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Health Insurance Plan Options
Post-65 Plans
Emeriti Health Plan II – Aetna Traditional Choice®
For more information, please review the Health Plan Comparison Chart
or the more detailed Summary of Plan Benefits.
To estimate your health care expenses in retirement, use the Retirement Health Care Cost Calculator.
To calculate the monthly premiums for the different 2007 Emeriti Health Insurance Plan Options, use the Emeriti Online Premium Rate Guide.
The Emeriti Program provides these distinctive features:
- Catastrophic protection
- A choice of Medicare-approved Part D prescription drug coverages
- Coverage of any doctor or facility that accepts Medicare
- National access to insurance
- Annual choice among Emeriti Health Insurance Plan Options
- Preventive care
- Urgent or emergency coverage for up to six months while traveling abroad.
More information on Medicare can be found on the Henry J. Kaiser Family Foundation
Website, or by visiting Medicare.Gov.
Emeriti Health Plan II – Aetna Traditional Choice®
How the Major Medical Coverage Plan Works
Aetna Traditional Choice® is an indemnity plan in which you and your covered family members may receive care from any physician, hospital, or other health care provider who participates in Medicare.
When you need care, you simply visit any health care provider who participates in Medicare. The provider submits a claim to Medicare and benefits are paid based on the provisions of Medicare Part A and Part B. If a balance remains after Medicare makes payment, Medicare submits this balance directly to Aetna. Aetna then reviews the claim and makes payment on the balance. Before Aetna pays benefits, you must meet the plan deductible of $750. (This deductible applies to medical expenses. A separate deductible applies to prescription drug expenses.) Then Aetna pays a portion of the expense (80% for most covered expenses) and you pay a portion (20%).
The plan places a limit on what you must pay out of pocket for your care. When your out-of-pocket medical costs reach the catastrophic threshold of $2,000, the plan pays 100% of your covered expenses for the rest of the calendar year. Major medical and prescription drug expenses have separate catastrophic thresholds. See below for information on how the prescription drug coverage works.
Note that there is an annual allowance of $300 for annual physical, with an additional $100 allowance for speech and hearing combined, and a $100 allowance for vision.
It may take a few weeks to get the Medicare Direct established; in the meantime, if you have a claim, please use the Medical Benefits Claim Form. For individuals who are traveling internationally for up to 6 months, and require emergency medical treatment, please use the same claim form.
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Emeriti Health Plan II – Aetna Traditional Choice®
How the Prescription Drug Plan Works
Plan II provides Medicare-approved Part D coverage that helps you pay for prescription medications at retail pharmacies (for short-term prescriptions) or through Aetna's mail order service (for long-term prescriptions). The plan uses different levels (or "stages") of cost sharing. Here's how it works:
- Stage 1: You meet an annual deductible of $250.
- Stage 2: You pay a percentage of the prescription drug cost until the total amount paid by you and the plan combined reaches $2,400. The percentage you pay depends on the type of drug prescribed, as follows:
20% for generic drugs
35% for brand-name drugs on the formulary list
50% for brand-name drugs not on the formulary list
- Stage 3: You pay a higher percentage after $2,400 in costs, until your true out-of-pocket costs reach $3,850. The percentage you pay depends on the type of drug prescribed, as follows:
20% for generic drugs
35% for brand-name drugs on the formulary list
50% for brand-name drugs not on the formulary list
For a list of formulary drugs, click here.
- Stage 4: If your true out-of-pocket expenses (the total of Stages 1, 2 and 3) exceed $3,850 in a given calendar year, the Plan pays 100% of the remaining prescription drug expenses for the rest of that year.
The Aetna Medicare Preferred Drug List (3-Tier Open Formulary) is a list of covered drugs selected by Aetna Medicare in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. This document includes the Aetna Medicare Plan’s comprehensive formulary as of January 1, 2007. You can always access current formulary drug status by visiting our website at www.aetnamedicare.com or by calling the toll-free number on the back of your Aetna Medicare member ID card, Monday to Friday, 8 a.m. to 6 p.m.
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Emeriti Health Plan II – Aetna Traditional Choice®
How to Fill Your Prescriptions
There are two ways to fill prescriptions:
- You may fill short-term prescriptions at retail pharmacies that belong to Aetna's network. You can use DocFind® to locate participating pharmacies near you. When you visit the pharmacy, show your Aetna ID card. If you haven't met your deductible, you'll need to pay the full cost of the prescription unless you are using a Medicare prescription drug card or other discount program. If you've met your deductible, the pharmacist will know how much to collect for your share of the cost. Important: You must visit one of Aetna's 53,000 participating pharmacies in order to receive prescription drug benefits.
- You may fill long-term prescriptions (up to a 90-day supply) through Aetna Rx Home Delivery,® Aetna's mail order service. When you enroll, you'll receive information about this service, including how to order. When you order, Aetna will bill you for your medication if your share of the expense is $100 or less. If your share is more than $100, Aetna will contact you with cost and payment information. Your medication will be mailed once Aetna has received your payment. You can order refills by mail, phone or online at Aetna Navigator.
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Emeriti Health Plan II – Aetna Traditional Choice®
Aetna Special Programs
As Aetna members, you and your covered dependents may take advantage of special programs that address specific health conditions and needs. Click on the link(s) below to learn more, or click here for a full description of each program.
- Alternative Health Care Program – discounts on alternative therapies (such as acupuncture), vitamins and nutritional supplements, and natural products (such as aromatherapy, foot care and body care products).
- Fitness Program – discounts on health club memberships and certain exercise equipment through GlobalFit™.
- National Medical Excellence Program® – support care coordination and other services when you or a covered family member needs an organ transplant or other complex medical procedure. For more information about the National Medical Excellence Program (including how to participate), call the toll-free Member Services number on your Aetna ID card.
- National Advantage Program – special rates and discounts with doctors, hospitals and ancillary providers.
- Vision One® Discount Program – discounts on eye care products, including eyeglasses, contact lenses and solution, non-prescription sunglasses and other eye care accessories, and LASIK surgery.
- Women's Health Program – benefits that focus on the unique health care needs of women; for example, annual OB/GYN exams and cancer screenings.
- Informed Health Line – toll-free access to nurses who can provide information on medical conditions and treatment options, plus help with questions for your doctor.
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Aetna provides all coverage for institutions and their retirees in 48 states and the District of Columbia. For institutions and their retirees in Minnesota, HealthPartners provides comprehensive coverage, and Aetna provides prescription drug only plans. There will be some differences in coverage from what is described in this website. Call 1-866-EMERITI and talk to an Emeriti Specialist from HealthPartners to find out about the plans offered.
If your institution has fewer than 50 employees, your Emeriti insurance option will be limited to a separate insurance offering mandated by your state insurance department as part of small group insurance reform. Please call an Emeriti Specialist from Aetna to find out what insurance coverage is available to you.
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