESIGN
  Benefit                                   Flat $10,000                            Flat $20,000                             Flat $50,000

  Guaranteed Issue
  2 – 9 Lives                               $10,000                                 $20,000                                  $20,000
  10 – 50 Lives                             $10,000                                 $20,000                                  $50,000

  Reduction Schedule                        Employee’s Original Life                Employee’s Original Life                 Employee’s Original Life
                                            Amount Reduces to 65% at                Amount Reduces to 65% at                 Amount Reduces to 65% at
                                            age 65; 40% at age 70;                  age 65; 40% at age 70;                   age 65; 40% at age 70;
                                            25% at age 75                           25% at age 75                            25% at age 75

  Premium Waiver Provision                  Premium Waiver 60                       Premium Waiver 60                        Premium Waiver 60

  Accelerated Death Benefit                 Up to 50% of Life Amount                Up to 50% of Life Amount                 Up to 50% of Life Amount

  Dependent Life                            Spouse $5,000; Child $2,000             Spouse $5,000; Child $2,000              Spouse $5,000; Child $2,000

  AD&D Ultra®                               Matches Basic Life Benefit              Matches Basic Life Benefit               Matches Basic Life Benefit

  Additional Features                       Passenger Restraint & Airbag, Education (for dependent child and/or spouse), Child Care, Repatriation,
                                            Coma, Total Disability, 365-Day Covered Covered Loss

  DISABILITY PLAN DESIGN
  Monthly Benefit                           Flat $500;                              Flat $1,000; Only offset Workers’        Flat $1,000; Only offset Workers’
                                            No offsets                              Compensation, any state                  Compensation, any state
                                                                                    disability plan, and primary &           disability plan, and primary &
                                                                                    family Social Security benefits          family Social Security benefits
                                                                                    Benefit if applicable                    Benefit if applicable

  Elimination Period                        30 days                                 30 days                                  30 days

  Definition of Disability                  Own occupation                          Own occupation                           First 24 months of benefits: Own
                                            20% Earnings Loss                       20% Earnings Loss                        Occupation Earnings Loss of 20% or
                                            (80% Earnings Test)                     (80% Earnings Test)                      more; Any reasonable occupation
                                                                                                                             thereafter: 40% earnings loss.

  Benefit Duration                          24 months of benefits                   24 months of benefits                    60 months of benefits

  Pre-Existing Condition Limitation         3/12                                    3/12                                     3/12

  Types of Disability                       Occupational & Non-Occupational         Occupational & Non-Occupational          Occupational & Non-Occupational

  Mental Health/Substance Abuse             24 months of benefits                   24 months of benefits                    24 months of benefits

  Rates* (per employee per month)           $8                                      $15                                      $27

*The above rates are valid for effective dates up to December 31, 2005 and are guaranteed for an assumed 12-month first-year policy period.

14
TERM LIFE BENEFITS
AETNA SMALL GROUP BASIC EMPLOYEE TERM LIFE PLAN OPTIONS
Term Life Benefits are also available separately from the packaged product.

  Term Life Benefits            2 – 9 Employees                                 10 – 50 Employees

  Basic Life Schedule           Flat $10,000, $15,000, $20,000, $50,000         Flat $10,000, $15,000, $20,000, $50,000,
                                                                                $75,000, $100,000, $125,000
  Class Schedules               Not Available                                   Up to 3 classes (with a minimum requirement of 3
                                                                                employees in each class)— the benefit amount of the
                                                                                highest class cannot be more than 5 times the
                                                                                benefit amount of the lowest class
  Premium Waiver Provision      Premium Waiver 60                               Premium Waiver 60
  Age Reduction Schedule        Original Life Amount Reduces to 65% at          Original Life Amount Reduces to 65% at
                                age 65, 40% at age 70, 25% at age 75            age 65, 40% at age 70, 25% at age 75
  Accelerated Death Benefit     Up to 50% of Life Amount                        Up to 50% of Life Amount
  Guaranteed Issue              $20,000                                         10-25 - $75,000
                                                                                26-50 - $100,000
  Participation Requirements    100%                                            100% on noncontributory plans; 75% on
                                                                                contributory plans
  Contribution Requirements     100% Employer Contribution                      Minimum 50% Employer Contribution
  AD&D ULTRA®

  AD&D Schedule                 Automatically Included; Same as Life plan       Automatically Included; Same as Life plan
  Additional Features           Passenger Restraint & Airbag, Education (for    Passenger Restraint & Airbag, Education (for
                                dependent child and/or spouse), Child Care,     dependent child and/or spouse), Child Care,
                                Repatriation, Coma, Total Disability, 365-Day   Repatriation, Coma, Total Disability, 365-Day
                                Covered Loss                                    Covered Loss
  OPTIONAL DEPENDENT TERM LIFE

  Spouse Amount                 Not Available                                   $5,000
  Child Amount                  Not Available                                   $2,000

                                                                                                                                      15
Limitations and Exclusions

Dental Limitations and                           AD&D Ultra Limitations                             Disability Limitations and
Exclusions                                       and Exclusions                                     Exclusions
Listed below are some of the charges and         This coverage is only for losses caused            No benefits are payable if the disability:
services for which these dental plans do         by accidents. No benefits are payable for          ■   Is due to intentionally self-inflicted
not provide coverage. For a complete list        a loss caused or contributed to by:                    injury (while sane or insane).
of exclusions and limitations, refer to          ■   A bodily or mental infirmity.                  ■   Results from your committing, or
plan documents.                                  ■   A disease, ptomaine or bacterial infection.*       attempting to commit, a felony.
■   Dental services or supplies that are         ■   Medical or surgical treatment.*                ■   Is due to insurrection, rebellion or
    primarily used to alter, improve or
                                                 ■   Suicide or attempted suicide                       taking part in a riot or civil commotion.
    enhance appearance.
                                                     (while sane or insane).                        ■   Is due to war or any act of war
■   Experimental services, supplies or
                                                 ■   An intentionally self-inflicted injury.            (declared or not declared)
    procedures.
                                                 ■   A war or any act of war (declared              ■   Results from an automobile accident
■   Treatment of any jaw joint disorder, such
                                                     or not declared).                                  caused by you while you are intoxicated.
    as temporomandibular joint disorder.
                                                                                                        (“Intoxicated” means: the blood
■   Replacement of lost, missing or stolen
                                                 ■   Voluntary inhalation of poisonous gases.
                                                                                                        alcohol level of the driver of the auto-
    appliances and certain damaged appliances.   ■   Commission of or attempt to commit a               mobile meets or exceeds the level at
■   Those services that Aetna defines as not         felony provided that the covered                   which intoxication would be pre-
    necessary for the diagnosis, care                person is convicted of the felony.                 sumed under the law of the state
    or treatment of a condition involved.        ■   A covered person’s intoxication or being           where the accident occurred.)
                                                     under the influence of any narcotics           On any day during a period of
Specific service limitations
                                                     unless administered or consumed on the         disability that a person is confined
■   DMO Plans: Oral exams (4 per year)               advice of a physician.                         in a penal or correctional institution
■   PPO Plans: Oral exams (2 routine             ■   Intended or accidental contact with            for conviction of a criminal or other
    and 2 problem-focused per year)                  nuclear or atomic energy by explosion          public offense, the person will not be
■   All Plans:                                       and/or release.                                deemed to be disabled and no benefits
    > Bitewing X-rays (1 set per year)           ■   Air or space travel. This does not apply       will be payable.
    > Complete series X-rays                         if a person is a passenger, with no duties     No benefit is payable for any disability
      (1 set every 3 years)                          at all, on an aircraft being used only to      that occurs during the first 12 months
    > Cleanings (2 per year)                         carry passengers (with                         of coverage and is due to a pre-existing
    > Fluoride (1 per year; children                 or without cargo).                             condition for which the member was
      under 16)                                  *These do not apply if the loss is                 diagnosed, treated or received services,
    > Sealants (1 treatment per tooth,            caused by:                                        treatment, drugs or medicines three (3)
      every 3 years on permanent molars;                                                            months prior to coverage effective date.
                                                 ■   An infection that results directly from
      children under 16)
                                                     the injury, or surgery needed because
    > Scaling & root planing
                                                     of the injury. The injury must not be
      (4 quadrants every 2 years)
                                                     one that is excluded by the terms of
    > Osseous surgery (1 per quadrant
                                                     the contract.
      every 3 years)
■   All other limitations and exclusions
    in your plan documents.
16
Notes

        17
Notes

18
Notes

        19
Aetna is the brand name used for products and services provided by one or more of the Aetna group
of subsidiary companies. The Aetna companies that offer, underwrite or administer benefits coverage
include Aetna Health Inc., Aetna Life Insurance Company and/or Aetna Dental Inc. For the Aetna Golden
Choice Plan, Corporate Health Insurance Company also offers, underwrites or administers benefits.

This material is for informational purposes only and is neither an offer of coverage nor medical advice. It contains
only a partial, general description of plan benefits or programs and does not constitute a contract. Aetna arranges
for the provision of healthcare/dental services. However, Aetna itself is not a provider of healthcare/dental servic-
es and therefore, cannot guarantee any results or outcomes. Consult the plan documents (Schedule of Benefits,
Certificate of Coverage, Evidence of Coverage, Group Agreement, Group Insurance Certificate, Booklet, Booklet-
certificate, Group Policy) to determine governing contractual provisions, including procedures, exclusions and lim-
itations relating to the plan. The availability of a plan or program may vary by geographic service area and by plan
design. With the exception of Aetna Rx Home Delivery® service, participating providers and vendors are independ-
ent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Aetna Rx Home
Delivery, LLC, is a subsidiary of Aetna Inc. The availability of any particular provider cannot be guaranteed, and
provider network composition is subject to change. Notice of the change shall be provided in accordance with
applicable state law. Certain primary care providers are affiliated with integrated delivery systems or other provider
groups (such as independent practice associations and physician-hospital organizations), and members who select
these providers will generally be referred to specialists and hospitals within those systems or groups. However, if a
system or group does not include a provider qualified to meet member’s medical needs, member may request to
have services provided by non-system or non-group providers. Member’s request will be reviewed and will require
prior authorization from the system or group and/or Aetna to be a covered benefit.
Information supplied by Aetna InteliHealth® is for informational purposes only, is not medical advice and is not
intended to be a substitute for proper medical care provided by a physician. Informed Health® Line nurses cannot
diagnose, prescribe or give medical advice. Specific questions should be addressed to your doctor. Alternative
health care programs, Vision One® and the fitness program are rate-access programs and may be in addition to
any plan benefits. Program providers are solely responsible for the products and services provided thereunder.
Aetna does not endorse any vendor, product or service associated with these programs. Discounts offered hereun-
der are not insurance.
Some benefits are subject to limitations or visit maximums. Members or Providers may be required to precertify, or
obtain prior approval of coverage for certain services such as non-emergency inpatient hospital care. If your plan
covers outpatient prescription drugs, your plan may include a drug formulary (preferred drug list). A formulary is
a list of prescription drugs generally covered under your prescription drug benefits plan on a preferred basis
subject to applicable limitations and conditions. Your pharmacy benefit is generally not limited to the drugs listed
on the formulary. The medications listed on the formulary are subject to change in accordance with applicable state
law. For information regarding how medications are reviewed and selected for the formulary, formulary
information, and information about other pharmacy programs such as precertification and step-therapy, please
refer to Aetna’s website at www.aetna.com, or the Aetna Medication Formulary Guide. Many drugs, including
many of those listed on the formulary, are subject to rebate arrangements between Aetna and the manufacturer
of the drugs. Rebates received by Aetna from drug manufacturers are not reflected in the cost paid by a member
for a prescription drug. In addition, in circumstances where your prescription plan utilizes copayments or
coinsurance calculated on a percentage basis or a deductible, use of formulary drugs may not necessarily result in
lower costs for the member. Members should consult with their treating physicians regarding questions about
specific medications. Refer to your plan documents or contact Member Services for information regarding the
terms and limitations of coverage. Closed formularies and step therapy do not apply to New Jersey plan options.
Aetna Rx Home Delivery refers to Aetna Rx Home Delivery, LLC, a subsidiary of Aetna Inc., that is a licensed
pharmacy providing mail-order pharmacy services. Aetna’s negotiated charge with Aetna Rx Home Delivery may
be higher than Aetna Rx Home Delivery’s cost of purchasing drugs and providing mail-order pharmacy services.
Aetna does not credential or otherwise make any representations as to the quality or appropriateness of long-term
care providers offering discounts to Aetna members.
While this material is believed to be accurate as of the print date, it is subject to change.
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