Health Insurance Plan Options

Pre-65 Plan

The Emeriti Health Insurance Plan Options are available for eligible employees who have met the requirements for retirement eligibility at an Emeriti member institution and have retired from the institution, are age 65 or older, and are enrolled in Medicare Parts A and B. The Program can also provide insurance for an insured employee's spouse (or domestic partner if permitted under the institution's plan) who is age 65 or over and enrolled in Medicare Parts A and B, in the post-65 Emeriti Health Insurance Plan Option selected by the retired employee.

The Emeriti Program does not provide insurance for retired employees who are under age 65. The Program can provide insurance for the spouse (or domestic partner if permitted under the institution's plan) and eligible children who are under age 65, in the applicable pre-65 plan for dependents if the retired employee is enrolled in one of the post-65 Emeriti Health Insurance Plan Options.

How the Plan Works
Sharing the Cost
Aetna Special Programs
Medical Claim Form for enrolled members

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.

More information on Medicare can be found on the Henry J. Kaiser Family Foundation website, or by visiting Medicare.Gov.

Aetna Open Choice PPO/Indemnity Plan

How the Plan Works

The Aetna Open Choice PPO/Indemnity Plan works differently depending on where you live.

• If you live in an Aetna PPO service area, the plan pays benefits according to a preferred provider arrangement. You may receive care from any licensed provider, but when you choose a provider who belongs to Aetna's network* (a preferred provider), the plan pays a higher level of benefits. In addition, the preferred provider files claims for you. If you choose a non-preferred provider, the plan pays a lower level of benefits and you must file your own claims. The Summary of Benefits chart compares preferred and non-preferred benefits.
  
  
• If you live outside Aetna's PPO service area, the plan pays benefits according to an indemnity arrangement. That is, there's a single level of benefits regardless of who provides your care. This level of benefits that correspond to the Indemnity plan are equal to the preferred level "In network" shown on the Summary of Benefits chart, but without a panel of providers you need to use to get this level of benefits. In most situations, you will need to pay for your care at the time you receive it and then file a claim for reimbursement with Aetna. In some cases, the provider may be willing to file a claim with Aetna on your behalf.

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Pre-65 Plan

Aetna Open Choice PPO/Indemnity Plan

Sharing the Cost

You share in the cost of your care by paying a calendar year deductible and a percentage of your covered expenses.

• The calendar year deductible is the amount of covered expenses you must pay each calendar year before the plan starts to pay benefits. A calendar year starts on January 1 and ends on December 31. Both medical and prescription drug expenses apply toward the plan's deductible. Note that the calendar year deductible does not apply to certain preventive care services, shown on the Summary of Benefits chart.
• Once you meet the deductible, you pay a percentage of your remaining expense(s) and the plan pays the rest. The part you pay is called your coinsurance. The plan pays 80% for most covered expenses when you use a preferred provider, so your coinsurance is 20%.
• The plan places a limit on what you must pay out of pocket for your care. When your out-of-pocket costs reach the coinsurance limit, the plan pays 100% of your covered expenses for the rest of the calendar year. Both medical and prescription drug expenses apply toward the plan's coinsurance limit.
• The plan also has a lifetime maximum benefit. This is the most the plan will pay in benefits over a covered person's lifetime.

The dollar amounts of the plan's deductible, coinsurance limit and lifetime maximum benefit are shown in the Summary of Benefits chart. You'll see that the coinsurance limit is lower when you use preferred providers, and higher when you use non-preferred providers.

If you are eligible for Medicare, the benefits of your Aetna plan will be coordinated with those of Medicare using a process called Medicare Integration.

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Pre-65 Plan

Aetna Open Choice PPO/Indemnity Plan

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 here to learn more.

• Alternative Health Care Program
• Fitness Program
• Healthy Outlook Program®
• Informed Health® Line
• National Medical Excellence Program®
• National Advantage Program
• Vision One® Discount Program
• Women's Health Program

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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.