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Smarter is healthy


Smarter is healthy.
                                                                        Aetna Navigator®

 With Aetna’s secure member website*, members can better manage their
 health and benefits with easy online access to:

  Claims, Balances, and eligibility information
  Print a temporary ID Card or order a new ID Card
  Find a Doctor with DocFind
  Personal Health Record and Health History Report
  Member Payment Estimator, Doctors’ Rates, Medical Procedure by Facility Cost Tool, Estimate the
   Cost of Care
  Price-A-Drug***
                                                                                            ®        ®
  Health information with SmartSource**, Aetna InteliHealth and Healthwise Knowledgebase

* Available to members with Aetna benefits. An Aetna medical or Aetna dental plan is not required.
** Availability varies by plan
*** Aetna pharmacy required
                          Easy Registration and Log-in

   Accessible anytime,
   Secure registration
   Ann, virtual assistant, to
    assist with login or
    registration questions
   Easy access to
    information from menus,
    quick links, related
    shortcuts and Site Map
                                   View Claim Details and Balances

   Navigator provides claim
    search, claim lists, and claim
    details for 24 months after date
    of service

   Easy access to fund balances
    and details

   Have a question about a
    claim? “Send a Message”
    includes the details of your
                                               Self-Service Features

 Find a provider
  with DocFind®

 Request a new
  ID card, print a
  temporary ID

*Participation in GlobalFit is for new gym members only. Membership to a gym of which members are now, or were recently members, may not be available.
**Offered by WellCall, Inc. through GlobalFit.
                     Updated                           Your Aetna
     Access                                            Resource for
    Through                           By Name          Provider
    Navigator                                          Information

                   Tips On
Providers          DocFind                 Search by
   and                                        City
Hospitals                                      or
                                           Zip Code

             Labs and
                       Ann, Aetna’s virtual assistant

 Available, 24/7, to answer members
  health care questions

 Guides members to the information
  and tools they are looking for, on
  every page of the website

 Helps with registration and login, as
  well as:
     – Find ID cards
     – Locate benefits, claims and
       cost-of-care information
     – Understand health care terms
       and much more
                     Aetna Navigator® – on the go!

With Aetna’s mobile web and mobile app, members can better manage their health
and benefits. Members simply use the secure member log in and get access to:

     DocFind®
     Claim search
     Member ID card information
     Price-a-Drug
     Personal health record
     Contact Us capabilities
     Forgot user name and
     Registration

Mobile Web is optimized for over 5,000 devices
Mobile applications available for Apple iOS devices (iPhone, iPod touch, iPad) and
BlackBerry® CurveTM models
                                MWSU HMO Plan Refresher

                              Member needs medical services

         Member goes to an in-network             Member goes to an out-of-network
            physician or hospital                      physician or hospital

   Maximum coverage                               Benefits are not covered –
   Co-pay for office visits                        except for emergency and out-of-
   Provider files claim forms; no balance bill     area urgent care
   Provider initiates preauthorization
                      MWSU OAMC Plan Refresher

 Participating   providers coordinates care and precertification

 Non   participating providers member is responsible for precertification

 Coverage    for routine and preventive care

 Benefits   payable for services received in or out of network

 Benefit   payment differs between in and out of network providers

 Lower   out of pocket costs for in network providers
                                           For Your Information

Emergency Care
    HMO Plan – Urgent Care $50 copay; ER $100 copay
    OAMC Base – Urgent Care 20% after deductible; ER $100 copay and 20% after deductible
    OAMC Buy Up – Urgent Care $25 copay; ER $100 copay and 15% after deductible
    HSA Plan – Urgent Care and ER 20% after deductible

Aetna Pharmacy Changes
    Medications can move to over the counter
    Member notification will occur if this takes place
    Formulary Updated once a year in the fall

Travel Abroad
    Emergency care only
    Member pays out of pocket first and then will file claims for reimbursement
            Your Dentist...Your Choice

Choice #1 - Visit an Aetna PPO dentist and receive
 services at negotiated rates

Choice #2 - Visit any licensed dentist of your choice for
 maximum flexibility under your plan
               How Both Options Work

Option #1 - When you visit a dentist in our dental PPO network…
  – Meet your deductible
  – Coinsurance
  – No claim forms
  – Discounts on services not covered

 Option #2 - When you see any other licensed dentist …
  – Meet your deductible
  – Coinsurance
  – Out-of-pocket expenses may be higher
  – You may have to file claim forms
  – You may be subject to balance billing

   ***Pre-determination of benefits strongly recommended for basic and major services
     where the anticipated cost is $200 or more
             Flexible Spending Account

        -Notice will be sent via mail or e-mail
        -60 days from service to send in substantiation before turning off card

 Account Access
        -Flex Account Hotline (913) 789-4600

 Over the Counter (OTC) Medications
        -Can be reimbursed with a written prescription
        -Pay up front, then reimbursed
        -Form located on MWSU website (need for reimbursement)

           -Approved as an OTC for adults and Children (March 2011)
           -”Allegra Allergy”
           -Contains the same medicine
           -For coupons, visit

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