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

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

Benefit Comparison for  Plan Year 3/1/07 - 2/29/08

 

Aetna Choice POS II Plan Design - Plan Highlights
	BASE PLAN	BASE PLAN
	IN NETWORK	OUT OF NETWORK
Annual Deductible (per calendar year)	$200 Individual $600 Family	$   500 Individual $1,500 Family
Coinsurance Limit	$1,500 Individual (plus deductible) $4,500 Family (plus deductible)	$3,000 Individual (plus deductible) $9,000 Family (plus deductible)
Lifetime Maximum Benefit	Unlimited except where otherwise indicated	Unlimited except where otherwise indicated
Physician's Office Copay Primary Care Specialist (Aexcel provider) Specialist (non-Aexcel prov)	100% after $20 copay 100% after $30 copay 100% after $45 copay	60% after deductible
Inpatient Services	90% after deductible	60% after deductible
Outpatient Surgery      Outpatient Facility	90% after deductible	60% after deductible
Outpatient Laboratory & Radiology Services	Included in office visit copayment	60% after deductible
Maternity Care   Physician's Office    (prenatal & post natal)   In the Hospital    (for mother & newborn)	$30/$45 for first visit only 90% after deductible	60% after deductible 60% after deductible
Emergency & Urgent Care    Emergency Room    Urgent Care Facility	100% after $150 per visit; waived if confined, 90% after deductible if admitted 100% after a $40 copay	100% after $150 per visit; waived if confined, 60% after deductible if admitted 60% after deductible
International care	n/a	60% after deductible
Mental Health    Outpatient Visits      Inpatient Services	100% after $30 copay 90% after deductible	60% after deductible 60% after deductible
Chemical Dependency     Outpatient Visits     Inpatient Services	100% after $30 copay; up to 60 visits per calendar year* 90% after deductible, up to 60 days per calendar year*	60% after deductible; up to 60 visits per calendar year* 60% after deductible; up to 60 days per calendar year*
Home Health Care	90% after deductible, up to 100 visits per calendar year*	60% after deductible up 100 visits per calendar year*
Rehabilitation, Speech, Occupational and Physical Therapy	100% after a $30 copay, up to 60 visits per calendar year*	60% after deductible, up to 60 visits per calendar year*
Allergy Services (includes testing, serum and injections)	100% after $30/$45  copay	60% after deductible
Prescription Drugs   Participating Pharmacy    Copayment       (30 day supply)   Mail Order Copayment       (31-90 day supply)	Minimum/Maximum                                      Copayments 25% Generic                   $ 5 min/$ 15 max 25% Brand                    $20 min/$  60 max 25% Generic                  $ 10 min/$ 30 max 25% Brand                     $40 min/$120 max	- 80% after deductible at non-participating pharmacy (for emergency prescriptions, only)
	BASE PLUS PLAN	BASE PLUS PLAN
	IN NETWORK	OUT OF NETWORK
Annual Deductible (per calendar year)	None	$   500 Individual $1,500 Family
Coinsurance Limit	None	$2,000 Individual (plus deductible) $6,000 Family (plus deductible)
Lifetime Maximum Benefit	Unlimited except where otherwise indicated	Unlimited except where otherwise indicated
Physician's Office Copay Primary Care Specialist (Aexcel provider) Specialist (non-Aexcel prov)	100% after $20 copay 100% after $20 copay 100% after $30 copay	70% after deductible
Inpatient Services	100% after $300 copay	70% after deductible
Outpatient Surgery      Outpatient Facility	100% after $200 copay	70% after deductible
Outpatient Laboratory & Radiology Services	Included in office visit copayment	70% after deductible
Maternity Care   Physician's Office    (prenatal & post natal)   In the Hospital    (for mother & newborn)	$20/30 for first visit only $300 per admission, per person	70% after deductible 70% after deductible
Emergency & Urgent Care    Emergency Room    Urgent Care Facility	100% after $150 per visit; waived if confined, $300 copay if admitted 100% after a $40 copay	100% after $150 per visit; waived if confined, 70% after deductible if admitted 70% after deductible
International care	n/a	70% after deductible
Mental Health    Outpatient Visits      Inpatient Services	100% after $30 copay 100% after $300 confinement copay	70% after deductible 70% after deductible
Chemical Dependency     Outpatient Visits     Inpatient Services	100% after $30 copay; up to 60 visits per calendar year* 100% after $300 confinement copay, up to 60 days per calendar year*	70% after deductible; up to 60 visits per calendar year* 70% after deductible; up to 60 days per calendar year*
Home Health Care	100% up to 100 visits per calendar year*	70% after deductible up 100 visits per calendar year*
Rehabilitation, Speech, Occupational and Physical Therapy	100% after a $30 copay, up to 60 visits per calendar year*	70% after deductible, up to 60 visits per calendar year*
Allergy Services (includes testing, serum and injections)	100% after $20/30 copay	70% after deductible
Prescription Drugs   Participating Pharmacy    Copayment       (30 day supply)   Mail Order Copayment       (31-90 day supply)	Minimum/Maximum                                      Copayments 25% Generic                   $ 5 min/$ 15 max 25% Brand                    $20 min/$ 60 max 25% Generic                  $ 10 min/$ 30 max 25% Brand                     $40 min/$120 max	- 80% after deductible at non-participating pharmacy (for emergency prescriptions, only)
* Maximums are a combined limit for in-network and out-of-network services.