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Aetna Small Business Health Plan Options

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					Aetna Small Business Health Plan Options
                                              SM
NYC Community Plan
Manhattan, Bronx, Queens, Staten Island and Brooklyn
RATES EFFECTIVE 4/1/2010 through 6/15/2010
   Plan         Referred       Referred Emergency Referred    Referred   Referred Out-                    Lifetime             Pharmacy Plan              Single Rate         Employee           Parent Child   Family Rate
  Options        Primary      Inpatient   Room    Deductible     Plan     of-Pocket                       Maximum                                                            Spouse Rate            Rate
                  Care        Hospital /                     Coinsurance  Maximum
               Physician /    Outpatient
                Specialist     Surgery
               Office Visit

     NYC     $30 / $50        $1,000 copay $150 copay      N/A         N/A             N/A            Referred -        No Prescription Drug Benefit -       $284.00            $606.00            $512.00        $833.00
 Community copay              per admission                                                           Unlimited Self-   Discount RX Card Only
 PlanSM 4-07                                                                                          Referred -
                                                                                                      $1,000,000
     NYC     $30 / $50        $1,000 copay $150 copay      N/A         N/A             N/A            Referred -        No Prescription Drug Benefit -       $299.00            $636.00            $537.00        $875.00
 Community copay              per admission                                                           Unlimited Self-   Discount RX Card Only
 PlanSM 2-07                                                                                          Referred -
                                                                                                      $1,000,000
    NYC    $30 / $50                          $150 copay   N/A         N/A             N/A            Referred -                                             $312.00            $663.00            $561.00        $913.00
                               $250 copay
 Community copay                                                                                      Unlimited Self-
                              per day up to                                                                               Generics Only - Retail: $15
Plan 6E-08
    SM
                                                                                                      Referred -
                               4 days per                                                                                     Mail Order: $30
                                                                                                      $1,000,000
                                admission

    NYC    $20 / $40                          $150 copay   N/A         N/A             N/A            Referred -                                             $320.00            $682.00            $576.00        $938.00
                               $250 copay
 Community copay              per day up to                                                           Unlimited Self-     Generics Only - Retail: $15
Plan 5E-08
    SM
                               3 days per                                                             Referred -              Mail Order: $30
                                admission                                                             $1,000,000

    NYC      $20 / $40        $750 copay $150 copay        N/A         N/A             N/A            Referred -        Retail: $15 / 50%                    $322.00            $686.00            $580.00        $944.00
 Community copay              per admission                                                           Unlimited Self-   Mail Order:
PlanSM 3D-07                                                                                          Referred -        $30 / 50%
                                                                                                      $1,000,000
                                                                                                                        $3,000 cal yr max; Retail/Mail
                                                                                                                        Order combined
    NYC    $20 / $40          $750 copay $150 copay        N/A         N/A             N/A            Referred -        Retail: $15 / 50%                    $337.00            $719.00            $607.00        $988.00
 Community copay              per admission                                                           Unlimited Self-   Mail Order:
    SM
Plan 1D-07                                                                                            Referred -        $30 / 50%
                                                                                                      $1,000,000
                                                                                                                        $3,000 cal yr max; Retail/Mail
                                                                                                                        Order combined



Self-Referred Deductible limit is $5,000 / $15,000.
Self-Referred Coinsurance is 30% after deductible.
Self-Referred Out of Pocket Maximum is $20,000 / $60,000.

Deductible does not apply towards Out-of-Pocket Maximum; Referred and Self-Referred accumulate separately. Certain services may not apply toward the Deductible or Out-of-Pocket Maximum.
The NYC Community Plan is an "in-network only” plan (Referred and Self-Referred). Benefits for emergency services only are available from health care providers who do not participate in the Aetna network.
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 Aetna Health Insurance Company of New York (Aetna).
These quoted rates are for a 12-month period from the effective date of coverage and are valid only for the benefits level and conditions stated and such other terms and
conditions as set forth in the Aetna Group Policy or official renewal letters. Any changes in benefits level, conditions stated or other terms of the Policy may
require change in rates. These rates are applicable only to the Aetna service areas stated above. These rates are subject to final approval by Aetna. Rates have been filed with the
NY State Department of Insurance. Aetna reserves the right to modify the final rates based on actual enrollment.
Plans/rates are effective as of 4/1/10 and could change at any time due to legislative or filing actions.
This list of benefits isn't inclusive of all the benefits these plans offer. Please refer to the Aetna Avenue® brochure for more information on our products.
              NYC Community Plan (1/10)
Aetna Small Business Health Plan Options
Genesee, Livingston, Monroe, Ontario, Orleans, Wayne, Wyoming, Yates
RATES EFFECTIVE 4/1/2010 TO 6/15/2010

    Plan Options      Primary Care             Inpatient Hospital /         Emergency            Network                Out-of-Network           Network Plan   Out-of-           Network                 Out-of-Network            Lifetime Maximum        Monthly Premium -           Monthly Premium -          Monthly Premium -
                                                                                                          1                        1
                       Physician /             Outpatient Surgery             Room              Deductible               Deductible              Coinsurance Network Plan        Maximum                    Maximum                                          Pharmacy Plan F              Pharmacy Plan G           Pharmacy Plan H
                     Specialist Office                                                         (Individual / Family)     (Individual / Family)                Coinsurance       Out-of-Pocket             Out-of-Pocket                                         $0/$30/$50                   $15/$35/$70          Generics Only - $10
                                                                                                                                                                                          1                         1
                          Visit                                                                                                                                                     Limit                     Limit                                       Mail Order: $0/$60/$100     Mail Order: $30/$70/$140 Mail Order: Generics Only
                                                                                                                                                                                (Individual / Family)     (Individual / Family)                                                                                           $20
    OA EPO 1-10 $25 / $50 copay;           10% after deductible /        10% after          $1,000 / $3,000            N/A                       10% after    N/A            $2,000 / $6,000            N/A                       Unlimited                   S:        $428               S:       $406             S:      $383
                deductible waived          10% after deductible          deductible                                                              deductible                                                                                                  E/S        $1,023            E/S:      $972            E/S:     $916
                                                                                                                                                                                                                                                             P/C        $865              P/C:      $822            P/C:     $774
                                                                                                                                                                                                                                                              F:        $1,338             F:       $1,271           F:      $1,198
    OA EPO 2-10 $25 / $50 copay;           10% after deductible /        10% after          $2,000 / $6,000            N/A                       10% after    N/A            $4,000 / $12,000           N/A                       Unlimited                   S:        $380               S:       $359             S:      $335
                deductible waived          10% after deductible          deductible                                                              deductible                                                                                                  E/S        $910              E/S:      $859            E/S:     $802
                                                                                                                                                                                                                                                             P/C        $769              P/C:      $726            P/C:     $678
                                                                                                                                                                                                                                                              F:        $1,190             F:       $1,123           F:      $1,049
    OA EPO 3-10 $30 / $50 copay;           20% after deductible /        20% after             $1,500 / $4,500         N/A                       20% after    N/A            $3,000 / $9,000            N/A                       Unlimited                   S:        $392               S:       $371             S:      $347
                deductible waived          20% after deductible          deductible                                                              deductible                                                                                                  E/S:       $938              E/S:      $887            E/S:     $830
                                                                                                                                                                                                                                                             P/C        $793              P/C       $749            P/C      $702
                                                                                                                                                                                                                                                              F:        $1,226             F:       $1,160           F:      $1,086
OA EPO 4-10        $30 / $50 copay;        20% after deductible /        20% after          $2,500 / $7,500            N/A                       20% after    N/A            $5,000 / $15,000           N/A                       Unlimited                   S:        $353               S:       $332             S:      $308
                   deductible waived       20% after deductible          deductible                                                              deductible                                                                                                  E/S:       $845              E/S:      $794            E/S:     $737
                                                                                                                                                                                                                                                             P/C:       $714              P/C:      $671            P/C:     $623
                                                                                                                                                                                                                                                              F:        $1,105             F:       $1,038           F:      $964
OA EPO 5-10        $40 / $60 copay;        30% after deductible /        30% after          $2,500 / $7,500            N/A                       30% after    N/A            $5,000 / $15,000           N/A                       Unlimited                   S:        $342               S:       $321             S:      $297
                   deductible waived       30% after deductible          deductible                                                              deductible                                                                                                  E/S:       $818              E/S:      $767            E/S:     $710
                                                                                                                                                                                                                                                             P/C:       $691              P/C:      $648            P/C:     $600
                                                                                                                                                                                                                                                              F:        $1,070             F:       $1,003           F:      $928
OA EPO 6-10        $50 / $75 copay;        30% after deductible /        30% after          $3,000 / $9,000            N/A                       30% after    N/A            $6,000 / $18,000           N/A                       Unlimited                   S:        $322               S:       $301             S:      $277
                   deductible waived       30% after deductible          deductible                                                              deductible                                                                                                  E/S:       $771              E/S:      $720            E/S:     $662
                                                                                                                                                                                                                                                             P/C:       $651              P/C:      $608            P/C:     $559
                                                                                                                                                                                                                                                              F:        $1,008             F:       $941             F:      $866
    OA MC 1-10     $25 / $50 copay;        10% after deductible /        10% after          $1,000 / $3,000            $2,000 / $6,000           10% after    30% after      $2,000 / $6,000            $4,000 / $12,000          Network - Unlimited         S:        $484               S:       $462             S:      $438
                   deductible waived       10% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network -           E/S        $1,158            E/S:      $1,105          E/S:     $1,047
                                                                                                                                                                                                                                  $1,000,000                 P/C        $979              P/C:      $934            P/C:     $885
                                                                                                                                                                                                                                                              F:        $1,514             F:       $1,445           F:      $1,369
    OA MC 2-10     $25 / $50 copay;        10% after deductible /        10% after          $2,000 / $6,000            $4,000 / $12,000          10% after    30% after      $4,000 / $12,000           $8,000 / $24,000          Network - Unlimited         S:        $424               S:       $402             S:      $377
                   deductible waived       10% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network -           E/S        $1,014            E/S:      $961            E/S:     $902
                                                                                                                                                                                                                                  $1,000,000                 P/C        $857              P/C:      $812            P/C:     $762
                                                                                                                                                                                                                                                              F:        $1,325             F:       $1,256           F:      $1,179
    OA MC 3-10     $30 / $50 copay;        20% after deductible /        20% after             $1,500 / $4,500         $3,000 / $9,000           20% after    40% after      $3,000 / $9,000            $6,000 / $18,000          Network - Unlimited         S:        $441               S:       $418             S:      $394
                   deductible waived       20% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network -           E/S:       $1,054            E/S:      $1,001          E/S:     $943
                                                                                                                                                                                                                                  $1,000,000                 P/C        $891              P/C       $846            P/C      $796
                                                                                                                                                                                                                                                              F:        $1,378             F:       $1,309           F:      $1,232
OA MC 4-10         $30 / $50 copay;        20% after deductible /        20% after          $2,500 / $7,500            $5,000 / $15,000          20% after    40% after      $5,000 / $15,000           $10,000 / $30,000         Network - Unlimited         S:        $395               S:       $372             S:      $348
                   deductible waived       20% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network -           E/S:       $944              E/S:      $891            E/S:     $832
                                                                                                                                                                                                                                  $1,000,000                 P/C:       $798              P/C:      $753            P/C:     $703
                                                                                                                                                                                                                                                              F:        $1,234             F:       $1,165           F:      $1,088
OA MC Limited $30 / $50 copay;             30% after deductible /        30% after          $3,000 / $6,000            $6,000 / $18,000          30% after    50% after      $9,000 / $18,000           $18,000 / $54,000         $500,000 (Network and     Pharmacy Plan F not         Pharmacy Plan G not          S:      $281
Benefits      deductible waived;           30% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network           available with this plan    available with this plan     E/S:     $673
Plan-10       Limited to 6 office                                                                                                                                                                                                 Combined)                                                                         P/C:     $568
              visits per calendar                                                                                                                                                                                                                                                                                    F:      $879
              year; Network and
              Out-of-Network
              Combined

1
 Deductible applies toward Out-of-Pocket Limit; Network and Out-of-Network accumulate separately. Certain services may not apply toward the Deductible or Out-of-Pocket Limit.
2
  Deductible, and all payments for RX and all covered expenses, unless indicated otherwise, apply towards the Out-of-Pocket Limit.
3
  HSA Compatible plans are administered on a plan year basis.
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 Aetna Health Insurance Company of New York (Aetna).
These quoted rates are for a 12-month period from the effective date of coverage and are valid only for the benefits level and conditions stated and such other terms and
conditions as set forth in the Aetna Life Insurance Company Group Policy or official renewal letters. Any changes in benefits level, conditions stated or other terms of the Policy may
require change in rates. These rates are applicable only to the Aetna service areas stated above. These rates are subject to final approval by Aetna. Rates have been filed with the
NY State Department of Insurance. Aetna reserves the right to modify the final rates based on actual enrollment.
Plans/rates are effective as of 4/1/10 and could change at any time due to legislative or filing actions.
                                                                                                             ®
This list of benefits isn't inclusive of all the benefits these plans offer. Please refer to the Aetna Avenue brochures for more information on our products.




             (RA-01) 4/10
             50.03.942.1-NY1
Aetna Small Business Health Plan Options
Genesee, Livingston, Monroe, Ontario, Orleans, Wayne, Wyoming, Yates
RATES EFFECTIVE 4/1/2010 TO 6/15/2010

    Plan Options      Primary Care             Inpatient Hospital /         Emergency              Network           Out-of-Network Network Plan        Out-of-                    Network           Out-of-Network       Lifetime Maximum                              Monthly Premium
                                                                                                             1                     1
                       Physician /             Outpatient Surgery             Room               Deductible            Deductible        Coinsurance Network Plan                 Maximum               Maximum
                     Specialist Office                                                       (Individual / Family) (Individual / Family)             Coinsurance                Out-of-Pocket         Out-of-Pocket
                                                                                                                                                                                           1                     1
                          Visit                                                                                                                                                     Limit                 Limit
                                                                                                                                                                             (Individual / Family) (Individual / Family)
OA EPO 1-10        10% after deductible 10% after deductible /            10% after          $1,500 / $3,000       N/A                   10% after         N/A               $2,250 / $4,500       N/A                   Unlimited            Pharmacy Plan F not        S:     $371       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible              deductible                                                     deductible                                                                                          available with this plan   E/S:    $886      available with this plan
Compatible
          2, 3     $0 copay;                                                                                                                                                                                                                                            P/C:    $749
                   deductible waived                                                                                                                                                                                                                                     F:     $1,159


OA EPO 2-10        10% after deductible 10% after deductible /            10% after          $2,000 / $4,000       N/A                   10% after         N/A               $3,000 / $6,000    N/A                  Unlimited                Pharmacy Plan F not        S:     $334       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible              deductible                                                     deductible                                                                                          available with this plan   E/S:    $800      available with this plan
Compatible
          2,3      $0 copay;                                                                                                                                                                                                                                            P/C:    $676
                   deductible waived                                                                                                                                                                                                                                     F:     $1,046


OA EPO 3-10        20% after deductible 20% after deductible /            20% after          $3,000 / $6,000       N/A                   20% after         N/A               $4,500 / $9,000    N/A                  Unlimited                Pharmacy Plan F not        S:     $279       Pharmacy Plan H not
HSA                Preventive Care -    20% after deductible              deductible                                                     deductible                                                                                          available with this plan   E/S:    $667      available with this plan
Compatible
          2,3      $0 copay; deductible                                                                                                                                                                                                                                 P/C:    $563
                   waived                                                                                                                                                                                                                                                F:     $872


OA EPO 4-10        0% after deductible 0% after deductible /              0% after           $5,000 / $10,000      N/A                   0% after          N/A               $5,950 / $11,900   N/A                  Unlimited                Pharmacy Plan F not        S:     $252       Pharmacy Plan H not
HSA                Preventive Care - $0 0% after deductible               deductible                                                     deductible                                                                                          available with this plan   E/S:    $603      available with this plan
Compatible
          2,3      copay; deductible                                                                                                                                                                                                                                    P/C:    $509
                   waived                                                                                                                                                                                                                                                F:     $788


OA MC 2-10         10% after deductible 10% after deductible /            10% after          $2,000 / $4,000       $4,000 / $8,000       10% after         30% after         $3,000 / $6,000    $8,000 / $16,000     Network - Unlimited      Pharmacy Plan F not        S:     $378       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible              deductible                                                     deductible        deductible                                                Out-of-Network -        available with this plan   E/S:    $905      available with this plan
Compatible
          2,3      $0 copay;                                                                                                                                                                                         $1,000,000                                         P/C:    $765
                   deductible waived                                                                                                                                                                                                                                     F:     $1,183


OA MC 3-10         20% after deductible 20% after deductible /            20% after          $3,000 / $6,000       $6,000 / $12,000      20% after         40% after         $4,500 / $9,000    $9,000 / $18,000     Network - Unlimited      Pharmacy Plan F not        S:     $322       Pharmacy Plan H not
HSA                Preventive Care -    20% after deductible              deductible                                                     deductible        deductible                                                Out-of-Network -        available with this plan   E/S:    $770      available with this plan
Compatible
          2,3      $0 copay; deductible                                                                                                                                                                              $1,000,000                                         P/C:    $651
                   waived                                                                                                                                                                                                                                                F:     $1,007


OA MC 4-10         0% after deductible 0% after deductible /              0% after           $5,000 / $10,000      $10,000 / $20,000 0% after              30% after         $5,950 / $11,900   $20,000 / $40,000    Network - Unlimited      Pharmacy Plan F not        S:     $282       Pharmacy Plan H not
HSA                Preventive Care - $0 0% after deductible               deductible                                                 deductible            deductible                                                Out-of-Network -        available with this plan   E/S:    $674      available with this plan
Compatible
          2,3      copay; deductible                                                                                                                                                                                 $1,000,000                                         P/C:    $569
                   waived                                                                                                                                                                                                                                                F:     $881


Indemnity          20% after deductible 20% after deductible /            20% after          $2,500 / $7,500       $2,500 / $7,500       20% after         20% after         $5,000 / $15,000   $5,000 / $15,000     $1,000,000               Pharmacy Plan F not        S:     $1,627     Pharmacy Plan H not
1-10                                    20% after deductible              deductible         (Network and          (Network and          deductible        deductible        (Network and       (Network and                                 available with this plan   E/S:    $3,893    available with this plan
                                                                                             Out-of-Network        Out-of-Network                                            Out-of-Network     Out-of-Network                                                          P/C:    $3,289
                                                                                             combined)             combined)                                                 combined)          combined)                                                                F:     $5,089
1
 Deductible applies toward Out-of-Pocket Limit; Network and Out-of-Network accumulate separately. Certain services may not apply toward the Deductible or Out-of-Pocket Limit.
2
  Deductible, and all payments for RX and all covered expenses, unless indicated otherwise, count towards the Out-of-Pocket Limit.
3
  HSA Compatible plans are administered on a plan year basis.
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 Aetna Health Insurance Company of New York (Aetna).
These quoted rates are for a 12-month period from the effective date of coverage and are valid only for the benefits level and conditions stated and such other terms and
conditions as set forth in the Aetna Life Insurance Company Group Policy or official renewal letters. Any changes in benefits level, conditions stated or other terms of the Policy may
require change in rates. These rates are applicable only to the Aetna service areas stated above. These rates are subject to final approval by Aetna. Rates have been filed with the
NY State Department of Insurance. Aetna reserves the right to modify the final rates based on actual enrollment.
Plans/rates are effective as of 4/1/10 and could change at any time due to legislative or filing actions.
                                                                                                             ®
This list of benefits isn't inclusive of all the benefits these plans offer. Please refer to the Aetna Avenue brochures for more information on our products.




             (RA-01) 4/10
             50.03.942.1-NY1
Aetna Small Business Health Plan Options
Cayuga, Onondaga, Oswego, Broome, Tioga
RATES EFFECTIVE 4/1/2010 TO 6/15/2010

    Plan Options        Primary Care            Inpatient Hospital /         Emergency             Network              Out-of-Network          Network Plan   Out-of-            Network                 Out-of-Network            Lifetime Maximum        Monthly Premium -           Monthly Premium -          Monthly Premium -
                         Physician /            Outpatient Surgery             Room                        1                           1        Coinsurance Network Plan         Maximum                    Maximum                                          Pharmacy Plan F             Pharmacy Plan G            Pharmacy Plan H
                                                                                                 Deductible                  Deductible
                       Specialist Office                                                       (Individual / Family)    (Individual / Family)                Coinsurance        Out-of-Pocket             Out-of-Pocket                                         $0/$30/$50                   $15/$35/$70           Generics Only - $10
                            Visit                                                                                                                                                   Limit1                      Limit1                                    Mail Order: $0/$60/$100     Mail Order: $30/$70/$140 Mail Order: Generics Only
                                                                                                                                                                                (Individual / Family)     (Individual / Family)                                                                                           $20
    OA EPO 1-10 $25 / $50 copay;             10% after deductible /       10% after          $1,000 / $3,000           N/A                      10% after    N/A             $2,000 / $6,000            N/A                       Unlimited                   S:        $479               S:      $455              S:      $429
                deductible waived            10% after deductible         deductible                                                            deductible                                                                                                   E/S        $1,145           E/S:      $1,088           E/S:     $1,025
                                                                                                                                                                                                                                                             P/C        $968             P/C:      $919             P/C:     $866
                                                                                                                                                                                                                                                              F:        $1,497             F:      $1,423            F:      $1,341
    OA EPO 2-10 $25 / $50 copay;             10% after deductible /       10% after          $2,000 / $6,000           N/A                      10% after    N/A             $4,000 / $12,000           N/A                       Unlimited                   S:        $426              S:        $402            S:      $375
                deductible waived            10% after deductible         deductible                                                            deductible                                                                                                   E/S        $1,018          E/S:        $961           E/S:     $898
                                                                                                                                                                                                                                                             P/C        $861            P/C:        $812           P/C:     $758
                                                                                                                                                                                                                                                              F:        $1,331            F:        $1,257          F:      $1,174
    OA EPO 3-10 $30 / $50 copay;             20% after deductible /       20% after            $1,500 / $4,500         N/A                      20% after    N/A             $3,000 / $9,000            N/A                       Unlimited                   S:        $439              S:        $415            S:      $388
                deductible waived            20% after deductible         deductible                                                            deductible                                                                                                   E/S        $1,050          E/S:        $993           E/S:     $929
                                                                                                                                                                                                                                                             P/C        $887             P/C        $839           P/C      $785
                                                                                                                                                                                                                                                              F:        $1,372            F:        $1,298          F:      $1,215
OA EPO 4-10          $30 / $50 copay;        20% after deductible /       20% after          $2,500 / $7,500           N/A                      20% after    N/A             $5,000 / $15,000           N/A                       Unlimited                   S:        $396              S:        $372            S:      $345
                     deductible waived       20% after deductible         deductible                                                            deductible                                                                                                  E/S:        $946            E/S:        $889           E/S:     $825
                                                                                                                                                                                                                                                            P/C:        $799            P/C:        $751           P/C:     $697
                                                                                                                                                                                                                                                              F:        $1,237            F:        $1,162          F:      $1,078
OA EPO 5-10          $40 / $60 copay;        30% after deductible /       30% after          $2,500 / $7,500           N/A                      30% after    N/A             $5,000 / $15,000           N/A                       Unlimited                   S:        $383              S:        $359            S:      $332
                     deductible waived       30% after deductible         deductible                                                            deductible                                                                                                  E/S:        $915            E/S:        $858           E/S:     $794
                                                                                                                                                                                                                                                            P/C:        $774            P/C:        $725           P/C:     $671
                                                                                                                                                                                                                                                              F:        $1,197            F:        $1,122          F:      $1,038
OA EPO 6-10          $50 / $75 copay;        30% after deductible /       30% after          $3,000 / $9,000           N/A                      30% after    N/A             $6,000 / $18,000           N/A                       Unlimited                   S:        $361              S:        $337            S:      $310
                     deductible waived       30% after deductible         deductible                                                            deductible                                                                                                  E/S:        $863            E/S:        $805           E/S:     $741
                                                                                                                                                                                                                                                            P/C:        $729            P/C:        $681           P/C:     $626
                                                                                                                                                                                                                                                              F:        $1,128            F:        $1,053          F:      $969
    OA MC 1-10       $25 / $50 copay;        10% after deductible /       10% after          $1,000 / $3,000           $2,000 / $6,000          10% after    30% after       $2,000 / $6,000            $4,000 / $12,000          Network - Unlimited         S:        $542              S:        $517            S:      $490
                     deductible waived       10% after deductible         deductible                                                            deductible   deductible                                                           Out-of-Network -           E/S        $1,296          E/S:        $1,236         E/S:     $1,172
                                                                                                                                                                                                                                  $1,000,000                 P/C        $1,095          P/C:        $1,045         P/C:     $990
                                                                                                                                                                                                                                                              F:        $1,694            F:        $1,617          F:      $1,532
    OA MC 2-10       $25 / $50 copay;        10% after deductible /       10% after          $2,000 / $6,000           $4,000 / $12,000         10% after    30% after       $4,000 / $12,000           $8,000 / $24,000          Network - Unlimited         S:        $474              S:        $449            S:      $422
                     deductible waived       10% after deductible         deductible                                                            deductible   deductible                                                           Out-of-Network -           E/S        $1,134          E/S:        $1,075         E/S:     $1,009
                                                                                                                                                                                                                                  $1,000,000                 P/C        $959            P/C:        $908           P/C:     $853
                                                                                                                                                                                                                                                              F:        $1,483            F:        $1,405          F:      $1,320
    OA MC 3-10       $30 / $50 copay;        20% after deductible /       20% after            $1,500 / $4,500         $3,000 / $9,000          20% after    40% after       $3,000 / $9,000            $6,000 / $18,000          Network - Unlimited         S:        $493              S:        $468            S:      $441
                     deductible waived       20% after deductible         deductible                                                            deductible   deductible                                                           Out-of-Network -          E/S:        $1,180          E/S:        $1,120         E/S:     $1,055
                                                                                                                                                                                                                                  $1,000,000                 P/C        $997             P/C        $946           P/C      $891
                                                                                                                                                                                                                                                              F:        $1,542            F:        $1,464          F:      $1,379
OA MC 4-10           $30 / $50 copay;        20% after deductible /       20% after          $2,500 / $7,500           $5,000 / $15,000         20% after    40% after       $5,000 / $15,000           $10,000 / $30,000         Network - Unlimited         S:        $442              S:        $417            S:      $389
                     deductible waived       20% after deductible         deductible                                                            deductible   deductible                                                           Out-of-Network -          E/S:        $1,057          E/S:        $997           E/S:     $931
                                                                                                                                                                                                                                  $1,000,000                P/C:        $893            P/C:        $842           P/C:     $787
                                                                                                                                                                                                                                                              F:        $1,381            F:        $1,304          F:      $1,217
OA MC Limited $30 / $50 copay;               30% after deductible /       30% after          $3,000 / $6,000           $6,000 / $18,000         30% after    50% after       $9,000 / $18,000           $18,000 / $54,000         $500,000 (Network and    Pharmacy Plan F not         Pharmacy Plan G not          S:      $315
Benefits      deductible waived;             30% after deductible         deductible                                                            deductible   deductible                                                           Out-of-Network           available with this plan    available with this plan    E/S:     $753
Plan-10       Limited to 6 office                                                                                                                                                                                                 Combined)                                                                        P/C:     $636
              visits per calendar                                                                                                                                                                                                                                                                                   F:      $984
              year; Network and
              Out-of-Network
              Combined

1
    Deductible applies toward Out-of-Pocket Limit; Network and Out-of-Network accumulate separately. Certain services may not apply toward the Deductible or Out-of-Pocket Limit.
2
    Deductible, and all payments for RX and all covered expenses, unless indicated otherwise, apply towards the Out-of-Pocket Limit.
3
  HSA Compatible plans are administered on a plan year basis.
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 Aetna Health Insurance Company of New York (Aetna).
These quoted rates are for a 12-month period from the effective date of coverage and are valid only for the benefits level and conditions stated and such other terms and
conditions as set forth in the Aetna Life Insurance Company Group Policy or official renewal letters. Any changes in benefits level, conditions stated or other terms of the Policy may
require change in rates. These rates are applicable only to the Aetna service areas stated above. These rates are subject to final approval by Aetna. Rates have been filed with the
NY State Department of Insurance. Aetna reserves the right to modify the final rates based on actual enrollment.
Plans/rates are effective as of 4/1/10 and could change at any time due to legislative or filing actions.
                                                                                                             ®
This list of benefits isn't inclusive of all the benefits these plans offer. Please refer to the Aetna Avenue brochures for more information on our products.




               (RA-02-04) 4/10
               50.03.942.1-NY24                                                                                                                                                                                                                                                                                      Page 1 of 2
Aetna Small Business Health Plan Options
Cayuga, Onondaga, Oswego, Broome, Tioga
RATES EFFECTIVE 4/1/2010 TO 6/15/2010

    Plan Options         Primary Care           Inpatient Hospital /         Emergency             Network           Out-of-Network Network Plan        Out-of-                    Network           Out-of-Network        Lifetime Maximum                              Monthly Premium
                          Physician /           Outpatient Surgery             Room                          1                     1     Coinsurance Network Plan                 Maximum               Maximum
                                                                                                 Deductible            Deductible
                        Specialist Office                                                    (Individual / Family) (Individual / Family)             Coinsurance                Out-of-Pocket         Out-of-Pocket
                             Visit                                                                                                                                                  Limit1                Limit1
                                                                                                                                                                             (Individual / Family) (Individual / Family)
OA EPO 1-10           10% after deductible 10% after deductible /         10% after          $1,500 / $3,000       N/A                   10% after         N/A               $2,250 / $4,500      N/A                    Unlimited            Pharmacy Plan F not         S:     $415      Pharmacy Plan H not
HSA                   Preventive Care -    10% after deductible           deductible                                                     deductible                                                                                           available with this plan   E/S:    $992      available with this plan
Compatible     2, 3   $0 copay;                                                                                                                                                                                                                                          P/C:    $838
                      deductible waived                                                                                                                                                                                                                                   F:     $1,297


OA EPO 2-10           10% after deductible 10% after deductible /         10% after          $2,000 / $4,000       N/A                   10% after         N/A               $3,000 / $6,000    N/A                  Unlimited                Pharmacy Plan F not         S:     $374      Pharmacy Plan H not
HSA                   Preventive Care -    10% after deductible           deductible                                                     deductible                                                                                           available with this plan   E/S:    $895      available with this plan
Compatible2,3         $0 copay;                                                                                                                                                                                                                                          P/C:    $756
                      deductible waived                                                                                                                                                                                                                                   F:     $1,170


OA EPO 3-10           20% after deductible 20% after deductible /         20% after          $3,000 / $6,000       N/A                   20% after         N/A               $4,500 / $9,000    N/A                  Unlimited                Pharmacy Plan F not         S:     $312      Pharmacy Plan H not
HSA                   Preventive Care -    20% after deductible           deductible                                                     deductible                                                                                           available with this plan   E/S:    $746      available with this plan
Compatible2,3         $0 copay; deductible                                                                                                                                                                                                                               P/C:    $630
                      waived                                                                                                                                                                                                                                              F:     $975


OA EPO 4-10           0% after deductible 0% after deductible /           0% after           $5,000 / $10,000      N/A                   0% after          N/A               $5,950 / $11,900   N/A                  Unlimited                Pharmacy Plan F not         S:     $282      Pharmacy Plan H not
HSA                   Preventive Care - $0 0% after deductible            deductible                                                     deductible                                                                                           available with this plan   E/S:    $674      available with this plan
Compatible2,3         copay; deductible                                                                                                                                                                                                                                  P/C:    $570
                      waived                                                                                                                                                                                                                                              F:     $882


OA MC 2-10            10% after deductible 10% after deductible /         10% after          $2,000 / $4,000       $4,000 / $8,000       10% after         30% after         $3,000 / $6,000    $8,000 / $16,000     Network - Unlimited      Pharmacy Plan F not         S:     $423      Pharmacy Plan H not
HSA                   Preventive Care -    10% after deductible           deductible                                                     deductible        deductible                                                Out-of-Network -         available with this plan   E/S:    $1,013    available with this plan
Compatible2,3         $0 copay;                                                                                                                                                                                      $1,000,000                                          P/C:    $856
                      deductible waived                                                                                                                                                                                                                                   F:     $1,324


OA MC 3-10            20% after deductible 20% after deductible /         20% after          $3,000 / $6,000       $6,000 / $12,000      20% after         40% after         $4,500 / $9,000    $9,000 / $18,000     Network - Unlimited      Pharmacy Plan F not         S:     $360      Pharmacy Plan H not
HSA                   Preventive Care -    20% after deductible           deductible                                                     deductible        deductible                                                Out-of-Network -         available with this plan   E/S:    $862      available with this plan
Compatible2,3         $0 copay; deductible                                                                                                                                                                           $1,000,000                                          P/C:    $728
                      waived                                                                                                                                                                                                                                              F:     $1,127


OA MC 4-10            0% after deductible 0% after deductible /           0% after           $5,000 / $10,000      $10,000 / $20,000 0% after              30% after         $5,950 / $11,900   $20,000 / $40,000    Network - Unlimited      Pharmacy Plan F not         S:     $315      Pharmacy Plan H not
HSA                   Preventive Care - $0 0% after deductible            deductible                                                 deductible            deductible                                                Out-of-Network -         available with this plan   E/S:    $754      available with this plan
Compatible     2,3    copay; deductible                                                                                                                                                                              $1,000,000                                          P/C:    $637
                      waived                                                                                                                                                                                                                                              F:     $985


Indemnity             20% after deductible 20% after deductible /         20% after          $2,500 / $7,500       $2,500 / $7,500       20% after         20% after         $5,000 / $15,000   $5,000 / $15,000     $1,000,000               Pharmacy Plan F not         S:     $1,821    Pharmacy Plan H not
1-10                                       20% after deductible           deductible         (Network and          (Network and          deductible        deductible        (Network and       (Network and                                  available with this plan   E/S:    $4,356    available with this plan
                                                                                             Out-of-Network        Out-of-Network                                            Out-of-Network     Out-of-Network                                                           P/C:    $3,681
                                                                                             combined)             combined)                                                 combined)          combined)                                                                 F:     $5,695
1
    Deductible applies toward Out-of-Pocket Limit; Network and Out-of-Network accumulate separately. Certain services may not apply toward the Deductible or Out-of-Pocket Limit.
2
    Deductible, and all payments for RX and all covered expenses, unless indicated otherwise, count towards the Out-of-Pocket Limit.
3
  HSA Compatible plans are administered on a plan year basis.
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 Aetna Health Insurance Company of New York (Aetna).
These quoted rates are for a 12-month period from the effective date of coverage and are valid only for the benefits level and conditions stated and such other terms and
conditions as set forth in the Aetna Life Insurance Company Group Policy or official renewal letters. Any changes in benefits level, conditions stated or other terms of the Policy may
require change in rates. These rates are applicable only to the Aetna service areas stated above. These rates are subject to final approval by Aetna. Rates have been filed with the
NY State Department of Insurance. Aetna reserves the right to modify the final rates based on actual enrollment.
Plans/rates are effective as of 4/1/10 and could change at any time due to legislative or filing actions.
                                                                                                             ®
This list of benefits isn't inclusive of all the benefits these plans offer. Please refer to the Aetna Avenue brochures for more information on our products.




               (RA-02-04) 4/10
               50.03.942.1-NY24                                                                                                                                                                                                                                                                Page 2 of 2
Aetna Small Business Health Plan Options
Cortland, Madison, Seneca, Tompkins, Chemug, Delaware, Steuben, Herkimer, Oneida, Albany, Rensselaer, Saratoga, Schenectady, Warren, Washington
RATES EFFECTIVE 4/1/2010 TO 6/15/2010

    Plan Options      Primary Care             Inpatient Hospital /         Emergency             Network               Out-of-Network           Network Plan   Out-of-           Network                 Out-of-Network            Lifetime Maximum        Monthly Premium -           Monthly Premium -          Monthly Premium -
                                                                                                           1                       1
                       Physician /             Outpatient Surgery             Room               Deductible              Deductible              Coinsurance Network Plan        Maximum                    Maximum                                          Pharmacy Plan F              Pharmacy Plan G           Pharmacy Plan H
                     Specialist Office                                                         (Individual / Family)     (Individual / Family)                Coinsurance       Out-of-Pocket             Out-of-Pocket                                         $0/$30/$50                   $15/$35/$70          Generics Only - $10
                                                                                                                                                                                          1                         1
                          Visit                                                                                                                                                     Limit                     Limit                                       Mail Order: $0/$60/$100     Mail Order: $30/$70/$140 Mail Order: Generics Only
                                                                                                                                                                                (Individual / Family)     (Individual / Family)                                                                                           $20
    OA EPO 1-10 $25 / $50 copay;           10% after deductible /         10% after          $1,000 / $3,000           N/A                       10% after    N/A            $2,000 / $6,000            N/A                       Unlimited                   S:        $479               S:       $455             S:      $429
                deductible waived          10% after deductible           deductible                                                             deductible                                                                                                  E/S        $1,145            E/S:      $1,088          E/S:     $1,025
                                                                                                                                                                                                                                                             P/C        $968              P/C:      $919            P/C:     $866
                                                                                                                                                                                                                                                              F:        $1,497             F:       $1,423           F:      $1,341
    OA EPO 2-10 $25 / $50 copay;           10% after deductible /         10% after          $2,000 / $6,000           N/A                       10% after    N/A            $4,000 / $12,000           N/A                       Unlimited                   S:        $426               S:       $402             S:      $375
                deductible waived          10% after deductible           deductible                                                             deductible                                                                                                  E/S        $1,018            E/S:      $961            E/S:     $898
                                                                                                                                                                                                                                                             P/C        $861              P/C:      $812            P/C:     $758
                                                                                                                                                                                                                                                              F:        $1,331             F:       $1,257           F:      $1,174
    OA EPO 3-10 $30 / $50 copay;           20% after deductible /         20% after            $1,500 / $4,500         N/A                       20% after    N/A            $3,000 / $9,000            N/A                       Unlimited                   S:        $439               S:       $415             S:      $388
                deductible waived          20% after deductible           deductible                                                             deductible                                                                                                  E/S:       $1,050            E/S:      $993            E/S:     $929
                                                                                                                                                                                                                                                             P/C        $887              P/C       $839            P/C      $785
                                                                                                                                                                                                                                                              F:        $1,372             F:       $1,298           F:      $1,215
OA EPO 4-10        $30 / $50 copay;        20% after deductible /         20% after          $2,500 / $7,500           N/A                       20% after    N/A            $5,000 / $15,000           N/A                       Unlimited                   S:        $396               S:       $372             S:      $345
                   deductible waived       20% after deductible           deductible                                                             deductible                                                                                                  E/S:       $946              E/S:      $889            E/S:     $825
                                                                                                                                                                                                                                                             P/C:       $799              P/C:      $751            P/C:     $697
                                                                                                                                                                                                                                                              F:        $1,237             F:       $1,162           F:      $1,078
OA EPO 5-10        $40 / $60 copay;        30% after deductible /         30% after          $2,500 / $7,500           N/A                       30% after    N/A            $5,000 / $15,000           N/A                       Unlimited                   S:        $383               S:       $359             S:      $332
                   deductible waived       30% after deductible           deductible                                                             deductible                                                                                                  E/S:       $915              E/S:      $858            E/S:     $794
                                                                                                                                                                                                                                                             P/C:       $774              P/C:      $725            P/C:     $671
                                                                                                                                                                                                                                                              F:        $1,197             F:       $1,122           F:      $1,038
OA EPO 6-10        $50 / $75 copay;        30% after deductible /         30% after          $3,000 / $9,000           N/A                       30% after    N/A            $6,000 / $18,000           N/A                       Unlimited                   S:        $361               S:       $337             S:      $310
                   deductible waived       30% after deductible           deductible                                                             deductible                                                                                                  E/S:       $863              E/S:      $805            E/S:     $741
                                                                                                                                                                                                                                                             P/C:       $729              P/C:      $681            P/C:     $626
                                                                                                                                                                                                                                                              F:        $1,128             F:       $1,053           F:      $969
    OA MC 1-10     $25 / $50 copay;        10% after deductible /         10% after          $1,000 / $3,000           $2,000 / $6,000           10% after    30% after      $2,000 / $6,000            $4,000 / $12,000          Network - Unlimited         S:        $542               S:       $517             S:      $490
                   deductible waived       10% after deductible           deductible                                                             deductible   deductible                                                          Out-of-Network -           E/S        $1,296            E/S:      $1,236          E/S:     $1,172
                                                                                                                                                                                                                                  $1,000,000                 P/C        $1,095            P/C:      $1,045          P/C:     $990
                                                                                                                                                                                                                                                              F:        $1,694             F:       $1,617           F:      $1,532
    OA MC 2-10     $25 / $50 copay;        10% after deductible /         10% after          $2,000 / $6,000           $4,000 / $12,000          10% after    30% after      $4,000 / $12,000           $8,000 / $24,000          Network - Unlimited         S:        $474               S:       $449             S:      $422
                   deductible waived       10% after deductible           deductible                                                             deductible   deductible                                                          Out-of-Network -           E/S        $1,134            E/S:      $1,075          E/S:     $1,009
                                                                                                                                                                                                                                  $1,000,000                 P/C        $959              P/C:      $908            P/C:     $853
                                                                                                                                                                                                                                                              F:        $1,483             F:       $1,405           F:      $1,320
    OA MC 3-10     $30 / $50 copay;        20% after deductible /         20% after            $1,500 / $4,500         $3,000 / $9,000           20% after    40% after      $3,000 / $9,000            $6,000 / $18,000          Network - Unlimited         S:        $493               S:       $468             S:      $441
                   deductible waived       20% after deductible           deductible                                                             deductible   deductible                                                          Out-of-Network -           E/S:       $1,180            E/S:      $1,120          E/S:     $1,055
                                                                                                                                                                                                                                  $1,000,000                 P/C        $997              P/C       $946            P/C      $891
                                                                                                                                                                                                                                                              F:        $1,542             F:       $1,464           F:      $1,379
OA MC 4-10         $30 / $50 copay;        20% after deductible /         20% after          $2,500 / $7,500           $5,000 / $15,000          20% after    40% after      $5,000 / $15,000           $10,000 / $30,000         Network - Unlimited         S:        $442               S:       $417             S:      $389
                   deductible waived       20% after deductible           deductible                                                             deductible   deductible                                                          Out-of-Network -           E/S:       $1,057            E/S:      $997            E/S:     $931
                                                                                                                                                                                                                                  $1,000,000                 P/C:       $893              P/C:      $842            P/C:     $787
                                                                                                                                                                                                                                                              F:        $1,381             F:       $1,304           F:      $1,217
OA MC Limited $30 / $50 copay;             30% after deductible /         30% after          $3,000 / $6,000           $6,000 / $18,000          30% after    50% after      $9,000 / $18,000           $18,000 / $54,000         $500,000 (Network and     Pharmacy Plan F not         Pharmacy Plan G not          S:      $315
Benefits      deductible waived;           30% after deductible           deductible                                                             deductible   deductible                                                          Out-of-Network           available with this plan    available with this plan     E/S:     $753
Plan-10       Limited to 6 office                                                                                                                                                                                                 Combined)                                                                         P/C:     $636
              visits per calendar                                                                                                                                                                                                                                                                                    F:      $984
              year; Network and
              Out-of-Network
              Combined

1
 Deductible applies toward Out-of-Pocket Limit; Network and Out-of-Network accumulate separately. Certain services may not apply toward the Deductible or Out-of-Pocket Limit.
2
  Deductible, and all payments for RX and all covered expenses, unless indicated otherwise, apply towards the Out-of-Pocket Limit.
3
  HSA Compatible plans are administered on a plan year basis.
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 Aetna Health Insurance Company of New York (Aetna).
These quoted rates are for a 12-month period from the effective date of coverage and are valid only for the benefits level and conditions stated and such other terms and
conditions as set forth in the Aetna Life Insurance Company Group Policy or official renewal letters. Any changes in benefits level, conditions stated or other terms of the Policy may
require change in rates. These rates are applicable only to the Aetna service areas stated above. These rates are subject to final approval by Aetna. Rates have been filed with the
NY State Department of Insurance. Aetna reserves the right to modify the final rates based on actual enrollment.
Plans/rates are effective as of 4/1/10 and could change at any time due to legislative or filing actions.
                                                                                                             ®
This list of benefits isn't inclusive of all the benefits these plans offer. Please refer to the Aetna Avenue brochures for more information on our products.




             (RA-03-05-06-07) 4/10
             50.03.942.1-NY3567                                                                                                                                                                                                                                                                                      Page 1 of 2
Aetna Small Business Health Plan Options
Cortland, Madison, Seneca, Tompkins, Chemug, Delaware, Steuben, Herkimer, Oneida, Albany, Rensselaer, Saratoga, Schenectady, Warren, Washington
RATES EFFECTIVE 4/1/2010 TO 6/15/2010

    Plan Options      Primary Care             Inpatient Hospital /         Emergency              Network           Out-of-Network Network Plan        Out-of-                    Network           Out-of-Network       Lifetime Maximum                              Monthly Premium
                                                                                                             1                     1
                       Physician /             Outpatient Surgery             Room               Deductible            Deductible        Coinsurance Network Plan                 Maximum               Maximum
                     Specialist Office                                                       (Individual / Family) (Individual / Family)             Coinsurance                Out-of-Pocket         Out-of-Pocket
                                                                                                                                                                                           1                     1
                          Visit                                                                                                                                                     Limit                 Limit
                                                                                                                                                                             (Individual / Family) (Individual / Family)
OA EPO 1-10        10% after deductible 10% after deductible /            10% after          $1,500 / $3,000       N/A                   10% after         N/A               $2,250 / $4,500       N/A                   Unlimited            Pharmacy Plan F not        S:     $415       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible              deductible                                                     deductible                                                                                          available with this plan   E/S:    $992      available with this plan
Compatible
          2, 3     $0 copay;                                                                                                                                                                                                                                            P/C:    $838
                   deductible waived                                                                                                                                                                                                                                     F:     $1,297


OA EPO 2-10        10% after deductible 10% after deductible /            10% after          $2,000 / $4,000       N/A                   10% after         N/A               $3,000 / $6,000    N/A                  Unlimited                Pharmacy Plan F not        S:     $374       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible              deductible                                                     deductible                                                                                          available with this plan   E/S:    $895      available with this plan
Compatible
          2,3      $0 copay;                                                                                                                                                                                                                                            P/C:    $756
                   deductible waived                                                                                                                                                                                                                                     F:     $1,170


OA EPO 3-10        20% after deductible 20% after deductible /            20% after          $3,000 / $6,000       N/A                   20% after         N/A               $4,500 / $9,000    N/A                  Unlimited                Pharmacy Plan F not        S:     $312       Pharmacy Plan H not
HSA                Preventive Care -    20% after deductible              deductible                                                     deductible                                                                                          available with this plan   E/S:    $746      available with this plan
Compatible
          2,3      $0 copay; deductible                                                                                                                                                                                                                                 P/C:    $630
                   waived                                                                                                                                                                                                                                                F:     $975


OA EPO 4-10        0% after deductible 0% after deductible /              0% after           $5,000 / $10,000      N/A                   0% after          N/A               $5,950 / $11,900   N/A                  Unlimited                Pharmacy Plan F not        S:     $282       Pharmacy Plan H not
HSA                Preventive Care - $0 0% after deductible               deductible                                                     deductible                                                                                          available with this plan   E/S:    $674      available with this plan
Compatible
          2,3      copay; deductible                                                                                                                                                                                                                                    P/C:    $570
                   waived                                                                                                                                                                                                                                                F:     $882


OA MC 2-10         10% after deductible 10% after deductible /            10% after          $2,000 / $4,000       $4,000 / $8,000       10% after         30% after         $3,000 / $6,000    $8,000 / $16,000     Network - Unlimited      Pharmacy Plan F not        S:     $423       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible              deductible                                                     deductible        deductible                                                Out-of-Network -        available with this plan   E/S:    $1,013    available with this plan
Compatible
          2,3      $0 copay;                                                                                                                                                                                         $1,000,000                                         P/C:    $856
                   deductible waived                                                                                                                                                                                                                                     F:     $1,324


OA MC 3-10         20% after deductible 20% after deductible /            20% after          $3,000 / $6,000       $6,000 / $12,000      20% after         40% after         $4,500 / $9,000    $9,000 / $18,000     Network - Unlimited      Pharmacy Plan F not        S:     $360       Pharmacy Plan H not
HSA                Preventive Care -    20% after deductible              deductible                                                     deductible        deductible                                                Out-of-Network -        available with this plan   E/S:    $862      available with this plan
Compatible
          2,3      $0 copay; deductible                                                                                                                                                                              $1,000,000                                         P/C:    $728
                   waived                                                                                                                                                                                                                                                F:     $1,127


OA MC 4-10         0% after deductible 0% after deductible /              0% after           $5,000 / $10,000      $10,000 / $20,000 0% after              30% after         $5,950 / $11,900   $20,000 / $40,000    Network - Unlimited      Pharmacy Plan F not        S:     $315       Pharmacy Plan H not
HSA                Preventive Care - $0 0% after deductible               deductible                                                 deductible            deductible                                                Out-of-Network -        available with this plan   E/S:    $754      available with this plan
Compatible
          2,3      copay; deductible                                                                                                                                                                                 $1,000,000                                         P/C:    $637
                   waived                                                                                                                                                                                                                                                F:     $985


Indemnity          20% after deductible 20% after deductible /            20% after          $2,500 / $7,500       $2,500 / $7,500       20% after         20% after         $5,000 / $15,000   $5,000 / $15,000     $1,000,000               Pharmacy Plan F not        S:     $1,821     Pharmacy Plan H not
1-10                                    20% after deductible              deductible         (Network and          (Network and          deductible        deductible        (Network and       (Network and                                 available with this plan   E/S:    $4,356    available with this plan
                                                                                             Out-of-Network        Out-of-Network                                            Out-of-Network     Out-of-Network                                                          P/C:    $3,681
                                                                                             combined)             combined)                                                 combined)          combined)                                                                F:     $5,695
1
 Deductible applies toward Out-of-Pocket Limit; Network and Out-of-Network accumulate separately. Certain services may not apply toward the Deductible or Out-of-Pocket Limit.
2
  Deductible, and all payments for RX and all covered expenses, unless indicated otherwise, count towards the Out-of-Pocket Limit.
3
  HSA Compatible plans are administered on a plan year basis.
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 Aetna Health Insurance Company of New York (Aetna).
These quoted rates are for a 12-month period from the effective date of coverage and are valid only for the benefits level and conditions stated and such other terms and
conditions as set forth in the Aetna Life Insurance Company Group Policy or official renewal letters. Any changes in benefits level, conditions stated or other terms of the Policy may
require change in rates. These rates are applicable only to the Aetna service areas stated above. These rates are subject to final approval by Aetna. Rates have been filed with the
NY State Department of Insurance. Aetna reserves the right to modify the final rates based on actual enrollment.
Plans/rates are effective as of 4/1/10 and could change at any time due to legislative or filing actions.
                                                                                                             ®
This list of benefits isn't inclusive of all the benefits these plans offer. Please refer to the Aetna Avenue brochures for more information on our products.




             (RA-03-05-06-07) 4/10
             50.03.942.1-NY3567                                                                                                                                                                                                                                                                Page 2 of 2
Aetna Small Business Health Plan Options
Allegany, Cattaraugus, Chautauqua, Erie, Niagara
RATES EFFECTIVE 4/1/2010 TO 6/15/2010

    Plan Options      Primary Care             Inpatient Hospital /         Emergency            Network                Out-of-Network           Network Plan   Out-of-           Network                 Out-of-Network            Lifetime Maximum        Monthly Premium -           Monthly Premium -          Monthly Premium -
                                                                                                          1                        1
                       Physician /             Outpatient Surgery             Room              Deductible               Deductible              Coinsurance Network Plan        Maximum                    Maximum                                          Pharmacy Plan F              Pharmacy Plan G           Pharmacy Plan H
                     Specialist Office                                                         (Individual / Family)     (Individual / Family)                Coinsurance       Out-of-Pocket             Out-of-Pocket                                         $0/$30/$50                   $15/$35/$70          Generics Only - $10
                                                                                                                                                                                          1                         1
                          Visit                                                                                                                                                     Limit                     Limit                                       Mail Order: $0/$60/$100     Mail Order: $30/$70/$140 Mail Order: Generics Only
                                                                                                                                                                                (Individual / Family)     (Individual / Family)                                                                                           $20
    OA EPO 1-10 $25 / $50 copay;           10% after deductible /        10% after          $1,000 / $3,000            N/A                       10% after    N/A            $2,000 / $6,000            N/A                       Unlimited                   S:        $591               S:       $561             S:      $529
                deductible waived          10% after deductible          deductible                                                              deductible                                                                                                  E/S        $1,413            E/S:      $1,343          E/S:     $1,265
                                                                                                                                                                                                                                                             P/C        $1,194            P/C:      $1,135          P/C:     $1,069
                                                                                                                                                                                                                                                              F:        $1,848             F:       $1,755           F:      $1,654
    OA EPO 2-10 $25 / $50 copay;           10% after deductible /        10% after          $2,000 / $6,000            N/A                       10% after    N/A            $4,000 / $12,000           N/A                       Unlimited                   S:        $525               S:       $496             S:      $463
                deductible waived          10% after deductible          deductible                                                              deductible                                                                                                  E/S        $1,257            E/S:      $1,186          E/S:     $1,108
                                                                                                                                                                                                                                                             P/C        $1,062            P/C:      $1,002          P/C:     $936
                                                                                                                                                                                                                                                              F:        $1,643             F:       $1,551           F:      $1,448
    OA EPO 3-10 $30 / $50 copay;           20% after deductible /        20% after             $1,500 / $4,500         N/A                       20% after    N/A            $3,000 / $9,000            N/A                       Unlimited                   S:        $542               S:       $512             S:      $479
                deductible waived          20% after deductible          deductible                                                              deductible                                                                                                  E/S:       $1,295            E/S:      $1,225          E/S:     $1,147
                                                                                                                                                                                                                                                             P/C        $1,095            P/C       $1,035          P/C      $969
                                                                                                                                                                                                                                                              F:        $1,694             F:       $1,601           F:      $1,499
OA EPO 4-10        $30 / $50 copay;        20% after deductible /        20% after          $2,500 / $7,500            N/A                       20% after    N/A            $5,000 / $15,000           N/A                       Unlimited                   S:        $488               S:       $459             S:      $426
                   deductible waived       20% after deductible          deductible                                                              deductible                                                                                                  E/S:       $1,168            E/S:      $1,097          E/S:     $1,018
                                                                                                                                                                                                                                                             P/C:       $987              P/C:      $927            P/C:     $860
                                                                                                                                                                                                                                                              F:        $1,527             F:       $1,434           F:      $1,331
OA EPO 5-10        $40 / $60 copay;        30% after deductible /        30% after          $2,500 / $7,500            N/A                       30% after    N/A            $5,000 / $15,000           N/A                       Unlimited                   S:        $472               S:       $443             S:      $410
                   deductible waived       30% after deductible          deductible                                                              deductible                                                                                                  E/S:       $1,130            E/S:      $1,059          E/S:     $980
                                                                                                                                                                                                                                                             P/C:       $955              P/C:      $895            P/C:     $828
                                                                                                                                                                                                                                                              F:        $1,477             F:       $1,385           F:      $1,281
OA EPO 6-10        $50 / $75 copay;        30% after deductible /        30% after          $3,000 / $9,000            N/A                       30% after    N/A            $6,000 / $18,000           N/A                       Unlimited                   S:        $445               S:       $415             S:      $382
                   deductible waived       30% after deductible          deductible                                                              deductible                                                                                                  E/S:       $1,065            E/S:      $994            E/S:     $914
                                                                                                                                                                                                                                                             P/C:       $900              P/C:      $840            P/C:     $773
                                                                                                                                                                                                                                                              F:        $1,392             F:       $1,299           F:      $1,195
    OA MC 1-10     $25 / $50 copay;        10% after deductible /        10% after          $1,000 / $3,000            $2,000 / $6,000           10% after    30% after      $2,000 / $6,000            $4,000 / $12,000          Network - Unlimited         S:        $669               S:       $638             S:      $605
                   deductible waived       10% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network -           E/S        $1,599            E/S:      $1,526          E/S:     $1,446
                                                                                                                                                                                                                                  $1,000,000                 P/C        $1,351            P/C:      $1,289          P/C:     $1,222
                                                                                                                                                                                                                                                              F:        $2,091             F:       $1,995           F:      $1,891
    OA MC 2-10     $25 / $50 copay;        10% after deductible /        10% after          $2,000 / $6,000            $4,000 / $12,000          10% after    30% after      $4,000 / $12,000           $8,000 / $24,000          Network - Unlimited         S:        $585               S:       $555             S:      $521
                   deductible waived       10% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network -           E/S        $1,400            E/S:      $1,326          E/S:     $1,246
                                                                                                                                                                                                                                  $1,000,000                 P/C        $1,183            P/C:      $1,121          P/C:     $1,052
                                                                                                                                                                                                                                                              F:        $1,830             F:       $1,734           F:      $1,628
    OA MC 3-10     $30 / $50 copay;        20% after deductible /        20% after             $1,500 / $4,500         $3,000 / $9,000           20% after    40% after      $3,000 / $9,000            $6,000 / $18,000          Network - Unlimited         S:        $608               S:       $578             S:      $544
                   deductible waived       20% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network -           E/S:       $1,456            E/S:      $1,382          E/S:     $1,302
                                                                                                                                                                                                                                  $1,000,000                 P/C        $1,230            P/C       $1,168          P/C      $1,100
                                                                                                                                                                                                                                                              F:        $1,903             F:       $1,807           F:      $1,702
OA MC 4-10         $30 / $50 copay;        20% after deductible /        20% after          $2,500 / $7,500            $5,000 / $15,000          20% after    40% after      $5,000 / $15,000           $10,000 / $30,000         Network - Unlimited         S:        $545               S:       $514             S:      $480
                   deductible waived       20% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network -           E/S:       $1,304            E/S:      $1,230          E/S:     $1,149
                                                                                                                                                                                                                                  $1,000,000                 P/C:       $1,102            P/C:      $1,040          P/C:     $971
                                                                                                                                                                                                                                                              F:        $1,705             F:       $1,609           F:      $1,502
OA MC Limited $30 / $50 copay;             30% after deductible /        30% after          $3,000 / $6,000            $6,000 / $18,000          30% after    50% after      $9,000 / $18,000           $18,000 / $54,000         $500,000 (Network and     Pharmacy Plan F not         Pharmacy Plan G not          S:      $388
Benefits      deductible waived;           30% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network           available with this plan    available with this plan     E/S:     $929
Plan-10       Limited to 6 office                                                                                                                                                                                                 Combined)                                                                         P/C:     $785
              visits per calendar                                                                                                                                                                                                                                                                                    F:      $1,214
              year; Network and
              Out-of-Network
              Combined

1
 Deductible applies toward Out-of-Pocket Limit; Network and Out-of-Network accumulate separately. Certain services may not apply toward the Deductible or Out-of-Pocket Limit.
2
  Deductible, and all payments for RX and all covered expenses, unless indicated otherwise, apply towards the Out-of-Pocket Limit.
3
  HSA Compatible plans are administered on a plan year basis.
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 Aetna Health Insurance Company of New York (Aetna).
These quoted rates are for a 12-month period from the effective date of coverage and are valid only for the benefits level and conditions stated and such other terms and
conditions as set forth in the Aetna Life Insurance Company Group Policy or official renewal letters. Any changes in benefits level, conditions stated or other terms of the Policy may
require change in rates. These rates are applicable only to the Aetna service areas stated above. These rates are subject to final approval by Aetna. Rates have been filed with the
                                                                                                                                                            .
NY State Department of Insurance. Aetna reserves the right to modify the final rates based on actual enrollment.
Plans/rates are effective as of 4/1/10 and could change at any time due to legislative or filing actions.
                                                                                                             ®
This list of benefits isn't inclusive of all the benefits these plans offer. Please refer to the Aetna Avenue brochures for more information on our products.




             (RA-08) 4/10
             50.03.942.1-NY8                                                                                                                                                                                                                                                                                         Page 1 of 2
Aetna Small Business Health Plan Options
Allegany, Cattaraugus, Chautauqua, Erie, Niagara
RATES EFFECTIVE 4/1/2010 TO 6/15/2010

    Plan Options      Primary Care             Inpatient Hospital /         Emergency             Network           Out-of-Network Network Plan        Out-of-                    Network           Out-of-Network       Lifetime Maximum                              Monthly Premium
                                                                                                            1                     1
                       Physician /             Outpatient Surgery             Room              Deductible            Deductible        Coinsurance Network Plan                 Maximum               Maximum
                     Specialist Office                                                      (Individual / Family) (Individual / Family)             Coinsurance                Out-of-Pocket         Out-of-Pocket
                                                                                                                                                                                          1                     1
                          Visit                                                                                                                                                    Limit                 Limit
                                                                                                                                                                            (Individual / Family) (Individual / Family)
OA EPO 1-10        10% after deductible 10% after deductible /           10% after          $1,500 / $3,000       N/A                    10% after        N/A               $2,250 / $4,500       N/A                   Unlimited            Pharmacy Plan F not        S:     $512       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible             deductible                                                      deductible                                                                                         available with this plan   E/S:    $1,224    available with this plan
Compatible
          2, 3     $0 copay;                                                                                                                                                                                                                                           P/C:    $1,034
                   deductible waived                                                                                                                                                                                                                                    F:     $1,600


OA EPO 2-10        10% after deductible 10% after deductible /           10% after          $2,000 / $4,000       N/A                    10% after        N/A               $3,000 / $6,000    N/A                  Unlimited                Pharmacy Plan F not        S:     $462       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible             deductible                                                      deductible                                                                                         available with this plan   E/S:    $1,104    available with this plan
Compatible
          2,3      $0 copay;                                                                                                                                                                                                                                           P/C:    $933
                   deductible waived                                                                                                                                                                                                                                    F:     $1,444


OA EPO 3-10        20% after deductible 20% after deductible /           20% after          $3,000 / $6,000       N/A                    20% after        N/A               $4,500 / $9,000    N/A                  Unlimited                Pharmacy Plan F not        S:     $385       Pharmacy Plan H not
HSA                Preventive Care -    20% after deductible             deductible                                                      deductible                                                                                         available with this plan   E/S:    $921      available with this plan
Compatible
          2,3      $0 copay; deductible                                                                                                                                                                                                                                P/C:    $778
                   waived                                                                                                                                                                                                                                               F:     $1,204


OA EPO 4-10        0% after deductible 0% after deductible /             0% after           $5,000 / $10,000      N/A                    0% after         N/A               $5,950 / $11,900   N/A                  Unlimited                Pharmacy Plan F not        S:     $348       Pharmacy Plan H not
HSA                Preventive Care - $0 0% after deductible              deductible                                                      deductible                                                                                         available with this plan   E/S:    $832      available with this plan
Compatible
          2,3      copay; deductible                                                                                                                                                                                                                                   P/C:    $703
                   waived                                                                                                                                                                                                                                               F:     $1,088


OA MC 2-10         10% after deductible 10% after deductible /           10% after          $2,000 / $4,000       $4,000 / $8,000        10% after        30% after         $3,000 / $6,000    $8,000 / $16,000     Network - Unlimited      Pharmacy Plan F not        S:     $522       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible             deductible                                                      deductible       deductible                                                Out-of-Network -        available with this plan   E/S:    $1,250    available with this plan
Compatible
          2,3      $0 copay;                                                                                                                                                                                        $1,000,000                                         P/C:    $1,056
                   deductible waived                                                                                                                                                                                                                                    F:     $1,634


OA MC 3-10         20% after deductible 20% after deductible /           20% after          $3,000 / $6,000       $6,000 / $12,000       20% after        40% after         $4,500 / $9,000    $9,000 / $18,000     Network - Unlimited      Pharmacy Plan F not        S:     $445       Pharmacy Plan H not
HSA                Preventive Care -    20% after deductible             deductible                                                      deductible       deductible                                                Out-of-Network -        available with this plan   E/S:    $1,064    available with this plan
Compatible
          2,3      $0 copay; deductible                                                                                                                                                                             $1,000,000                                         P/C:    $899
                   waived                                                                                                                                                                                                                                               F:     $1,390


OA MC 4-10         0% after deductible 0% after deductible /             0% after           $5,000 / $10,000      $10,000 / $20,000 0% after              30% after         $5,950 / $11,900   $20,000 / $40,000    Network - Unlimited      Pharmacy Plan F not        S:     $389       Pharmacy Plan H not
HSA                Preventive Care - $0 0% after deductible              deductible                                                 deductible            deductible                                                Out-of-Network -        available with this plan   E/S:    $930      available with this plan
Compatible
          2,3      copay; deductible                                                                                                                                                                                $1,000,000                                         P/C:    $786
                   waived                                                                                                                                                                                                                                               F:     $1,216


Indemnity          20% after deductible 20% after deductible /           20% after          $2,500 / $7,500       $2,500 / $7,500        20% after        20% after         $5,000 / $15,000   $5,000 / $15,000     $1,000,000               Pharmacy Plan F not        S:     $2,247     Pharmacy Plan H not
1-10                                    20% after deductible             deductible         (Network and          (Network and           deductible       deductible        (Network and       (Network and                                 available with this plan   E/S:    $5,375    available with this plan
                                                                                            Out-of-Network        Out-of-Network                                            Out-of-Network     Out-of-Network                                                          P/C:    $4,542
                                                                                            combined)             combined)                                                 combined)          combined)                                                                F:     $7,028
1
 Deductible applies toward Out-of-Pocket Limit; Network and Out-of-Network accumulate separately. Certain services may not apply toward the Deductible or Out-of-Pocket Limit.
2
  Deductible, and all payments for RX and all covered expenses, unless indicated otherwise, count towards the Out-of-Pocket Limit.
3
  HSA Compatible plans are administered on a plan year basis.
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 Aetna Health Insurance Company of New York (Aetna).
These quoted rates are for a 12-month period from the effective date of coverage and are valid only for the benefits level and conditions stated and such other terms and
conditions as set forth in the Aetna Life Insurance Company Group Policy or official renewal letters. Any changes in benefits level, conditions stated or other terms of the Policy may
require change in rates. These rates are applicable only to the Aetna service areas stated above. These rates are subject to final approval by Aetna. Rates have been filed with the
NY State Department of Insurance. Aetna reserves the right to modify the final rates based on actual enrollment.
Plans/rates are effective as of 4/1/10 and could change at any time due to legislative or filing actions.
                                                                                                             ®
This list of benefits isn't inclusive of all the benefits these plans offer. Please refer to the Aetna Avenue brochures for more information on our products.




             (RA-08) 4/10
             50.03.942.1-NY8                                                                                                                                                                                                                                                                  Page 2 of 2
Aetna Small Business Health Plan Options
Chenango, Columbia, Fulton, Greene, Montgomery, Schuyler, Clinton, Essex, Franklin, Hamilton, Jefferson, Lewis, Saint Lawrence, Schoharie
RATES EFFECTIVE 4/1/2010 TO 6/15/2010

    Plan Options      Primary Care             Inpatient Hospital /         Emergency            Network                Out-of-Network           Network Plan   Out-of-           Network                 Out-of-Network            Lifetime Maximum        Monthly Premium -           Monthly Premium -          Monthly Premium -
                                                                                                          1                        1
                       Physician /             Outpatient Surgery             Room              Deductible               Deductible              Coinsurance Network Plan        Maximum                    Maximum                                          Pharmacy Plan F              Pharmacy Plan G           Pharmacy Plan H
                     Specialist Office                                                         (Individual / Family)     (Individual / Family)                Coinsurance       Out-of-Pocket             Out-of-Pocket                                         $0/$30/$50                   $15/$35/$70          Generics Only - $10
                                                                                                                                                                                          1                         1
                          Visit                                                                                                                                                     Limit                     Limit                                       Mail Order: $0/$60/$100     Mail Order: $30/$70/$140 Mail Order: Generics Only
                                                                                                                                                                                (Individual / Family)     (Individual / Family)                                                                                           $20
    OA EPO 1-10 $25 / $50 copay;           10% after deductible /        10% after          $1,000 / $3,000            N/A                       10% after    N/A            $2,000 / $6,000            N/A                       Unlimited                   S:        $525               S:       $498             S:      $470
                deductible waived          10% after deductible          deductible                                                              deductible                                                                                                  E/S        $1,255            E/S:      $1,192          E/S:     $1,124
                                                                                                                                                                                                                                                             P/C        $1,060            P/C:      $1,007          P/C:     $949
                                                                                                                                                                                                                                                              F:        $1,641             F:       $1,559           F:      $1,469
    OA EPO 2-10 $25 / $50 copay;           10% after deductible /        10% after          $2,000 / $6,000            N/A                       10% after    N/A            $4,000 / $12,000           N/A                       Unlimited                   S:        $467               S:       $440             S:      $411
                deductible waived          10% after deductible          deductible                                                              deductible                                                                                                  E/S        $1,116            E/S:      $1,053          E/S:     $984
                                                                                                                                                                                                                                                             P/C        $943              P/C:      $890            P/C:     $831
                                                                                                                                                                                                                                                              F:        $1,459             F:       $1,377           F:      $1,286
    OA EPO 3-10 $30 / $50 copay;           20% after deductible /        20% after             $1,500 / $4,500         N/A                       20% after    N/A            $3,000 / $9,000            N/A                       Unlimited                   S:        $481               S:       $455             S:      $426
                deductible waived          20% after deductible          deductible                                                              deductible                                                                                                  E/S:       $1,150            E/S:      $1,088          E/S:     $1,018
                                                                                                                                                                                                                                                             P/C        $972              P/C       $919            P/C      $860
                                                                                                                                                                                                                                                              F:        $1,504             F:       $1,422           F:      $1,331
OA EPO 4-10        $30 / $50 copay;        20% after deductible /        20% after          $2,500 / $7,500            N/A                       20% after    N/A            $5,000 / $15,000           N/A                       Unlimited                   S:        $433               S:       $407             S:      $378
                   deductible waived       20% after deductible          deductible                                                              deductible                                                                                                  E/S:       $1,037            E/S:      $974            E/S:     $904
                                                                                                                                                                                                                                                             P/C:       $876              P/C:      $823            P/C:     $764
                                                                                                                                                                                                                                                              F:        $1,355             F:       $1,273           F:      $1,182
OA EPO 5-10        $40 / $60 copay;        30% after deductible /        30% after          $2,500 / $7,500            N/A                       30% after    N/A            $5,000 / $15,000           N/A                       Unlimited                   S:        $419               S:       $393             S:      $364
                   deductible waived       30% after deductible          deductible                                                              deductible                                                                                                  E/S:       $1,003            E/S:      $940            E/S:     $870
                                                                                                                                                                                                                                                             P/C:       $848              P/C:      $795            P/C:     $735
                                                                                                                                                                                                                                                              F:        $1,312             F:       $1,230           F:      $1,138
OA EPO 6-10        $50 / $75 copay;        30% after deductible /        30% after          $3,000 / $9,000            N/A                       30% after    N/A            $6,000 / $18,000           N/A                       Unlimited                   S:        $395               S:       $369             S:      $339
                   deductible waived       30% after deductible          deductible                                                              deductible                                                                                                  E/S:       $945              E/S:      $882            E/S:     $812
                                                                                                                                                                                                                                                             P/C:       $799              P/C:      $746            P/C:     $686
                                                                                                                                                                                                                                                              F:        $1,236             F:       $1,154           F:      $1,061
    OA MC 1-10     $25 / $50 copay;        10% after deductible /        10% after          $1,000 / $3,000            $2,000 / $6,000           10% after    30% after      $2,000 / $6,000            $4,000 / $12,000          Network - Unlimited         S:        $594               S:       $566             S:      $537
                   deductible waived       10% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network -           E/S        $1,420            E/S:      $1,355          E/S:     $1,284
                                                                                                                                                                                                                                  $1,000,000                 P/C        $1,200            P/C:      $1,145          P/C:     $1,085
                                                                                                                                                                                                                                                              F:        $1,857             F:       $1,771           F:      $1,679
    OA MC 2-10     $25 / $50 copay;        10% after deductible /        10% after          $2,000 / $6,000            $4,000 / $12,000          10% after    30% after      $4,000 / $12,000           $8,000 / $24,000          Network - Unlimited         S:        $520               S:       $492             S:      $462
                   deductible waived       10% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network -           E/S        $1,243            E/S:      $1,178          E/S:     $1,106
                                                                                                                                                                                                                                  $1,000,000                 P/C        $1,050            P/C:      $995            P/C:     $934
                                                                                                                                                                                                                                                              F:        $1,625             F:       $1,540           F:      $1,446
    OA MC 3-10     $30 / $50 copay;        20% after deductible /        20% after             $1,500 / $4,500         $3,000 / $9,000           20% after    40% after      $3,000 / $9,000            $6,000 / $18,000          Network - Unlimited         S:        $540               S:       $513             S:      $483
                   deductible waived       20% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network -           E/S:       $1,292            E/S:      $1,227          E/S:     $1,156
                                                                                                                                                                                                                                  $1,000,000                 P/C        $1,092            P/C       $1,037          P/C      $977
                                                                                                                                                                                                                                                              F:        $1,690             F:       $1,605           F:      $1,511
OA MC 4-10         $30 / $50 copay;        20% after deductible /        20% after          $2,500 / $7,500            $5,000 / $15,000          20% after    40% after      $5,000 / $15,000           $10,000 / $30,000         Network - Unlimited         S:        $484               S:       $457             S:      $426
                   deductible waived       20% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network -           E/S:       $1,158            E/S:      $1,093          E/S:     $1,020
                                                                                                                                                                                                                                  $1,000,000                 P/C:       $978              P/C:      $923            P/C:     $862
                                                                                                                                                                                                                                                              F:        $1,514             F:       $1,428           F:      $1,334
OA MC Limited $30 / $50 copay;             30% after deductible /        30% after          $3,000 / $6,000            $6,000 / $18,000          30% after    50% after      $9,000 / $18,000           $18,000 / $54,000         $500,000 (Network and     Pharmacy Plan F not         Pharmacy Plan G not          S:      $345
Benefits      deductible waived;           30% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network           available with this plan    available with this plan     E/S:     $825
Plan-10       Limited to 6 office                                                                                                                                                                                                 Combined)                                                                         P/C:     $697
              visits per calendar                                                                                                                                                                                                                                                                                    F:      $1,078
              year; Network and
              Out-of-Network
              Combined

1
 Deductible applies toward Out-of-Pocket Limit; Network and Out-of-Network accumulate separately. Certain services may not apply toward the Deductible or Out-of-Pocket Limit.
2
  Deductible, and all payments for RX and all covered expenses, unless indicated otherwise, apply towards the Out-of-Pocket Limit.
3
  HSA Compatible plans are administered on a plan year basis.
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 Aetna Health Insurance Company of New York (Aetna).
These quoted rates are for a 12-month period from the effective date of coverage and are valid only for the benefits level and conditions stated and such other terms and
conditions as set forth in the Aetna Life Insurance Company Group Policy or official renewal letters. Any changes in benefits level, conditions stated or other terms of the Policy may
require change in rates. These rates are applicable only to the Aetna service areas stated above. These rates are subject to final approval by Aetna. Rates have been filed with the
                                                                                                                                                            .
NY State Department of Insurance. Aetna reserves the right to modify the final rates based on actual enrollment.
Plans/rates are effective as of 4/1/10 and could change at any time due to legislative or filing actions.
                                                                                                             ®
This list of benefits isn't inclusive of all the benefits these plans offer. Please refer to the Aetna Avenue brochures for more information on our products.




             (RA-09) 4/10
             50.03.942.1-NY9                                                                                                                                                                                                                                                                                         Page 1 of 2
Aetna Small Business Health Plan Options
Chenango, Columbia, Fulton, Greene, Montgomery, Schuyler, Clinton, Essex, Franklin, Hamilton, Jefferson, Lewis, Saint Lawrence, Schoharie
RATES EFFECTIVE 4/1/2010 TO 6/15/2010

    Plan Options      Primary Care             Inpatient Hospital /         Emergency             Network           Out-of-Network Network Plan        Out-of-                     Network           Out-of-Network       Lifetime Maximum                              Monthly Premium
                                                                                                            1                     1
                       Physician /             Outpatient Surgery             Room              Deductible            Deductible        Coinsurance Network Plan                  Maximum               Maximum
                     Specialist Office                                                      (Individual / Family) (Individual / Family)             Coinsurance                 Out-of-Pocket         Out-of-Pocket
                                                                                                                                                                                           1                     1
                          Visit                                                                                                                                                     Limit                 Limit
                                                                                                                                                                             (Individual / Family) (Individual / Family)
OA EPO 1-10        10% after deductible 10% after deductible /           10% after          $1,500 / $3,000        N/A                   10% after        N/A                $2,250 / $4,500       N/A                   Unlimited            Pharmacy Plan F not        S:     $454       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible             deductible                                                      deductible                                                                                          available with this plan   E/S:    $1,087    available with this plan
Compatible
          2, 3     $0 copay;                                                                                                                                                                                                                                            P/C:    $918
                   deductible waived                                                                                                                                                                                                                                     F:     $1,421


OA EPO 2-10        10% after deductible 10% after deductible /           10% after          $2,000 / $4,000        N/A                   10% after        N/A                $3,000 / $6,000    N/A                  Unlimited                Pharmacy Plan F not        S:     $410       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible             deductible                                                      deductible                                                                                          available with this plan   E/S:    $981      available with this plan
Compatible
          2,3      $0 copay;                                                                                                                                                                                                                                            P/C:    $829
                   deductible waived                                                                                                                                                                                                                                     F:     $1,282


OA EPO 3-10        20% after deductible 20% after deductible /           20% after          $3,000 / $6,000        N/A                   20% after        N/A                $4,500 / $9,000    N/A                  Unlimited                Pharmacy Plan F not        S:     $342       Pharmacy Plan H not
HSA                Preventive Care -    20% after deductible             deductible                                                      deductible                                                                                          available with this plan   E/S:    $817      available with this plan
Compatible
          2,3      $0 copay; deductible                                                                                                                                                                                                                                 P/C:    $691
                   waived                                                                                                                                                                                                                                                F:     $1,069


OA EPO 4-10        0% after deductible 0% after deductible /             0% after           $5,000 / $10,000       N/A                   0% after         N/A                $5,950 / $11,900   N/A                  Unlimited                Pharmacy Plan F not        S:     $309       Pharmacy Plan H not
HSA                Preventive Care - $0 0% after deductible              deductible                                                      deductible                                                                                          available with this plan   E/S:    $739      available with this plan
Compatible
          2,3      copay; deductible                                                                                                                                                                                                                                    P/C:    $624
                   waived                                                                                                                                                                                                                                                F:     $966


OA MC 2-10         10% after deductible 10% after deductible /           10% after          $2,000 / $4,000        $4,000 / $8,000       10% after        30% after          $3,000 / $6,000    $8,000 / $16,000     Network - Unlimited      Pharmacy Plan F not        S:     $464       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible             deductible                                                      deductible       deductible                                                 Out-of-Network -        available with this plan   E/S:    $1,110    available with this plan
Compatible
          2,3      $0 copay;                                                                                                                                                                                         $1,000,000                                         P/C:    $938
                   deductible waived                                                                                                                                                                                                                                     F:     $1,451


OA MC 3-10         20% after deductible 20% after deductible /           20% after          $3,000 / $6,000        $6,000 / $12,000      20% after        40% after          $4,500 / $9,000    $9,000 / $18,000     Network - Unlimited      Pharmacy Plan F not        S:     $395       Pharmacy Plan H not
HSA                Preventive Care -    20% after deductible             deductible                                                      deductible       deductible                                                 Out-of-Network -        available with this plan   E/S:    $944      available with this plan
Compatible
          2,3      $0 copay; deductible                                                                                                                                                                              $1,000,000                                         P/C:    $798
                   waived                                                                                                                                                                                                                                                F:     $1,235


OA MC 4-10         0% after deductible 0% after deductible /             0% after           $5,000 / $10,000       $10,000 / $20,000 0% after             30% after          $5,950 / $11,900   $20,000 / $40,000    Network - Unlimited      Pharmacy Plan F not        S:     $345       Pharmacy Plan H not
HSA                Preventive Care - $0 0% after deductible              deductible                                                  deductible           deductible                                                 Out-of-Network -        available with this plan   E/S:    $826      available with this plan
Compatible
          2,3      copay; deductible                                                                                                                                                                                 $1,000,000                                         P/C:    $698
                   waived                                                                                                                                                                                                                                                F:     $1,080


Indemnity          20% after deductible 20% after deductible /           20% after          $2,500 / $7,500        $2,500 / $7,500       20% after        20% after          $5,000 / $15,000   $5,000 / $15,000     $1,000,000               Pharmacy Plan F not        S:     $1,995     Pharmacy Plan H not
1-10                                    20% after deductible             deductible         (Network and           (Network and          deductible       deductible         (Network and       (Network and                                 available with this plan   E/S:    $4,773    available with this plan
                                                                                            Out-of-Network         Out-of-Network                                            Out-of-Network     Out-of-Network                                                          P/C:    $4,033
                                                                                            combined)              combined)                                                 combined)          combined)                                                                F:     $6,240
1
 Deductible applies toward Out-of-Pocket Limit; Network and Out-of-Network accumulate separately. Certain services may not apply toward the Deductible or Out-of-Pocket Limit.
2
  Deductible, and all payments for RX and all covered expenses, unless indicated otherwise, count towards the Out-of-Pocket Limit.
3
  HSA Compatible plans are administered on a plan year basis.
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 Aetna Health Insurance Company of New York (Aetna).
These quoted rates are for a 12-month period from the effective date of coverage and are valid only for the benefits level and conditions stated and such other terms and
conditions as set forth in the Aetna Life Insurance Company Group Policy or official renewal letters. Any changes in benefits level, conditions stated or other terms of the Policy may
require change in rates. These rates are applicable only to the Aetna service areas stated above. These rates are subject to final approval by Aetna. Rates have been filed with the
                                                                                                                                                            .
NY State Department of Insurance. Aetna reserves the right to modify the final rates based on actual enrollment.
Plans/rates are effective as of 4/1/10 and could change at any time due to legislative or filing actions.
                                                                                                             ®
This list of benefits isn't inclusive of all the benefits these plans offer. Please refer to the Aetna Avenue brochures for more information on our products.




             (RA-09) 4/10
             50.03.942.1-NY9                                                                                                                                                                                                                                                                   Page 2 of 2
Aetna Small Business Health Plan Options
Dutchess, Orange, Putnam, Sullivan, Ulster
RATES EFFECTIVE 4/1/2010 TO 6/15/2010

    Plan Options      Primary Care             Inpatient Hospital /         Emergency            Network                Out-of-Network           Network Plan   Out-of-          Network                 Out-of-Network            Lifetime Maximum        Monthly Premium -           Monthly Premium -          Monthly Premium -
                                                                                                          1                        1
                       Physician /             Outpatient Surgery             Room              Deductible               Deductible              Coinsurance Network Plan       Maximum                    Maximum                                          Pharmacy Plan F              Pharmacy Plan G           Pharmacy Plan H
                     Specialist Office                                                         (Individual / Family)     (Individual / Family)                Coinsurance      Out-of-Pocket             Out-of-Pocket                                         $0/$30/$50                   $15/$35/$70          Generics Only - $10
                                                                                                                                                                                         1                         1
                          Visit                                                                                                                                                    Limit                     Limit                                       Mail Order: $0/$60/$100     Mail Order: $30/$70/$140 Mail Order: Generics Only
                                                                                                                                                                               (Individual / Family)     (Individual / Family)                                                                                           $20
    OA EPO 1-10 $25 / $50 copay;           10% after deductible /        10% after          $1,000 / $3,000            N/A                       10% after    N/A           $2,000 / $6,000            N/A                       Unlimited                   S:        $407               S:       $387             S:      $365
                deductible waived          10% after deductible          deductible                                                              deductible                                                                                                 E/S        $975              E/S:      $926            E/S:     $873
                                                                                                                                                                                                                                                            P/C        $824              P/C:      $782            P/C:     $737
                                                                                                                                                                                                                                                             F:        $1,274             F:       $1,211           F:      $1,141
    OA EPO 2-10 $25 / $50 copay;           10% after deductible /        10% after          $2,000 / $6,000            N/A                       10% after    N/A           $4,000 / $12,000           N/A                       Unlimited                   S:        $362               S:       $342             S:      $319
                deductible waived          10% after deductible          deductible                                                              deductible                                                                                                 E/S        $867              E/S:      $818            E/S:     $764
                                                                                                                                                                                                                                                            P/C        $732              P/C:      $691            P/C:     $645
                                                                                                                                                                                                                                                             F:        $1,133             F:       $1,070           F:      $999
    OA EPO 3-10 $30 / $50 copay;           20% after deductible /        20% after            $1,500 / $4,500          N/A                       20% after    N/A           $3,000 / $9,000            N/A                       Unlimited                   S:        $373               S:       $353             S:      $331
                deductible waived          20% after deductible          deductible                                                              deductible                                                                                                 E/S:       $893              E/S:      $845            E/S:     $791
                                                                                                                                                                                                                                                            P/C        $755              P/C       $714            P/C      $668
                                                                                                                                                                                                                                                             F:        $1,168             F:       $1,104           F:      $1,034
OA EPO 4-10        $30 / $50 copay;        20% after deductible /        20% after          $2,500 / $7,500            N/A                       20% after    N/A           $5,000 / $15,000           N/A                       Unlimited                   S:        $337               S:       $316             S:      $293
                   deductible waived       20% after deductible          deductible                                                              deductible                                                                                                 E/S:       $805              E/S:      $756            E/S:     $702
                                                                                                                                                                                                                                                            P/C:       $680              P/C:      $639            P/C:     $593
                                                                                                                                                                                                                                                             F:        $1,053             F:       $989             F:      $918
OA EPO 5-10        $40 / $60 copay;        30% after deductible /        30% after          $2,500 / $7,500            N/A                       30% after    N/A           $5,000 / $15,000           N/A                       Unlimited                   S:        $326               S:       $305             S:      $283
                   deductible waived       30% after deductible          deductible                                                              deductible                                                                                                 E/S:       $779              E/S:      $730            E/S:     $676
                                                                                                                                                                                                                                                            P/C:       $658              P/C:      $617            P/C:     $571
                                                                                                                                                                                                                                                             F:        $1,019             F:       $955             F:      $884
OA EPO 6-10        $50 / $75 copay;        30% after deductible /        30% after          $3,000 / $9,000            N/A                       30% after    N/A           $6,000 / $18,000           N/A                       Unlimited                   S:        $307               S:       $287             S:      $264
                   deductible waived       30% after deductible          deductible                                                              deductible                                                                                                 E/S:       $734              E/S:      $685            E/S:     $631
                                                                                                                                                                                                                                                            P/C:       $620              P/C:      $579            P/C:     $533
                                                                                                                                                                                                                                                             F:        $960               F:       $896             F:      $824
    OA MC 1-10     $25 / $50 copay;        10% after deductible /        10% after          $1,000 / $3,000            $2,000 / $6,000           10% after    30% after     $2,000 / $6,000            $4,000 / $12,000          Network - Unlimited         S:        $461               S:       $440             S:      $417
                   deductible waived       10% after deductible          deductible                                                              deductible   deductible                                                         Out-of-Network -           E/S        $1,103            E/S:      $1,052          E/S:     $998
                                                                                                                                                                                                                                 $1,000,000                 P/C        $932              P/C:      $889            P/C:     $843
                                                                                                                                                                                                                                                             F:        $1,442             F:       $1,376           F:      $1,304
    OA MC 2-10     $25 / $50 copay;        10% after deductible /        10% after          $2,000 / $6,000            $4,000 / $12,000          10% after    30% after     $4,000 / $12,000           $8,000 / $24,000          Network - Unlimited         S:        $404               S:       $382             S:      $359
                   deductible waived       10% after deductible          deductible                                                              deductible   deductible                                                         Out-of-Network -           E/S        $965              E/S:      $915            E/S:     $859
                                                                                                                                                                                                                                 $1,000,000                 P/C        $816              P/C:      $773            P/C:     $726
                                                                                                                                                                                                                                                             F:        $1,262             F:       $1,196           F:      $1,123
    OA MC 3-10     $30 / $50 copay;        20% after deductible /        20% after            $1,500 / $4,500          $3,000 / $9,000           20% after    40% after     $3,000 / $9,000            $6,000 / $18,000          Network - Unlimited         S:        $420               S:       $398             S:      $375
                   deductible waived       20% after deductible          deductible                                                              deductible   deductible                                                         Out-of-Network -           E/S:       $1,004            E/S:      $953            E/S:     $898
                                                                                                                                                                                                                                 $1,000,000                 P/C        $848              P/C       $805            P/C      $759
                                                                                                                                                                                                                                                             F:        $1,312             F:       $1,246           F:      $1,174
OA MC 4-10         $30 / $50 copay;        20% after deductible /        20% after          $2,500 / $7,500            $5,000 / $15,000          20% after    40% after     $5,000 / $15,000           $10,000 / $30,000         Network - Unlimited         S:        $376               S:       $355             S:      $331
                   deductible waived       20% after deductible          deductible                                                              deductible   deductible                                                         Out-of-Network -           E/S:       $899              E/S:      $849            E/S:     $792
                                                                                                                                                                                                                                 $1,000,000                 P/C:       $760              P/C:      $717            P/C:     $669
                                                                                                                                                                                                                                                             F:        $1,176             F:       $1,109           F:      $1,036
OA MC Limited $30 / $50 copay;             30% after deductible /        30% after          $3,000 / $6,000            $6,000 / $18,000          30% after    50% after     $9,000 / $18,000           $18,000 / $54,000         $500,000 (Network and     Pharmacy Plan F not         Pharmacy Plan G not          S:      $268
Benefits      deductible waived;           30% after deductible          deductible                                                              deductible   deductible                                                         Out-of-Network           available with this plan    available with this plan     E/S:     $641
Plan-10       Limited to 6 office                                                                                                                                                                                                Combined)                                                                         P/C:     $541
              visits per calendar                                                                                                                                                                                                                                                                                   F:      $837
              year; Network and
              Out-of-Network
              Combined

1
 Deductible applies toward Out-of-Pocket Limit; Network and Out-of-Network accumulate separately. Certain services may not apply toward the Deductible or Out-of-Pocket Limit.
2
  Deductible, and all payments for RX and all covered expenses, unless indicated otherwise, apply towards the Out-of-Pocket Limit.
3
  HSA Compatible plans are administered on a plan year basis.
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 Aetna Health Insurance Company of New York (Aetna).
These quoted rates are for a 12-month period from the effective date of coverage and are valid only for the benefits level and conditions stated and such other terms and
conditions as set forth in the Aetna Life Insurance Company Group Policy or official renewal letters. Any changes in benefits level, conditions stated or other terms of the Policy may
require change in rates. These rates are applicable only to the Aetna service areas stated above. These rates are subject to final approval by Aetna. Rates have been filed with the
NY State Department of Insurance. Aetna reserves the right to modify the final rates based on actual enrollment.
Plans/rates are effective as of 4/1/10 and could change at any time due to legislative or filing actions.
                                                                                                             ®
This list of benefits isn't inclusive of all the benefits these plans offer. Please refer to the Aetna Avenue brochures for more information on our products.




             (RA-10) 4/10
             50.03.942.1-NY10                                                                                                                                                                                                                                                                                       Page 1 of 2
Aetna Small Business Health Plan Options
Dutchess, Orange, Putnam, Sullivan, Ulster
RATES EFFECTIVE 4/1/2010 TO 6/15/2010

    Plan Options      Primary Care             Inpatient Hospital /         Emergency             Network           Out-of-Network Network Plan        Out-of-                     Network           Out-of-Network       Lifetime Maximum                              Monthly Premium
                                                                                                            1                     1
                       Physician /             Outpatient Surgery             Room              Deductible            Deductible        Coinsurance Network Plan                  Maximum               Maximum
                     Specialist Office                                                      (Individual / Family) (Individual / Family)             Coinsurance                 Out-of-Pocket         Out-of-Pocket
                                                                                                                                                                                           1                     1
                          Visit                                                                                                                                                     Limit                 Limit
                                                                                                                                                                             (Individual / Family) (Individual / Family)
OA EPO 1-10        10% after deductible 10% after deductible /           10% after          $1,500 / $3,000        N/A                   10% after        N/A                $2,250 / $4,500       N/A                   Unlimited            Pharmacy Plan F not        S:     $353       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible             deductible                                                      deductible                                                                                          available with this plan   E/S:    $844      available with this plan
Compatible
          2, 3     $0 copay;                                                                                                                                                                                                                                            P/C:    $713
                   deductible waived                                                                                                                                                                                                                                     F:     $1,104


OA EPO 2-10        10% after deductible 10% after deductible /           10% after          $2,000 / $4,000        N/A                   10% after        N/A                $3,000 / $6,000    N/A                  Unlimited                Pharmacy Plan F not        S:     $318       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible             deductible                                                      deductible                                                                                          available with this plan   E/S:    $762      available with this plan
Compatible
          2,3      $0 copay;                                                                                                                                                                                                                                            P/C:    $644
                   deductible waived                                                                                                                                                                                                                                     F:     $996


OA EPO 3-10        20% after deductible 20% after deductible /           20% after          $3,000 / $6,000        N/A                   20% after        N/A                $4,500 / $9,000    N/A                  Unlimited                Pharmacy Plan F not        S:     $265       Pharmacy Plan H not
HSA                Preventive Care -    20% after deductible             deductible                                                      deductible                                                                                          available with this plan   E/S:    $635      available with this plan
Compatible
          2,3      $0 copay; deductible                                                                                                                                                                                                                                 P/C:    $536
                   waived                                                                                                                                                                                                                                                F:     $830


OA EPO 4-10        0% after deductible 0% after deductible /             0% after           $5,000 / $10,000       N/A                   0% after         N/A                $5,950 / $11,900   N/A                  Unlimited                Pharmacy Plan F not        S:     $240       Pharmacy Plan H not
HSA                Preventive Care - $0 0% after deductible              deductible                                                      deductible                                                                                          available with this plan   E/S:    $574      available with this plan
Compatible
          2,3      copay; deductible                                                                                                                                                                                                                                    P/C:    $485
                   waived                                                                                                                                                                                                                                                F:     $750


OA MC 2-10         10% after deductible 10% after deductible /           10% after          $2,000 / $4,000        $4,000 / $8,000       10% after        30% after          $3,000 / $6,000    $8,000 / $16,000     Network - Unlimited      Pharmacy Plan F not        S:     $360       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible             deductible                                                      deductible       deductible                                                 Out-of-Network -        available with this plan   E/S:    $862      available with this plan
Compatible
          2,3      $0 copay;                                                                                                                                                                                         $1,000,000                                         P/C:    $728
                   deductible waived                                                                                                                                                                                                                                     F:     $1,127


OA MC 3-10         20% after deductible 20% after deductible /           20% after          $3,000 / $6,000        $6,000 / $12,000      20% after        40% after          $4,500 / $9,000    $9,000 / $18,000     Network - Unlimited      Pharmacy Plan F not        S:     $307       Pharmacy Plan H not
HSA                Preventive Care -    20% after deductible             deductible                                                      deductible       deductible                                                 Out-of-Network -        available with this plan   E/S:    $733      available with this plan
Compatible
          2,3      $0 copay; deductible                                                                                                                                                                              $1,000,000                                         P/C:    $620
                   waived                                                                                                                                                                                                                                                F:     $959


OA MC 4-10         0% after deductible 0% after deductible /             0% after           $5,000 / $10,000       $10,000 / $20,000 0% after             30% after          $5,950 / $11,900   $20,000 / $40,000    Network - Unlimited      Pharmacy Plan F not        S:     $268       Pharmacy Plan H not
HSA                Preventive Care - $0 0% after deductible              deductible                                                  deductible           deductible                                                 Out-of-Network -        available with this plan   E/S:    $641      available with this plan
Compatible
          2,3      copay; deductible                                                                                                                                                                                 $1,000,000                                         P/C:    $542
                   waived                                                                                                                                                                                                                                                F:     $839


Indemnity          20% after deductible 20% after deductible /           20% after          $2,500 / $7,500        $2,500 / $7,500       20% after        20% after          $5,000 / $15,000   $5,000 / $15,000     $1,000,000               Pharmacy Plan F not        S:     $1,550     Pharmacy Plan H not
1-10                                    20% after deductible             deductible         (Network and           (Network and          deductible       deductible         (Network and       (Network and                                 available with this plan   E/S:    $3,707    available with this plan
                                                                                            Out-of-Network         Out-of-Network                                            Out-of-Network     Out-of-Network                                                          P/C:    $3,133
                                                                                            combined)              combined)                                                 combined)          combined)                                                                F:     $4,847
1
 Deductible applies toward Out-of-Pocket Limit; Network and Out-of-Network accumulate separately. Certain services may not apply toward the Deductible or Out-of-Pocket Limit.
2
  Deductible, and all payments for RX and all covered expenses, unless indicated otherwise, count towards the Out-of-Pocket Limit.
3
  HSA Compatible plans are administered on a plan year basis.
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 Aetna Health Insurance Company of New York (Aetna).
These quoted rates are for a 12-month period from the effective date of coverage and are valid only for the benefits level and conditions stated and such other terms and
conditions as set forth in the Aetna Life Insurance Company Group Policy or official renewal letters. Any changes in benefits level, conditions stated or other terms of the Policy may
require change in rates. These rates are applicable only to the Aetna service areas stated above. These rates are subject to final approval by Aetna. Rates have been filed with the
NY State Department of Insurance. Aetna reserves the right to modify the final rates based on actual enrollment.
Plans/rates are effective as of 4/1/10 and could change at any time due to legislative or filing actions.
                                                                                                             ®
This list of benefits isn't inclusive of all the benefits these plans offer. Please refer to the Aetna Avenue brochures for more information on our products.




             (RA-10) 4/10
             50.03.942.1-NY10                                                                                                                                                                                                                                                                  Page 2 of 2
Aetna Small Business Health Plan Options
Bronx, Kings, New York, Queens, Richmond, Rockland, Westchester
RATES EFFECTIVE 4/1/2010 TO 6/15/2010

    Plan Options      Primary Care             Inpatient Hospital /         Emergency            Network                Out-of-Network           Network Plan   Out-of-           Network                 Out-of-Network            Lifetime Maximum        Monthly Premium -           Monthly Premium -          Monthly Premium -
                                                                                                          1                        1
                       Physician /             Outpatient Surgery             Room              Deductible               Deductible              Coinsurance Network Plan        Maximum                    Maximum                                          Pharmacy Plan F              Pharmacy Plan G           Pharmacy Plan H
                     Specialist Office                                                         (Individual / Family)     (Individual / Family)                Coinsurance       Out-of-Pocket             Out-of-Pocket                                         $0/$30/$50                   $15/$35/$70          Generics Only - $10
                                                                                                                                                                                          1                         1
                          Visit                                                                                                                                                     Limit                     Limit                                       Mail Order: $0/$60/$100     Mail Order: $30/$70/$140 Mail Order: Generics Only
                                                                                                                                                                                (Individual / Family)     (Individual / Family)                                                                                           $20
    OA EPO 1-10 $25 / $50 copay;           10% after deductible /        10% after          $1,000 / $3,000            N/A                       10% after    N/A            $2,000 / $6,000            N/A                       Unlimited                   S:        $497               S:       $472             S:      $445
                deductible waived          10% after deductible          deductible                                                              deductible                                                                                                  E/S        $1,189            E/S:      $1,130          E/S:     $1,065
                                                                                                                                                                                                                                                             P/C        $1,005            P/C:      $955            P/C:     $900
                                                                                                                                                                                                                                                              F:        $1,555             F:       $1,477           F:      $1,392
    OA EPO 2-10 $25 / $50 copay;           10% after deductible /        10% after          $2,000 / $6,000            N/A                       10% after    N/A            $4,000 / $12,000           N/A                       Unlimited                   S:        $442               S:       $417             S:      $390
                deductible waived          10% after deductible          deductible                                                              deductible                                                                                                  E/S        $1,058            E/S:      $998            E/S:     $932
                                                                                                                                                                                                                                                             P/C        $894              P/C:      $843            P/C:     $788
                                                                                                                                                                                                                                                              F:        $1,383             F:       $1,305           F:      $1,219
    OA EPO 3-10 $30 / $50 copay;           20% after deductible /        20% after             $1,500 / $4,500         N/A                       20% after    N/A            $3,000 / $9,000            N/A                       Unlimited                   S:        $456               S:       $431             S:      $403
                deductible waived          20% after deductible          deductible                                                              deductible                                                                                                  E/S:       $1,090            E/S:      $1,031          E/S:     $965
                                                                                                                                                                                                                                                             P/C        $921              P/C       $871            P/C      $815
                                                                                                                                                                                                                                                              F:        $1,425             F:       $1,348           F:      $1,262
OA EPO 4-10        $30 / $50 copay;        20% after deductible /        20% after          $2,500 / $7,500            N/A                       20% after    N/A            $5,000 / $15,000           N/A                       Unlimited                   S:        $411               S:       $386             S:      $358
                   deductible waived       20% after deductible          deductible                                                              deductible                                                                                                  E/S:       $982              E/S:      $923            E/S:     $856
                                                                                                                                                                                                                                                             P/C:       $830              P/C:      $780            P/C:     $724
                                                                                                                                                                                                                                                              F:        $1,285             F:       $1,207           F:      $1,120
OA EPO 5-10        $40 / $60 copay;        30% after deductible /        30% after          $2,500 / $7,500            N/A                       30% after    N/A            $5,000 / $15,000           N/A                       Unlimited                   S:        $397               S:       $373             S:      $345
                   deductible waived       30% after deductible          deductible                                                              deductible                                                                                                  E/S:       $951              E/S:      $891            E/S:     $825
                                                                                                                                                                                                                                                             P/C:       $803              P/C:      $753            P/C:     $697
                                                                                                                                                                                                                                                              F:        $1,243             F:       $1,165           F:      $1,078
OA EPO 6-10        $50 / $75 copay;        30% after deductible /        30% after          $3,000 / $9,000            N/A                       30% after    N/A            $6,000 / $18,000           N/A                       Unlimited                   S:        $374               S:       $350             S:      $322
                   deductible waived       30% after deductible          deductible                                                              deductible                                                                                                  E/S:       $896              E/S:      $836            E/S:     $769
                                                                                                                                                                                                                                                             P/C:       $757              P/C:      $707            P/C:     $650
                                                                                                                                                                                                                                                              F:        $1,171             F:       $1,093           F:      $1,006
    OA MC 1-10     $25 / $50 copay;        10% after deductible /        10% after          $1,000 / $3,000            $2,000 / $6,000           10% after    30% after      $2,000 / $6,000            $4,000 / $12,000          Network - Unlimited         S:        $563               S:       $537             S:      $509
                   deductible waived       10% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network -           E/S        $1,346            E/S:      $1,284          E/S:     $1,217
                                                                                                                                                                                                                                  $1,000,000                 P/C        $1,137            P/C:      $1,085          P/C:     $1,028
                                                                                                                                                                                                                                                              F:        $1,759             F:       $1,679           F:      $1,591
    OA MC 2-10     $25 / $50 copay;        10% after deductible /        10% after          $2,000 / $6,000            $4,000 / $12,000          10% after    30% after      $4,000 / $12,000           $8,000 / $24,000          Network - Unlimited         S:        $492               S:       $467             S:      $438
                   deductible waived       10% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network -           E/S        $1,178            E/S:      $1,116          E/S:     $1,048
                                                                                                                                                                                                                                  $1,000,000                 P/C        $995              P/C:      $943            P/C:     $886
                                                                                                                                                                                                                                                              F:        $1,540             F:       $1,459           F:      $1,370
    OA MC 3-10     $30 / $50 copay;        20% after deductible /        20% after             $1,500 / $4,500         $3,000 / $9,000           20% after    40% after      $3,000 / $9,000            $6,000 / $18,000          Network - Unlimited         S:        $512               S:       $486             S:      $458
                   deductible waived       20% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network -           E/S:       $1,225            E/S:      $1,163          E/S:     $1,095
                                                                                                                                                                                                                                  $1,000,000                 P/C        $1,035            P/C       $983            P/C      $926
                                                                                                                                                                                                                                                              F:        $1,601             F:       $1,521           F:      $1,432
OA MC 4-10         $30 / $50 copay;        20% after deductible /        20% after          $2,500 / $7,500            $5,000 / $15,000          20% after    40% after      $5,000 / $15,000           $10,000 / $30,000         Network - Unlimited         S:        $459               S:       $433             S:      $404
                   deductible waived       20% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network -           E/S:       $1,097            E/S:      $1,035          E/S:     $967
                                                                                                                                                                                                                                  $1,000,000                 P/C:       $927              P/C:      $875            P/C:     $817
                                                                                                                                                                                                                                                              F:        $1,434             F:       $1,354           F:      $1,264
OA MC Limited $30 / $50 copay;             30% after deductible /        30% after          $3,000 / $6,000            $6,000 / $18,000          30% after    50% after      $9,000 / $18,000           $18,000 / $54,000         $500,000 (Network and     Pharmacy Plan F not         Pharmacy Plan G not          S:      $327
Benefits      deductible waived;           30% after deductible          deductible                                                              deductible   deductible                                                          Out-of-Network           available with this plan    available with this plan     E/S:     $782
Plan-10       Limited to 6 office                                                                                                                                                                                                 Combined)                                                                         P/C:     $660
              visits per calendar                                                                                                                                                                                                                                                                                    F:      $1,022
              year; Network and
              Out-of-Network
              Combined

1
 Deductible applies toward Out-of-Pocket Limit; Network and Out-of-Network accumulate separately. Certain services may not apply toward the Deductible or Out-of-Pocket Limit.
2
  Deductible, and all payments for RX and all covered expenses, unless indicated otherwise, apply towards the Out-of-Pocket Limit.
3
  HSA Compatible plans are administered on a plan year basis.
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 Aetna Health Insurance Company of New York (Aetna).
These quoted rates are for a 12-month period from the effective date of coverage and are valid only for the benefits level and conditions stated and such other terms and
conditions as set forth in the Aetna Life Insurance Company Group Policy or official renewal letters. Any changes in benefits level, conditions stated or other terms of the Policy may
require change in rates. These rates are applicable only to the Aetna service areas stated above. These rates are subject to final approval by Aetna. Rates have been filed with the
                                                                                                                                                              .
NY State Department of Insurance. Aetna reserves the right to modify the final rates based on actual enrollment.
Plans/rates are effective as of 4/1/10 and could change at any time due to legislative or filing actions.
                                                                                                             ®
This list of benefits isn't inclusive of all the benefits these plans offer. Please refer to the Aetna Avenue brochures for more information on our products.




             (RA-12-14-15) 4/10
             50.03.942.1-NY121415                                                                                                                                                                                                                                                                                    Page 1 of 2
Aetna Small Business Health Plan Options
Bronx, Kings, New York, Queens, Richmond, Rockland, Westchester
RATES EFFECTIVE 4/1/2010 TO 6/15/2010

    Plan Options      Primary Care             Inpatient Hospital /         Emergency             Network           Out-of-Network Network Plan        Out-of-                     Network           Out-of-Network       Lifetime Maximum                              Monthly Premium
                                                                                                            1                     1
                       Physician /             Outpatient Surgery             Room              Deductible            Deductible        Coinsurance Network Plan                  Maximum               Maximum
                     Specialist Office                                                      (Individual / Family) (Individual / Family)             Coinsurance                 Out-of-Pocket         Out-of-Pocket
                                                                                                                                                                                           1                     1
                          Visit                                                                                                                                                     Limit                 Limit
                                                                                                                                                                             (Individual / Family) (Individual / Family)
OA EPO 1-10        10% after deductible 10% after deductible /           10% after          $1,500 / $3,000        N/A                   10% after        N/A                $2,250 / $4,500       N/A                   Unlimited            Pharmacy Plan F not        S:     $431       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible             deductible                                                      deductible                                                                                          available with this plan   E/S:    $1,030    available with this plan
Compatible
          2, 3     $0 copay;                                                                                                                                                                                                                                            P/C:    $870
                   deductible waived                                                                                                                                                                                                                                     F:     $1,347


OA EPO 2-10        10% after deductible 10% after deductible /           10% after          $2,000 / $4,000        N/A                   10% after        N/A                $3,000 / $6,000    N/A                  Unlimited                Pharmacy Plan F not        S:     $388       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible             deductible                                                      deductible                                                                                          available with this plan   E/S:    $929      available with this plan
Compatible
          2,3      $0 copay;                                                                                                                                                                                                                                            P/C:    $785
                   deductible waived                                                                                                                                                                                                                                     F:     $1,215


OA EPO 3-10        20% after deductible 20% after deductible /           20% after          $3,000 / $6,000        N/A                   20% after        N/A                $4,500 / $9,000    N/A                  Unlimited                Pharmacy Plan F not        S:     $324       Pharmacy Plan H not
HSA                Preventive Care -    20% after deductible             deductible                                                      deductible                                                                                          available with this plan   E/S:    $775      available with this plan
Compatible
          2,3      $0 copay; deductible                                                                                                                                                                                                                                 P/C:    $655
                   waived                                                                                                                                                                                                                                                F:     $1,013


OA EPO 4-10        0% after deductible 0% after deductible /             0% after           $5,000 / $10,000       N/A                   0% after         N/A                $5,950 / $11,900   N/A                  Unlimited                Pharmacy Plan F not        S:     $293       Pharmacy Plan H not
HSA                Preventive Care - $0 0% after deductible              deductible                                                      deductible                                                                                          available with this plan   E/S:    $700      available with this plan
Compatible
          2,3      copay; deductible                                                                                                                                                                                                                                    P/C:    $592
                   waived                                                                                                                                                                                                                                                F:     $916


OA MC 2-10         10% after deductible 10% after deductible /           10% after          $2,000 / $4,000        $4,000 / $8,000       10% after        30% after          $3,000 / $6,000    $8,000 / $16,000     Network - Unlimited      Pharmacy Plan F not        S:     $440       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible             deductible                                                      deductible       deductible                                                 Out-of-Network -        available with this plan   E/S:    $1,052    available with this plan
Compatible
          2,3      $0 copay;                                                                                                                                                                                         $1,000,000                                         P/C:    $889
                   deductible waived                                                                                                                                                                                                                                     F:     $1,375


OA MC 3-10         20% after deductible 20% after deductible /           20% after          $3,000 / $6,000        $6,000 / $12,000      20% after        40% after          $4,500 / $9,000    $9,000 / $18,000     Network - Unlimited      Pharmacy Plan F not        S:     $374       Pharmacy Plan H not
HSA                Preventive Care -    20% after deductible             deductible                                                      deductible       deductible                                                 Out-of-Network -        available with this plan   E/S:    $895      available with this plan
Compatible
          2,3      $0 copay; deductible                                                                                                                                                                              $1,000,000                                         P/C:    $756
                   waived                                                                                                                                                                                                                                                F:     $1,170


OA MC 4-10         0% after deductible 0% after deductible /             0% after           $5,000 / $10,000       $10,000 / $20,000 0% after             30% after          $5,950 / $11,900   $20,000 / $40,000    Network - Unlimited      Pharmacy Plan F not        S:     $327       Pharmacy Plan H not
HSA                Preventive Care - $0 0% after deductible              deductible                                                  deductible           deductible                                                 Out-of-Network -        available with this plan   E/S:    $783      available with this plan
Compatible
          2,3      copay; deductible                                                                                                                                                                                 $1,000,000                                         P/C:    $661
                   waived                                                                                                                                                                                                                                                F:     $1,023


Indemnity          20% after deductible 20% after deductible /           20% after          $2,500 / $7,500        $2,500 / $7,500       20% after        20% after          $5,000 / $15,000   $5,000 / $15,000     $1,000,000               Pharmacy Plan F not        S:     $1,891     Pharmacy Plan H not
1-10                                    20% after deductible             deductible         (Network and           (Network and          deductible       deductible         (Network and       (Network and                                 available with this plan   E/S:    $4,523    available with this plan
                                                                                            Out-of-Network         Out-of-Network                                            Out-of-Network     Out-of-Network                                                          P/C:    $3,822
                                                                                            combined)              combined)                                                 combined)          combined)                                                                F:     $5,914
1
 Deductible applies toward Out-of-Pocket Limit; Network and Out-of-Network accumulate separately. Certain services may not apply toward the Deductible or Out-of-Pocket Limit.
2
  Deductible, and all payments for RX and all covered expenses, unless indicated otherwise, count towards the Out-of-Pocket Limit.
3
  HSA Compatible plans are administered on a plan year basis.
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 Aetna Health Insurance Company of New York (Aetna).
These quoted rates are for a 12-month period from the effective date of coverage and are valid only for the benefits level and conditions stated and such other terms and
conditions as set forth in the Aetna Life Insurance Company Group Policy or official renewal letters. Any changes in benefits level, conditions stated or other terms of the Policy may
require change in rates. These rates are applicable only to the Aetna service areas stated above. These rates are subject to final approval by Aetna. Rates have been filed with the
                                                                                                                                                            .
NY State Department of Insurance. Aetna reserves the right to modify the final rates based on actual enrollment.
Plans/rates are effective as of 4/1/10 and could change at any time due to legislative or filing actions.
                                                                                                             ®
This list of benefits isn't inclusive of all the benefits these plans offer. Please refer to the Aetna Avenue brochures for more information on our products.




             (RA-12-14-15) 4/10
             50.03.942.1-NY121415                                                                                                                                                                                                                                                              Page 2 of 2
Aetna Small Business Health Plan Options
Nassau, Suffolk
RATES EFFECTIVE 4/1/2010 TO 6/15/2010

    Plan Options      Primary Care             Inpatient Hospital /         Emergency             Network               Out-of-Network           Network Plan   Out-of-           Network                 Out-of-Network            Lifetime Maximum        Monthly Premium -           Monthly Premium -          Monthly Premium -
                                                                                                           1                       1
                       Physician /             Outpatient Surgery             Room               Deductible              Deductible              Coinsurance Network Plan        Maximum                    Maximum                                          Pharmacy Plan F              Pharmacy Plan G           Pharmacy Plan H
                     Specialist Office                                                         (Individual / Family)     (Individual / Family)                Coinsurance       Out-of-Pocket             Out-of-Pocket                                         $0/$30/$50                   $15/$35/$70          Generics Only - $10
                                                                                                                                                                                          1                         1
                          Visit                                                                                                                                                     Limit                     Limit                                       Mail Order: $0/$60/$100     Mail Order: $30/$70/$140 Mail Order: Generics Only
                                                                                                                                                                                (Individual / Family)     (Individual / Family)                                                                                           $20
    OA EPO 1-10 $25 / $50 copay;           10% after deductible /         10% after          $1,000 / $3,000           N/A                       10% after    N/A            $2,000 / $6,000            N/A                       Unlimited                   S:        $508               S:       $483             S:      $455
                deductible waived          10% after deductible           deductible                                                             deductible                                                                                                  E/S        $1,215            E/S:      $1,155          E/S:     $1,088
                                                                                                                                                                                                                                                             P/C        $1,027            P/C:      $976            P/C:     $919
                                                                                                                                                                                                                                                              F:        $1,589             F:       $1,510           F:      $1,423
    OA EPO 2-10 $25 / $50 copay;           10% after deductible /         10% after          $2,000 / $6,000           N/A                       10% after    N/A            $4,000 / $12,000           N/A                       Unlimited                   S:        $452               S:       $426             S:      $398
                deductible waived          10% after deductible           deductible                                                             deductible                                                                                                  E/S        $1,081            E/S:      $1,020          E/S:     $952
                                                                                                                                                                                                                                                             P/C        $913              P/C:      $862            P/C:     $805
                                                                                                                                                                                                                                                              F:        $1,413             F:       $1,334           F:      $1,245
    OA EPO 3-10 $30 / $50 copay;           20% after deductible /         20% after            $1,500 / $4,500         N/A                       20% after    N/A            $3,000 / $9,000            N/A                       Unlimited                   S:        $466               S:       $440             S:      $412
                deductible waived          20% after deductible           deductible                                                             deductible                                                                                                  E/S:       $1,114            E/S:      $1,053          E/S:     $986
                                                                                                                                                                                                                                                             P/C        $941              P/C       $890            P/C      $833
                                                                                                                                                                                                                                                              F:        $1,456             F:       $1,377           F:      $1,289
OA EPO 4-10        $30 / $50 copay;        20% after deductible /         20% after          $2,500 / $7,500           N/A                       20% after    N/A            $5,000 / $15,000           N/A                       Unlimited                   S:        $420               S:       $394             S:      $366
                   deductible waived       20% after deductible           deductible                                                             deductible                                                                                                  E/S:       $1,004            E/S:      $943            E/S:     $875
                                                                                                                                                                                                                                                             P/C:       $848              P/C:      $797            P/C:     $740
                                                                                                                                                                                                                                                              F:        $1,313             F:       $1,233           F:      $1,144
OA EPO 5-10        $40 / $60 copay;        30% after deductible /         30% after          $2,500 / $7,500           N/A                       30% after    N/A            $5,000 / $15,000           N/A                       Unlimited                   S:        $406               S:       $381             S:      $352
                   deductible waived       30% after deductible           deductible                                                             deductible                                                                                                  E/S:       $971              E/S:      $911            E/S:     $843
                                                                                                                                                                                                                                                             P/C:       $821              P/C:      $770            P/C:     $712
                                                                                                                                                                                                                                                              F:        $1,270             F:       $1,191           F:      $1,102
OA EPO 6-10        $50 / $75 copay;        30% after deductible /         30% after          $3,000 / $9,000           N/A                       30% after    N/A            $6,000 / $18,000           N/A                       Unlimited                   S:        $383               S:       $357             S:      $329
                   deductible waived       30% after deductible           deductible                                                             deductible                                                                                                  E/S:       $915              E/S:      $855            E/S:     $786
                                                                                                                                                                                                                                                             P/C:       $774              P/C:      $722            P/C:     $664
                                                                                                                                                                                                                                                              F:        $1,197             F:       $1,117           F:      $1,028
    OA MC 1-10     $25 / $50 copay;        10% after deductible /         10% after         $1,000 / $3,000            $2,000 / $6,000           10% after    30% after      $2,000 / $6,000            $4,000 / $12,000          Network - Unlimited         S:        $575               S:       $549             S:      $520
                   deductible waived       10% after deductible           deductible                                                             deductible   deductible                                                          Out-of-Network -           E/S        $1,375            E/S:      $1,312          E/S:     $1,244
                                                                                                                                                                                                                                  $1,000,000                 P/C        $1,162            P/C:      $1,109          P/C:     $1,051
                                                                                                                                                                                                                                                              F:        $1,798             F:       $1,715           F:      $1,626
    OA MC 2-10     $25 / $50 copay;        10% after deductible /         10% after         $2,000 / $6,000            $4,000 / $12,000          10% after    30% after      $4,000 / $12,000           $8,000 / $24,000          Network - Unlimited         S:        $503               S:       $477             S:      $448
                   deductible waived       10% after deductible           deductible                                                             deductible   deductible                                                          Out-of-Network -           E/S        $1,204            E/S:      $1,141          E/S:     $1,071
                                                                                                                                                                                                                                  $1,000,000                 P/C        $1,017            P/C:      $964            P/C:     $905
                                                                                                                                                                                                                                                              F:        $1,574             F:       $1,491           F:      $1,400
    OA MC 3-10     $30 / $50 copay;        20% after deductible /         20% after            $1,500 / $4,500         $3,000 / $9,000           20% after    40% after      $3,000 / $9,000            $6,000 / $18,000          Network - Unlimited         S:        $523               S:       $497             S:      $468
                   deductible waived       20% after deductible           deductible                                                             deductible   deductible                                                          Out-of-Network -           E/S:       $1,252            E/S:      $1,189          E/S:     $1,119
                                                                                                                                                                                                                                  $1,000,000                 P/C        $1,058            P/C       $1,004          P/C      $946
                                                                                                                                                                                                                                                              F:        $1,636             F:       $1,554           F:      $1,463
OA MC 4-10         $30 / $50 copay;        20% after deductible /         20% after          $2,500 / $7,500           $5,000 / $15,000          20% after    40% after      $5,000 / $15,000           $10,000 / $30,000         Network - Unlimited         S:        $469               S:       $442             S:      $413
                   deductible waived       20% after deductible           deductible                                                             deductible   deductible                                                          Out-of-Network -           E/S:       $1,121            E/S:      $1,058          E/S:     $988
                                                                                                                                                                                                                                  $1,000,000                 P/C:       $947              P/C:      $894            P/C:     $835
                                                                                                                                                                                                                                                              F:        $1,466             F:       $1,383           F:      $1,292
OA MC Limited $30 / $50 copay;             30% after deductible /         30% after          $3,000 / $6,000           $6,000 / $18,000          30% after    50% after      $9,000 / $18,000           $18,000 / $54,000         $500,000 (Network and     Pharmacy Plan F not         Pharmacy Plan G not          S:      $334
Benefits      deductible waived;           30% after deductible           deductible                                                             deductible   deductible                                                          Out-of-Network           available with this plan    available with this plan     E/S:     $799
Plan-10       Limited to 6 office                                                                                                                                                                                                 Combined)                                                                         P/C:     $675
              visits per calendar                                                                                                                                                                                                                                                                                    F:      $1,044
              year; Network and
              Out-of-Network
              Combined

1
 Deductible applies toward Out-of-Pocket Limit; Network and Out-of-Network accumulate separately. Certain services may not apply toward the Deductible or Out-of-Pocket Limit.
2
  Deductible, and all payments for RX and all covered expenses, unless indicated otherwise, apply towards the Out-of-Pocket Limit.
3
  HSA Compatible plans are administered on a plan year basis.
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 Aetna Health Insurance Company of New York (Aetna).
These quoted rates are for a 12-month period from the effective date of coverage and are valid only for the benefits level and conditions stated and such other terms and
conditions as set forth in the Aetna Life Insurance Company Group Policy or official renewal letters. Any changes in benefits level, conditions stated or other terms of the Policy may
require change in rates. These rates are applicable only to the Aetna service areas stated above. These rates are subject to final approval by Aetna. Rates have been filed with the
                                                                                                                                                            .
NY State Department of Insurance. Aetna reserves the right to modify the final rates based on actual enrollment.
Plans/rates are effective as of 4/1/10 and could change at any time due to legislative or filing actions.
                                                                                                             ®
This list of benefits isn't inclusive of all the benefits these plans offer. Please refer to the Aetna Avenue brochures for more information on our products.




             (RA-11) 4/10
             50.03.942.1-NY11                                                                                                                                                                                                                                                                                        Page 1 of 2
Aetna Small Business Health Plan Options
Nassau, Suffolk
RATES EFFECTIVE 4/1/2010 TO 6/15/2010

    Plan Options      Primary Care             Inpatient Hospital /         Emergency              Network           Out-of-Network Network Plan        Out-of-                    Network           Out-of-Network       Lifetime Maximum                              Monthly Premium
                                                                                                             1                     1
                       Physician /             Outpatient Surgery             Room               Deductible            Deductible        Coinsurance Network Plan                 Maximum               Maximum
                     Specialist Office                                                       (Individual / Family) (Individual / Family)             Coinsurance                Out-of-Pocket         Out-of-Pocket
                                                                                                                                                                                           1                     1
                          Visit                                                                                                                                                     Limit                 Limit
                                                                                                                                                                             (Individual / Family) (Individual / Family)
OA EPO 1-10        10% after deductible 10% after deductible /            10% after         $1,500 / $3,000        N/A                   10% after         N/A               $2,250 / $4,500       N/A                   Unlimited            Pharmacy Plan F not        S:     $440       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible              deductible                                                     deductible                                                                                          available with this plan   E/S:    $1,053    available with this plan
Compatible
          2, 3     $0 copay;                                                                                                                                                                                                                                            P/C:    $889
                   deductible waived                                                                                                                                                                                                                                     F:     $1,376


OA EPO 2-10        10% after deductible 10% after deductible /            10% after         $2,000 / $4,000        N/A                   10% after         N/A               $3,000 / $6,000    N/A                  Unlimited                Pharmacy Plan F not        S:     $397       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible              deductible                                                     deductible                                                                                          available with this plan   E/S:    $950      available with this plan
Compatible
          2,3      $0 copay;                                                                                                                                                                                                                                            P/C:    $802
                   deductible waived                                                                                                                                                                                                                                     F:     $1,242


OA EPO 3-10        20% after deductible 20% after deductible /            20% after         $3,000 / $6,000        N/A                   20% after         N/A               $4,500 / $9,000    N/A                  Unlimited                Pharmacy Plan F not        S:     $331       Pharmacy Plan H not
HSA                Preventive Care -    20% after deductible              deductible                                                     deductible                                                                                          available with this plan   E/S:    $792      available with this plan
Compatible
          2,3      $0 copay; deductible                                                                                                                                                                                                                                 P/C:    $669
                   waived                                                                                                                                                                                                                                                F:     $1,035


OA EPO 4-10        0% after deductible 0% after deductible /              0% after          $5,000 / $10,000       N/A                   0% after          N/A               $5,950 / $11,900   N/A                  Unlimited                Pharmacy Plan F not        S:     $299       Pharmacy Plan H not
HSA                Preventive Care - $0 0% after deductible               deductible                                                     deductible                                                                                          available with this plan   E/S:    $716      available with this plan
Compatible
          2,3      copay; deductible                                                                                                                                                                                                                                    P/C:    $605
                   waived                                                                                                                                                                                                                                                F:     $936


OA MC 2-10         10% after deductible 10% after deductible /            10% after         $2,000 / $4,000        $4,000 / $8,000       10% after         30% after         $3,000 / $6,000    $8,000 / $16,000     Network - Unlimited      Pharmacy Plan F not        S:     $449       Pharmacy Plan H not
HSA                Preventive Care -    10% after deductible              deductible                                                     deductible        deductible                                                Out-of-Network -        available with this plan   E/S:    $1,075    available with this plan
Compatible
          2,3      $0 copay;                                                                                                                                                                                         $1,000,000                                         P/C:    $908
                   deductible waived                                                                                                                                                                                                                                     F:     $1,405


OA MC 3-10         20% after deductible 20% after deductible /            20% after         $3,000 / $6,000        $6,000 / $12,000      20% after         40% after         $4,500 / $9,000    $9,000 / $18,000     Network - Unlimited      Pharmacy Plan F not        S:     $382       Pharmacy Plan H not
HSA                Preventive Care -    20% after deductible              deductible                                                     deductible        deductible                                                Out-of-Network -        available with this plan   E/S:    $915      available with this plan
Compatible
          2,3      $0 copay; deductible                                                                                                                                                                              $1,000,000                                         P/C:    $773
                   waived                                                                                                                                                                                                                                                F:     $1,196


OA MC 4-10         0% after deductible 0% after deductible /              0% after          $5,000 / $10,000       $10,000 / $20,000 0% after              30% after         $5,950 / $11,900   $20,000 / $40,000    Network - Unlimited      Pharmacy Plan F not        S:     $334       Pharmacy Plan H not
HSA                Preventive Care - $0 0% after deductible               deductible                                                 deductible            deductible                                                Out-of-Network -        available with this plan   E/S:    $800      available with this plan
Compatible
          2,3      copay; deductible                                                                                                                                                                                 $1,000,000                                         P/C:    $676
                   waived                                                                                                                                                                                                                                                F:     $1,046


Indemnity          20% after deductible 20% after deductible /            20% after         $2,500 / $7,500        $2,500 / $7,500       20% after         20% after         $5,000 / $15,000   $5,000 / $15,000     $1,000,000               Pharmacy Plan F not        S:     $1,932     Pharmacy Plan H not
1-10                                    20% after deductible              deductible        (Network and           (Network and          deductible        deductible        (Network and       (Network and                                 available with this plan   E/S:    $4,622    available with this plan
                                                                                            Out-of-Network         Out-of-Network                                            Out-of-Network     Out-of-Network                                                          P/C:    $3,906
                                                                                            combined)              combined)                                                 combined)          combined)                                                                F:     $6,044
1
 Deductible applies toward Out-of-Pocket Limit; Network and Out-of-Network accumulate separately. Certain services may not apply toward the Deductible or Out-of-Pocket Limit.
2
  Deductible, and all payments for RX and all covered expenses, unless indicated otherwise, count towards the Out-of-Pocket Limit.
3
  HSA Compatible plans are administered on a plan year basis.
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 Aetna Health Insurance Company of New York (Aetna).
These quoted rates are for a 12-month period from the effective date of coverage and are valid only for the benefits level and conditions stated and such other terms and
conditions as set forth in the Aetna Life Insurance Company Group Policy or official renewal letters. Any changes in benefits level, conditions stated or other terms of the Policy may
require change in rates. These rates are applicable only to the Aetna service areas stated above. These rates are subject to final approval by Aetna. Rates have been filed with the
                                                                                                                                                            .
NY State Department of Insurance. Aetna reserves the right to modify the final rates based on actual enrollment.
Plans/rates are effective as of 4/1/10 and could change at any time due to legislative or filing actions.
                                                                                                             ®
This list of benefits isn't inclusive of all the benefits these plans offer. Please refer to the Aetna Avenue brochures for more information on our products.




             (RA-11) 4/10
             50.03.942.1-NY11                                                                                                                                                                                                                                                                  Page 2 of 2

				
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