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1. Take charge of your health.
We’re here to help.
Aetna Advantage plans for individuals, families
and the self-employed
Texas
A guide to
understanding
your choices
and selecting a
quality health
insurance plan.
Inventory Code (7/08)
AA.02.305.1-TX
02.02.300.1 (8/05)

2. Aetna makes it easy for
a health insurance plan
They say that nothing More reasons to
is more important like Aetna
Contents
than your health. So why else should you choose an
Aetna health insurance plan? Here
And they’re right. That’s what makes
How to use this booklet 1 are more good reasons:
health insurance such an essential part
Aetna’s Texas of your life — even if you’re not on an n You can visit most any licensed doctor
service areas 2 employer’s group insurance plan. In fact, or hospital you choose. Your out-of-
especially if you’re not on a group plan, pocket costs will be lower in Aetna’s
Here are your plan choices 3 you’ve got to take charge of your health... network of participating physicians
and your health insurance needs. and hospitals.
How to select a plan 4
At Aetna, we offer a variety of quality
n You can visit your doctor’s office as
Plan comparison charts 5 often as you like.
Advantage individual health insurance
Programs to plans for Texas. Count on us to guide you n You don’t need a doctor’s referral to
help you be well 11 through the process and help you choose see a specialist.
the right plan for your personal needs. There’s no waiting period to enjoy
Things you need
n
preventive care.
to know to apply 12
Limitations and exclusions 13
Why Aetna? n Your children’s immunizations
are covered.
When you choose Aetna as your health n There’s no deductible for
insurance provider, you’re gaining a lot of
well-women exams when you
advantages. Among them:
visit a network provider.
Easy to understand. Yes, insurance can be
simple! We provide you with straightforward
language and easy-to-understand benefits.
Easy to choose. We’ll help you select from
plans designed to fit your personal situation.
Aetna’s nationwide provider network offers
you a vast selection of physicians and
hospitals.
Easy to afford. Since we offer so many Have questions?
benefit package options, you can choose how
Just e-mail AetnaAdvantagePlans@
much to spend in premiums versus
Aetna Advantage Plans for individuals, aetna.com or call 1-800-MY-Health
out-of-pocket expenses.
families and the self-employed are (1-800-694-3258). We’re here to help!
underwritten by Aetna Life Insurance Easy to manage. Use our easy-to-use
Company (Aetna) directly and/or Web-based tools to get valuable health Want a quote now?
through an out-of-state blanket trust. and benefits-related information, quickly
find Aetna network physicians in your Visit www.aetnaindividual.com or call
In some states, individuals may qualify
area, and manage your account — 1-800-MY-Health (1-800-694-3258).
as a business group of one and may
right online!
be eligible for guaranteed issue,
small group health plans.

3. you to choose
How to use this booklet 1. Review the descriptions of all Aetna’s It’s easy to get
Advantage plans for Texas, on page 3.
When we say we’re going to make health a quote and apply
2. Get some tips on plans that may
insurance easy for you, we mean it. Here
best match up with your situation Once you’ve narrowed down to a plan
are the steps you might want to take as
and priorities, on page 4. (or plans), we make it easy to get a quote
you read this booklet:
and apply for a policy, either online or
3. Review each plan’s specific features by mail.
in the charts beginning on page 5.
4. If you have questions, would like Online:
to discuss your own unique situation, 1. Visit www.aetnaindividual.com.
or want a rate quote, just e-mail us
2. Choose your state.
at AetnaAdvantagePlans@Aetna.com
or call 1-800-694-3258. 3. Use the helpful information and
tools to choose the best plan for you.
4. Click “Get A Quote.”
5. Apply online and submit an
electronic form of payment.
(Or mail the enclosed application
with one form of payment selected.)
6. Track the status of your application
by clicking the site’s Apps tab.
By Mail:
Simply complete and mail the enclosed
application, in the envelope provided,
with one form of payment selected.
Want a quote now?
Visit www.aetnaindividual.com or call
1-800-MY-Health (1-800-694-3258).
1-800-MY Health | www.aetnaindividual.com 1

4. AreA 1
Aetna’s Texas service areas*
Blanco Frio Kinney Real
Bosque Gillespie La Salle Refugio
Brazos Goliad Lavaca Robertson
Brooks Gonzales Llano (except San Saba
Brown Hamilton Horseshoe Bay) Taylor
Burleson Jim Hogg Madison Uvalde Your rates will depend on the area in which
Coleman Jones Mason Washington
Comanche Karnes Maverick
McMullen
Webb your county is located.
De Witt Kenedy Zapata
Dimmit Kerr Milam Zavala
Edwards Kimble Mills
AreA 2
Ector Lubbock Midland Wichita
Jasper McLennan Tom Green
(Brookeland)
AreA 3
Aransas Deaf Smith Jim Wells Roberts
Armstrong Donley Kleberg San Patricio
Bee Duval Lipscomb Sherman
Briscoe Gray Live Oak Starr
Calhoun Hall Moore Swisher
Cameron Hansford Nueces Victoria
Carson Hartley Ochiltree Wheeler
Castro Hemphill Oldham Willacy
Childress Hidalgo Parmer
Collingsworth Hutchinson Potter
Dallam Jackson Randall
AreA 4
Anderson Eastland King Sabine
Andrews Falls Knox San Augustine
Angelina Fisher Lamb Schleicher
Archer Floyd Leon Scurry
Bailey Foard Limestone Shackelford
Baylor Gaines Loving Shelby
Borden Garza Lynn Stephens
Bowie Glasscock Martin Sterling
Brewster Hale McCulloch Stonewall
Callahan Hardeman Menard Sutton
Cass Haskell Mitchell Terrell
Clay Henderson Motley Terry
Cochran (except Nacogdoches Throckmorton
Coke Mabank) Nolan Trinity
Concho Hockley Panola Upton
Cottle Houston Pecos Val Verde
Crane Howard Polk Ward
Crockett Hudspeth Presidio Wilbarger
Crosby Irion Reagan Winkler
Culberson Jack Reeves Yoakum
Dawson Jeff Davis Runnels Young
Dickens Kent Rusk
Products Offered
AreA 5** Areas 1-5 and 7 Areas 6, 8 and 9
Camp Franklin Johnson Red River
Preferred Provider Benefit Plan (PPO) 30 Managed Choice Open Access 30
Cherokee Freestone Kaufman Rockwall
Collin Grayson Lamar Smith Preferred Provider Benefit Plan (PPO) 40 Managed Choice Open Access 40
Cooke Gregg Marion Somervell Preferred Provider Benefit Plan (PPO) 2500 Managed Choice Open Access 2500
Dallas Harrison Montague Tarrant Preferred Provider Benefit Plan (PPO) 5000 Managed Choice Open Access 5000
Delta Henderson Morris Titus Preferred Provider Benefit Plan (PPO) Value 1500 Managed Choice Open Access Value 1500
Denton (Mabank) Navarro Upshur
Hill Preferred Provider Benefit Plan (PPO) Value 2500 Managed Choice Open Access Value 2500
Ellis Palo Pinto Van Zandt
Erath Hood Parker Wise Preferred Provider Benefit Plan (PPO) Value 5000 Managed Choice Open Access Value 5000
Fannin Hopkins Rains Wood Preferred Provider Benefit Plan (PPO) Managed Choice Open Access
Hunt High Deductible 3000 (HSA) High Deductible 3000 (HSA)
Preferred Provider Benefit Plan (PPO) Managed Choice Open Access
AreA 6** High Deductible 5000 (HSA) High Deductible 5000 (HSA)
Austin Grimes Liberty Tyler Preventative and Hospital Care 1250 Preventative and Hospital Care 1250
Brazoria Hardin Matagorda Walker Preventative and Hospital Care 3000 (HSA) Preventative and Hospital Care 3000 (HSA)
Chambers Harris Montgomery Waller
Colorado Jasper (except Newton Wharton
Fort Bend Brookeland) Orange
Galveston Jefferson San Jacinto
AreA 7** * All products not available in all counties. Please refer to the county in which you reside for
the available product.
Atascosa Bexar Guadalupe Medina
Bandera Comal Kendall Wilson ** The Aetna Performance Network® features Aexcel-designated specialists who have
demonstrated cost-effectiveness in the delivery of care and met certain clinical performance
measures. The Aexcel designation applies to select specialists in 12 specialty areas: Cardiology,
AreA 8** Cardiothoracic Surgery, Gastroenterology, General Surgery, Obstetrics and Gynecology,
Bastrop Coryell Lee Travis Orthopedics, Otolaryngology/ENT, Neurology, Neurosurgery, Plastic Surgery, Urology,
Bell Fayette Llano Williamson
Burnet Hays (Horseshoe Bay) and Vascular Surgery. Aetna members in the designated counties must choose Aexcel-
Caldwell Lampasas designated specialists or they will incur out-of-network charges. There is no additional cost
when members use Aexcel specialists. You’ll find them by looking for the star next to the
AreA 9 doctors’ names at www.aetna.com/docfind/custom/advplans or in your printed directory.
El Paso
2 1-800-MY Health | www.aetnaindividual.com

5. Discover the advantages of your
Aetna Advantage plan choices
For specifics on these health insurance plans,
see the charts beginning on page 5.
All Managed Choice Open Access and Preferred Provider Looking for a
Benefit Plan (PPO) Plans, MC* and PPO** Value Plans, MC* lower cost plan?
and PPO** High Deductible Plans, and MC* and PPO** Our Preventative and
First Dollar Plans include: Hospital Care plans include:
n isit most any licensed doctor or hospital you choose. Your out-of-pocket costs will
V
n Preventive care
be lower in Aetna’s nationwide network of participating physicians and hospitals.
n Annual GYN exams
n Unlimited office visits to your primary care physician and specialists (copays,
(annual Pap/Mammogram)
deductibles, & coinsurance apply to MC* and PPO** Value plans) n Well-child care
n No claim forms to fill out when you visit a network provider
(includes immunizations)
n No referrals required to see a specialist
n Routine physical exams
n No waiting period to access preventive health (routine physicals)
n Coverage for: inpatient hospital care,
n 100% annual routine GYN exam coverage — no waiting period, no dollar
outpatient surgery, skilled nursing or
maximum, and no copay or deductible when you visit a network provider home health care in lieu of a hospital stay.
n Coverage for prescription drugs
n
outine physicals include lab work and X-rays
R Add Participating Dental
n 100% coverage on in-network childhood immunizations
Network (PDN) Max Plan
MC* and PPO** MC* and PPO** MC* and PPO** With the Aetna Advantage Dental PDN Max
Value Plans First Dollar Plans High Deductible Plans insurance plan, you can obtain services from
Lower monthly premiums
n Freedom from deductibles
n (HSA Compatible) either a participating or non-participating
(that’s the “Value” part). when you choose an 100% coverage in network
n
dentist. Participating dentists have agreed
Nominal copay for first
n Aetna medical provider. after your deductible is met to provide services at a negotiated rate
two doctor’s office visits; Lower copay for
n Lower monthly premiums,
n
for both covered services, as well as non-
deductible and coinsurance in-network provider visits. Higher annual deductibles covered services such as cosmetic tooth
apply for 3 or more. No deductible for generic
n (at least $3,000 for
individuals and $6,000 whitening and orthodontic care, so you
No deductible for generic
n prescription drugs.
for families). generally pay less out-of-pocket. You also
prescription drugs.
Can be paired with a
n have the flexibility to visit a dentist who does
* Managed Choice Open Access tax-advantaged Health not participate in Aetna’s network, though
** Participating Provider Benefits Plan Savings Account (HSA). you will not benefit from negotiated fees.
Dental is offered only if medical coverage
is obtained
About HSAs…
A Health Savings Account, or HSA, is a personal account that lets you pay for qualified medical Want to cover your
expenses with tax-advantaged funds. You or an eligible family member make contributions to your children only?
HSA tax-free, and those dollars earn interest tax-free. Then, when you make withdrawals from All Aetna Advantage plans are available for
your account to pay for qualified health care expenses, they’re tax-free, too.
children only, which means you can enroll
To establish a Why Choose an Aetna HealthFund HSA? your child even if no other family member
Health Savings Account… n No set-up fees enrolls. Coverage includes immunizations,
First enroll in an Aetna HSA-compatible n No monthly administration fee well-child visits, emergency room and dental
High Deductible Health Plan. Then n No withdrawal forms required preventive services (if dental is selected).
request HSA enrollment materials by Note: when an HSA Compatible plan is
Convenient access to HSA funds via
n
calling 1-800-694-3258 or visiting selected for child only enrollment, an HSA
debit card or checkbook
www.aetnaindividualhsa.com to account is not available for the child.
n Track HSA activity through Aetna NavigatorTM
view and download the materials.
The HSA Investment Account allows you a number of different ways to invest
for the future, complementing the interest earning HSA Cash Account.
3

6. How to select a health insurance plan
that fits your needs
Perhaps you’ve just left an employer’s
group plan. Or you’re looking for an
option other than COBRA. Or you’re
not currently insured. Or maybe you’ve IF YOu … CON SID er…
just received another big rate increase
from another insurer and you’re looking Are looking for an affordable policy MC*/PPO** 5000, High Deductible 5000,
for something more affordable. with lower monthly payments… Preventative and Hospital Care 1250 &
3000, MC*/PPO** Value 5000
Whatever your situation, at Aetna, we’re
here to help. Let us offer a few tips to use only basic health care services MC*/PPO** 5000, MC*/PPO** Value
help you choose the right plan for your and want to keep lower monthly 5000 Preventative and Hospital Care 1250
unique situation and priorities. This chart payments… & 3000
may be a good starting point for you…
Don’t want to pay a lot for frequent First Dollar 30, MC*/PPO** 2500
doctor visits for you and the kids…
Want a balance of lower monthly MC*/PPO** 2500, MC*/PPO** Value 2500
payments and quality coverage…
Want to cap the amount you’ll spend MC*/PPO** 2500, MC*/PPO** Value
on total medical expenses each year… 1500, and MC*/PPO** Value 2500
Want a plan that works with a tax- MC*/PPO** High Deductible 3000 &
advantaged Health Savings Account 5000, Preventative and Hospital Care 3000
Think that robust coverage is more First Dollar 30, First Dollar 40 and
important than the lowest possible cost… MC*/PPO** Value 1500
* Managed Choice Open Access
** Participating Provider Benefits Plan
Is your doctor in the Aetna network?
Which local physicians, hospitals, pharmacies
and eyewear providers participate in the
Aetna Advantage Plan network?
Visit www.aetna.com/ docfind/custom/advplans.
Or call 1-800-694-3258 and ask
for a directory of providers.
4

7. FIrST DOLLAr PLAN OPTIONS
Managed Choice Open Access & Managed Choice Open Access &
Participating Provider Benefits Participating Provider Benefits
Plan (PPO) 30 Plan (PPO) 40
Deductible
Individual $0 $5,000 $0 $7,000
Family $0 $10,000 $0 $14,000
Coinsurance 30% up to 50% up to 40% up to 50% up to
(Member’s responsibility) out-of-pocket max. out-of-pocket max. out-of-pocket max. out-of-pocket max.
$0 once out-of-pocket max. is satisfied $0 once out-of-pocket max. is satisfied
Coinsurance Maximum
Individual $7,500 $7,500 $12,500 $5,500
Family $15,000 $15,000 $25,000 $11,000
Out-of-Pocket Maximum
Individual $7,500 $12,500 $12,500 $12,500
Family $15,000 $25,000 $25,000 $25,000
Includes Includes
deductible deductible
A few things Lifetime Maximum*
per insured
$5,000,000 $5,000,000 $5,000,000 $5,000,000
to keep in mind Non-Specialist Office Visit $30 copay 30% $40 copay 30%
Unlimited visits after deductible after deductible
General Physician, Family
n Generally speaking, the lower your Practitioner, Pediatrician or Internist
“premiums,” or monthly payments, Specialist Visit $40 copay 30% $50 copay 30%
Unlimited visits after deductible after deductible
the higher your “deductible,” which
Hospital Admission 30% 50% 40% 50%
is the amount you pay out of pocket after deductible after deductible
before the plan begins paying for Outpatient Surgery 30% 50% 40% 50%
after deductible after deductible
expenses. (Lower premiums also
urgent Care Facility $50 copay 50% $50 copay 50%
mean a higher “copay,” which is after deductible after deductible
the amount you pay out-of-pocket emergency room $100 copay** (waived if admitted) $100 copay** (waived if admitted)
at doctor visits, hospital stays, etc.) 30% coinsurance 40% coinsurance
Annual routine Gyn exam $0 copay 30% $0 copay 30%
n The lower your deductible (some plans No waiting period, after deductible after deductible
no calendar year max.
have no deductible at all, which means Annual Pap/Mammogram
they begin paying immediately), the Maternity Not covered Not covered
higher your monthly premiums will be. Except for pregnancy complications Except for pregnancy complications
Preventive Health — $30 copay 30% $40 copay 30%
n You’ll pay less by using “in-network” routine Physical after deductible after deductible
Aetna will pay up to $200 per exam Includes lab work and X-rays Includes lab work and X-rays
doctors, hospitals, pharmacies No waiting period
and other health care providers Lab/X-ray 30% 50% 40% 50%
who participate in Aetna’s vast after deductible after deductible
Skilled Nursing — 30% 50% 40% 50%
nationwide network than by using in lieu of hospital after deductible after deductible
“out-of-network” doctors. 30 days per calendar year*
Physical/Occupational Therapy 30% 50% 40% 50%
n Visit www.planforyourhealth.com and Chiropractic Care after deductible after deductible
for an in-depth list of terms in this 24 visits per calendar year* Aetna will pay a max. of $25 per visit Aetna will pay a max. of $25 per visit
brochure and what they mean. Home Health Care — 30% 50% 40% 50%
in lieu of hospital after deductible after deductible
30 visits per calendar year*
Durable Medical equipment 30% 50% 40% 50%
Aetna will pay up to $2000 per after deductible after deductible
calendar year*
PHArMACY
Pharmacy Deductible $500 $500 Not Applicable Not Applicable
per individual Does not apply to generic
Generic $15 copay $15 copay plus $20 copay $20 copay
Oral Contraceptives Included deductible waived 30% deductible plus 30%
waived
Preferred Brand $40 copay $40 copay Not Covered Not Covered
Oral Contraceptives Included after deductible plus 30% after Aetna Discount
deductible Applies
Non-Preferred Brand $60 copay $60 copay Not Covered Not Covered
Oral Contraceptives Included after deductible plus 30% after Aetna Discount
deductible Applies
Calendar Year Maximum Unlimited Unlimited Unlimited Unlimited
per individual*
* Maximum applies to combined in and out-of-network benefits.
** Copay is billed separately and not due at time of service. Copay does not count towards coinsurance or out-of-
pocket maximum.
+ Payment for out-of-network facility covered expenses is determined based on Aetna’s Market Fee Schedule.
Payment for out-of-network non-facility covered expenses is determined based on the negotiated charge that
would apply if such services were received from a Network Provider. 5

8. MANAGeD CHOICe OPeN ACCeSS &
PArTICIPATING PrOVIDer BeNeFITS PLAN (PPO) PLAN OPTIONS
Managed Choice Open Access & Managed Choice Open Access &
Participating Provider Benefits Plan Participating Provider Benefits Plan
(PPO) 2500 (PPO) 5000
MeMBer BeNeFITS In-Network Out-of-Network+ In-Network Out-of-Network+
Deductible
Individual $2,500 $5,000 $5,000 $10,000
Family $5,000 $10,000 $10,000 $20,000
Coinsurance 20% after 50% after 20% after 50% after
(Member’s responsibility) deductible up to deductible up to deductible up to deductible up to
out-of-pocket max. out-of-pocket max. out-of-pocket max. out-of-pocket max.
$0 once out-of-pocket max. is satisfied $0 once out-of-pocket max. is satisfied
Coinsurance Maximum
Individual $2,500 $5,000 $5,000 $2,500
Family $5,000 $10,000 $10,000 $5,000
Out-of-Pocket Maximum
Individual $5,000 $10,000 $10,000 $12,500
Family $10,000 $20,000 $20,000 $25,000
Includes deductible Includes deductible
Lifetime Maximum* $5,000,000 $5,000,000 $5,000,000 $5,000,000
per insured
Non-Specialist Office Visit $30 copay 30% $40 copay 30%
Unlimited visits deductible waived after deductible deductible waived after deductible
General Physician, Family Practitioner, Pediatrician or Internist
Specialist Visit $40 copay 30% $50 copay 30%
Unlimited visits deductible waived after deductible deductible waived after deductible
Hospital Admission 20% 50% 20% 50%
after deductible after deductible after deductible after deductible
Outpatient Surgery 20% 50% 20% 50%
after deductible after deductible after deductible after deductible
urgent Care Facility $50 copay 50% $50 copay 50%
deductible waived after deductible deductible waived after deductible
emergency room $100 copay** (waived if admitted) $100 copay** (waived if admitted)
20% coinsurance after deductible 20% coinsurance after deductible
Annual routine Gyn exam $0 copay 30% $0 copay 30%
No waiting period,no calendar year max. deductible waived after deductible deductible waived after deductible
Annual Pap/Mammogram
Maternity Not covered Not covered
Except for pregnancy complications Except for pregnancy complications
Preventive Health — $30 copay 30% $40 copay 30%
routine Physical deductible waived after deductible deductible waived after deductible
Aetna will pay up to $200 per exam Includes lab work and X-rays Includes lab work and X-rays
No waiting period
Lab/X-ray 20% 50% 20% 50%
after deductible after deductible after deductible after deductible
Skilled Nursing — 20% 50% 20% 50%
in lieu of hospital after deductible after deductible after deductible after deductible
30 days per calendar year*
Physical/Occupational Therapy and Chiropractic Care 20% 50% 20% 50%
24 visits per calendar year* after deductible after deductible after deductible after deductible
Aetna will pay a max. of $25 per visit Aetna will pay a max. of $25 per visit
Home Health Care — 20% 50% 20% 50%
in lieu of hospital after deductible after deductible after deductible after deductible
30 visits per calendar year*
Durable Medical equipment 20% 50% 20% 50%
Aetna will pay up to $2,000 per calendar year* after deductible after deductible after deductible after deductible
PHArMACY
Pharmacy Deductible $500 $500 $500 $500
per individual
Does not apply to generic Does not apply to generic
Generic $15 copay $15 copay plus $15 copay $15 copay plus
Oral Contraceptives Included deductible waived 30% deductible waived deductible waived 30% deductible waived
Preferred Brand $35 copay $35 copay plus 30% $35 copay $35 copay plus 30%
Oral Contraceptives Included after deductible after deductible after deductible after deductible
Non-Preferred Brand $50 copay $50 copay plus 30% $50 copay $50 copay plus 30%
Oral Contraceptives Included after deductible after deductible after deductible after deductible
Calendar Year Maximum per individual* $5,000 $5,000 $5,000 $5,000
6 1-800-MY Health | www.aetnaindividual.com

9. MANAGeD CHOICe OPeN ACCeSS &
PArTICIPATING PrOVIDer BeNeFITS PLAN (PPO) HIGH DeDuCTIBLe PLAN OPTIONS
Managed Choice Open Access & Participating Managed Choice Open Access & Participating
Provider Benefits Plan (PPO) High Provider Benefits Plan (PPO) High
Deductible 3000 (HSA Compatible) Deductible 5000 (HSA Compatible)
In-Network Out-of-Network+ In-Network Out-of-Network+
$3,000 $6,000 $5,000 $10,000
$6,000 $12,000 $10,000 $20,000
0% after 50% after 0% after 50% after
deductible up to deductible up to deductible up to deductible up to
out-of-pocket max. out-of-pocket max. out-of-pocket max. out-of-pocket max.
$0 once out-of-pocket max. is satisfied $0 once out-of-pocket max. is satisfied
$0 $6,500 $0 $2,500
$0 $13,000 $0 $5,000
$3,000 $12,500 $5,000 $12,500
$6,000 $25,000 $10,000 $25,000
Includes deductible Includes deductible
$5,000,000 $5,000,000 $5,000,000 $5,000,000
0% 30% 0% 30%
after deductible after deductible after deductible after deductible
0% 30% 0% 30%
after deductible after deductible after deductible after deductible
0% 50% 0% 50%
after deductible after deductible after deductible after deductible
0% 50% 0% 50%
after deductible after deductible after deductible after deductible
0% 50% 0% 50%
after deductible after deductible after deductible after deductible
$0 copay after deductible $0 copay after deductible
$0 copay 30% $0 copay 30%
deductible waived after deductible deductible waived after deductible
Not covered Not covered
Except for pregnancy complications Except for pregnancy complications
$20 copay 30% $25 copay 30%
deductible waived after deductible deductible waived after deductible
Includes lab work and X-rays Includes lab work and X-rays
0% 50% 0% 50%
after deductible after deductible after deductible after deductible
0% 50% 0% 50%
after deductible after deductible after deductible after deductible
0% 50% 0% 50%
after deductible after deductible after deductible after deductible
Aetna will pay a max. of $25 per visit Aetna will pay a max. of $25 per visit
0% 50% 0% 50%
after deductible after deductible after deductible after deductible
0% 50% 0% 50%
after deductible after deductible after deductible after deductible
Integrated Medical/ Integrated Medical/ Integrated Medical/ Integrated Medical/
Rx Deductible Rx Deductible Rx Deductible Rx Deductible
0% after Medical/ 30% after Medical/ 0% after Medical/ 30% after Medical/
Rx Deductible Rx Deductible Rx Deductible Rx Deductible
0% after Medical/ 30% after Medical/ 0% after Medical/ 30% after Medical/
Rx Deductible Rx Deductible Rx Deductible Rx Deductible
0% after Medical/ 30% after Medical/ 0% after Medical/ 30% after Medical/
Rx Deductible Rx Deductible Rx Deductible Rx Deductible
$5,000 $5,000 $5,000 $5,000
* Maximum applies to combined in and out-of-network benefits.
** Copay is billed separately and not due at time of service. Copay does not count towards coinsurance or out-of-pocket maximum.
+ Payment for out-of-network facility covered expenses is determined based on Aetna’s Market Fee Schedule. Payment for out-of-network non-facility
covered expenses is determined based on the negotiated charge that would apply if such services were received from a Network Provider. 7

10. If affordability is your top priority, the Value plans and Preventative and Hospital Care plans
are the plans for you! These plans feature health care benefit coverage with lower monthly premiums
and varying deductible levels.
PreVeNTATIVe AND HOSPITAL PLAN OPTIONS
Preventative and Hospital Care 3000
Preventative and Hospital Care 1250
(HSA Compatible)
MeMBer BeNeFITS In-Network Out-of-Network+ In-Network Out-of-Network+
Deductible
Individual $1,250 $2,500 $3,000 $6,000
Family $2,500 $5,000 $6,000 $12,000
Coinsurance 20% after deductible 50% after deductible 20% after deductible 50% after deductible
(Member’s responsibility) up to out-of-pocket up to out-of-pocket up to out-of-pocket up to out-of-pocket
max. max. max. max.
$0 once out-of-pocket max. is satisfied $0 once out-of-pocket max. is satisfied
Coinsurance Maximum
Individual $3,000 $7,500 $2,000 $4,000
Family $6,000 $15,000 $4,000 $8,000
Out-of-Pocket Maximum
Individual $4,250 $10,000 $5,000 $10,000
Family $8,500 $20,000 $10,000 $20,000
Includes deductible Includes deductible
Lifetime Maximum* per insured $1,000,000 $1,000,000 $1,000,000 $1,000,000
Non-Specialist Office Visit Not covered Not covered Not covered Not covered
General Physician, Family Practitioner, Pediatrician or Internist
Specialist Visit Not covered Not covered Not covered Not covered
Hospital Admission 20% 50% 20% 50%
after deductible after deductible after deductible after deductible
Outpatient Surgery 20% 50% 20% 50%
after deductible after deductible after deductible after deductible
urgent Care Facility Not covered Not covered Not covered Not covered
emergency room $100 copay** (waived if admitted) $100 copay** (waived if admitted)
20% coinsurance after deductible 20% coinsurance after deductible
Annual routine Gyn exam $0 copay 50% $0 copay 50%
No waiting period, no calendar year max. deductible waived after deductible deductible waived after deductible
Annual Pap/Mammogram
Maternity Not covered Not covered
Except for pregnancy complications Except for pregnancy complications
Preventive Health — routine Physical $25 copay 50% $35 copay 50%
Aetna will pay up to $200 per exam deductible waived after deductible deductible waived after deductible
No waiting period Includes lab work and X-rays Includes lab work and X-rays
Lab/X-ray Not covered Not covered Not covered Not covered
Skilled Nursing — in lieu of hospital 20% 50% 20% 50%
30 days per calendar year* after deductible after deductible after deductible after deductible
Physical/Occupational Therapy and Chiropractic Care Not covered Not covered Not covered Not covered
Home Health Care — in lieu of hospital 20% 50% 20% 50%
30 visits per calendar year* after deductible after deductible after deductible after deductible
Durable Medical equipment Not Covered Not Covered
Aetna will pay up to $2,000 per calendar year* except coverage for except coverage for
Diabetic Equip & Supplies Diabetic Equip & Supplies
PHArMACY
Pharmacy Deductible per individual Not applicable Not applicable Not applicable Not applicable
Generic $15 copay $15 copay plus 50% Not covered Not covered
Oral Contraceptives Included Aetna discount applies
Preferred Brand Not covered Not covered Not covered Not covered
Oral Contraceptives Included Aetna discount applies Aetna discount applies
Non-Preferred Brand Not covered Not covered Not covered Not covered
Oral Contraceptives Included Aetna discount applies Aetna discount applies
Calendar Year Maximum per individual* $5,000 $5,000 Not applicable Not applicable
8 1-800-MY Health | www.aetnaindividual.com

11. MANAGeD CHOICe OPeN ACCeSS &
PArTICIPATING PrOVIDer BeNeFITS PLAN (PPO) HIGH DeDuCTIBLe PLAN OPTIONS
Managed Choice Open Access & Managed Choice Open Access & Managed Choice Open Access &
Participating Provider Benefits Plan Participating Provider Benefits Plan Participating Provider Benefits Plan
(PPO) Value 1500 (PPO) Value 2500 (PPO) Value 5000
In-Network Out-of-Network+ In-Network Out-of-Network+ In-Network Out-of-Network+
$1,500 $3,000 $2,500 $5,000 $5,000 $10,000
$3,000 $6,000 $5,000 $10,000 $10,000 $20,000
30% after deductible 50% after deductible 30% after deductible 50% after deductible 30% after deductible 50% after deductible
up to out-of-pocket up to out-of-pocket up to out-of-pocket up to out-of-pocket up to out-of-pocket up to out-of-pocket
max. max. max. max. max. max.
$0 once out-of-pocket max. is satisfied $0 once out-of-pocket max. is satisfied $0 once out-of-pocket max. is satisfied
$1,500 $7,000 $2,500 $5,000 $5,000 $2,500
$3,000 $14,000 $5,000 $10,000 $10,000 $5,000
$3,000 $10,000 $5,000 $10,000 $10,000 $12,500
$6,000 $20,000 $10,000 $20,000 $20,000 $25,000
Includes deductible Includes deductible Includes deductible
$5,000,000 $5,000,000 $5,000,000 $5,000,000 $1,000,000 $1,000,000
Visit 1-2 $30 copay, 30% Visit 1-2 $30 copay, 30% Visit 1-2 $30 copay, 30%
deductible waived. after deductible deductible waived. after deductible deductible waived. after deductible
Visit 3+ 30% after Visit 3+ 30% after Visit 3+ 30% after
deductible. Specialist deductible. Specialist deductible. Specialist
and Non Specialist and Non Specialist and Non Specialist
share visit max. share visit max. share visit max.
Visit 1-2 $30 copay, 30% Visit 1-2 $30 copay, 30% Visit 1-2 $30 copay, 30%
deductible waived. after deductible deductible waived. after deductible deductible waived. after deductible
Visit 3+ 30% after Visit 3+ 30% after Visit 3+ 30% after
deductible. Specialist deductible. Specialist deductible. Specialist
and Non Specialist and Non Specialist and Non Specialist
share visit max. share visit max. share visit max.
30% 50% 30% 50% 30% 50%
after deductible after deductible after deductible after deductible after deductible after deductible
30% 50% 30% 50% 30% 50%
after deductible after deductible after deductible after deductible after deductible after deductible
$50 copay 50% $50 copay 50% $50 copay 50%
deductible waived after deductible deductible waived after deductible deductible waived after deductible
$100 copay** (waived if admitted) $100 copay** (waived if admitted) $100 copay** (waived if admitted)
30% coinsurance after deductible 30% coinsurance after deductible 30% coinsurance after deductible
$0 copay 30% $0 copay 30% $0 copay 30%
deductible waived after deductible deductible waived after deductible deductible waived after deductible
Not covered Not covered Not covered
Except for pregnancy complications Except for pregnancy complications Except for pregnancy complications
$50 copay 30% $50 copay 30% $50 copay 30%
deductible waived after deductible deductible waived after deductible deductible waived after deductible
Includes lab work and X-rays Includes lab work and X-rays Includes lab work and X-rays
30% 50% 30% 50% 30% 50%
after deductible after deductible after deductible after deductible after deductible after deductible
30% 50% 30% 50% 30% 50%
after deductible after deductible after deductible after deductible after deductible after deductible
30% 50% 30% 50% 30% 50%
after deductible after deductible after deductible after deductible after deductible after deductible
Aetna will pay a max. of $25 per visit Aetna will pay a max. of $25 per visit Aetna will pay a max. of $25 per visit
30% 50% 30% 50% 30% 50%
after deductible after deductible after deductible after deductible after deductible after deductible
30% 50% 30% 50% 30% 50%
after deductible after deductible after deductible after deductible after deductible after deductible
$500 $500 $500 $500 $500 $500
Does not apply to generic Does not apply to generic Does not apply to generic
$20 copay $20 copay plus 30% $20 copay $20 copay plus 30% $20 copay $20 copay plus 30%
deductible waived deductible waived deductible waived deductible waived deductible waived deductible waived
$40 copay $40 copay plus 30% $40 copay $40 copay plus 30% $40 copay $40 copay plus 30%
after deductible after deductible after deductible after deductible after deductible after deductible
Not covered Not covered Not covered Not covered Not covered Not covered
Aetna Discount Applies Aetna Discount Applies Aetna Discount Applies
$5,000 $5,000 $5,000 $5,000 $5,000 $5,000
* Maximum applies to combined in and out-of-network benefits.
** Copay is billed separately and not due at time of service. Copay does not count towards coinsurance or out-of-pocket maximum.
+ Payment for out-of-network facility covered expenses is determined based on Aetna’s Market Fee Schedule. Payment for out-of-network non-facility 9
covered expenses is determined based on the negotiated charge that would apply if such services were received from a Network Provider.

12. AeTNA ADVANTAGe PLAN OPTIONS
INDIVIDuAL DeNTAL PDN MAX PLAN
MeMBer BeNeFITS PreFerreD NONPreFerreD
Annual Deductible per Member (Does not apply $25; $25;
to Diagnostic and Preventive Services) $75 family maximum $75 family maximum
Annual Maximum Benefit Unlimited Unlimited
DIAGNOSTIC SerVICeS
Oral exams
Periodic oral exam 100% deductible waived 100% deductible waived
Comprehensive oral exam 100% deductible waived 100% deductible waived
Problem-focused oral exam 100% deductible waived 100% deductible waived
X-rays
Bitewing — single film 100% deductible waived 100% deductible waived
Complete series 100% deductible waived 100% deductible waived
PreVeNTATIVe SerVICeS
Adult cleaning 100% deductible waived 100% deductible waived
Child cleaning 100% deductible waived 100% deductible waived
Sealants — per tooth Discount Not covered
Fluoride application — with cleaning 100% deductible waived 100% deductible waived
Space maintainers Discount Not covered
BASIC SerVICeS
Amalgam fillings — 2 surfaces 100% after deductible 100% after deductible
Resin fillings — 2 surfaces Discount Not covered
Oral Surgery
Extraction — exposed root or erupted tooth Discount Not covered
Extraction of impacted tooth — soft tissue Discount Not covered
MAJOr SerVICeS
Complete upper denture Discount Not covered
Partial upper denture (resin based) Discount Not covered
Crown — Porcelain with noble metal Discount Not covered
Pontic — Porcelain with noble metal Discount Not covered
Inlay — Metallic (3 or more surfaces) Discount Not covered
Oral Surgery
Removal of impacted tooth — partially bony Discount Not covered
endodontic Services
Bicuspid root canal therapy Discount Not covered
Molar root canal therapy Discount Not covered
Periodontic Services
Scaling & root planing — per quadrant Discount Not covered
Osseous surgery — per quadrant Discount Not covered
OrTHODONTIC SerVICeS Discount Not covered
Access to negotiated discounts: members are eligible to receive non covered services, including cosmetic services such as tooth whitening, at the PDN negotiated rate when
visiting a participating PDN dentist at any time.
Nonpreferred (Out-of-Network) Coverage is limited to a maximum of the Plan’s payment, which is based on the contracted maximum fee for participating providers in the particular geographic area.
Above list of covered services is representative. A summary of exclusions is listed on page 13. For a full list of benefit coverage and exclusions refer to the plan documents.
All products not available in all counties. Please refer to the state map located on page 2 of the Aetna Advantage Brochure.
10

13. Aetna Advantage plan programs
to help you be well
Aetna Advantage Plans include eyecare Savings Aetna Navigator™
special programs1 with a wealth Aetna VisionSM Discount program offers It’s easy and convenient for Aetna
special savings on eye exams, contact lenses, members to manage their health benefits.
of features to complement our
frames, lenses, LASIK eye surgery, and eye Anytime – day or night – wherever they
standard health insurance care accessories. have Internet access, members can log
coverage. These programs in to Aetna Navigator, Aetna’s secure
include substantial savings Hearing Discount Program member website. Members who register
on products and educational Aetna’s HearingSM Discounts help Aetna on the site can check the status of their
members and their families save on hearing claims, contact Aetna Member Services,
materials geared toward your exams, hearing services and hearing aids. estimate the costs of health care services,
special health needs. These
and much more!
programs are value added and Aetna Natural Products
are NOT insurance. Here are a and ServicesSM program For more information on any of these
Eligible Aetna members and their families programs, please visit us online at
few of the ways we can help
can access complementary health care www.aetna.com.
you be well. products and services at reduced rates
Members will also have access to their
through the Aetna Natural Products and
Fitness Program own Personal Health Record, a single,
Services program. Members can save on
With our Fitness program, eligible Aetna secure place where they can view their
acupuncture, chiropractic care, massage
members and their families can enjoy preferred medical history and add other health
therapy and dietetic counseling as well
rates* on fitness club memberships at over information that’s important to them.***
as on over-the-counter vitamins, herbal
2,000 fitness clubs within the GlobalFit™ ***The Aetna Personal Health Record should not be
and nutritional supplements and other used as the sole source of information about your
network. In addition, members can access health conditions or medical treatment.
health-related products.
other programs such as at-home weight loss
programs, home fitness options and even Informed Health® Line
one-on-one health coaching** services. Get answers 24/7 to your health questions
Aetna Weight ManagementSM Program
via a toll-free hotline staffed by a team Want to save
of registered nurses. on dental expenses?
The Weight Management Program can
help you achieve your weight loss goals by Aetna rx Home Delivery® Vital Savings by Aetna® is a discount
providing you with a sensible weight loss With this optional program, order prescription program that provides you with dental
plan and balanced nutrition guide to fit medications through our convenient and savings. This is not insurance. Enrolling
your lifestyle. This program provides Aetna easy-to-use mail order pharmacy. To learn in the program will give you access
members and their eligible family members more or obtain order forms, visit to a network of providers who have
access to discounts on Jenny Craig® weight www.AetnaRxHomeDelivery.com. agreed to accept discounted rates
loss programs and products. Start with for services. To sign up today, visit
a FREE 30-day trial membership2; then choose www.vitalsavings.com or call
either a 6-month2 or 12-month2 program3 1-877-698-4825.
that’s right for you. You also receive individual
weight loss consultations, personalized
menu planning, tailored activity planning,
motivational materials and much more.
Aetna Natural Products and ServicesSM program, Eyecare Savings, Fitness and similar discount programs are rate-access programs and may be in addition to any plan benefits. Discount and other
similar health programs offered hereunder are not insurance, and program features are not guaranteed under the plan contract and may be discontinued at any time. Program providers are solely
responsible for the products and services provided hereunder. Aetna does not endorse any vendor, product or service associated with these programs. It is not necessary to be a member of an Aetna
plan to access the program participating providers.
1 Availability varies by plan. Talk with your Aetna representative for details.
2 Offers good at participating centers and through Jenny Direct at home only. Additional cost for all food purchases.
3 Additional weekly food discounts will grow throughout the year, based on active participation.
*At some clubs, participation in this program may be restricted to new club members.
11
**Provided by WellCall, Inc. through GlobalFit.

14. Things you need to know to apply
To qualify for an Aetna Advantage Plan, All applicants, enrolling spouses and All You Need to Know
you must be: dependents are subject to medical
About easy-Pay
n Under age 64 3/4 (If applying as a couple, underwriting to determine eligibility
both you and your spouse must be and appropriate premium rate level. Simple Automatic Payments via
under 64 3/4.) We offer various premium rate levels Electronic Funds Transfer (EFT)
n Under age 25 unmarried dependant based on the known and predicted registration: Complete the payment
qchildren of the subscriber or enrolling medical risk factors of each applicant. section of the Aetna Advantage Plans
spouse application. Select the EFT option to
n Legal residents in a state with products Levels of coverage and enrollment approve the automatic withdrawal of
offered by the Aetna Advantage Plans n You may be enrolled in your selected your initial premium and all subsequent
plan at the standard premium charge. premium payments.
n Legal U.S. residents for at least 6
continuous months. n You may be enrolled in your selected plan Invoices: You will not receive a paper
at a higher rate, based on medical findings. invoice when you are enrolled in EFT.
Your premium payments Payments will appear on your bank
n You may be declined coverage based on statement as “Aetna Autodebit Coverage.”
Your rates are guaranteed not to increase
significant medical risk factors.
for 12 months from your effective date once Terminating: To terminate EFT, you will
you’ve been accepted for coverage. After need to provide Aetna with 10 days written
Duplicate coverage
that, your premiums may change. Final rates notice prior to the date your next EFT
are subject to underwriting review. If you are currently covered by another carrier,
payment will be deducted. Without this
you must agree to discontinue the other written notice, your bank account may be
coverage before or on the effective date of debited for the next month’s premium. You
Your coverage
the Aetna Advantage Plan. Do not cancel will then need to contact Aetna to have
Your coverage remains in effect as long your current insurance until you are notified funds placed back in the checking account.
as you pay the required premium charges that you have been accepted for coverage.
on time, and as long as you maintain refunds: To process an EFT refund
membership eligibility. Coverage will be (placing money back in member’s
Pre-existing conditions checking account), Aetna will require
terminated if you become ineligible due
to any of the following circumstances: During the first 12 months following your at least 5 days after the withdrawal
effective date of coverage, no coverage was made to ensure valid payment.
n Non-payment of premiums will be provided for the treatment of a
rejected transactions: If the EFT
n Becoming a resident of a state or pre-existing condition unless you have
payment rejects for any reason, Aetna
location in which Aetna Advantage creditable prior coverage. will automatically terminate the EFT and
plans are not available. send you a letter saying you will receive
A pre-existing condition is an illness or injury
n Obtaining duplicate coverage for which medical advice or treatment was paper invoices. Processing time to reinstate
recommended or received within 6 months EFT will be 30–60 days. If an EFT payment
n For other reasons permissible by law
is rejected, you will need to pay that
preceding the effective date of coverage.
payment by paper check or credit card.
Medical underwriting requirements
The Aetna Advantage Plans are not Timing: Payments for Cycle 1 accounts
guaranteed issue plans and require medical (1st of the month effective date) will be
underwriting. Some individuals may be taken from your bank account between
federally eligible under the Health Insurance the 3rd and the 10th of the month the
premium is due. Payments for Cycle 2
Portability Accountability ACT (HIPAA),
accounts (15th of the month effective
through the Texas Comprehensive Health
date) will be taken from your bank
Insurance Pool (CHIP).
account between the 18th and 23rd
12 of the month the premium is due.

15. Texas limitations and exclusions
Medical n Medical expenses for a pre-existing Dental
These medical plans do not cover all health condition are not covered for the first Listed below are some of the charges
care expenses and include exclusions and 365 days after the member’s effective and services for which these dental
limitations. You should refer to your plan date. Look back period for determining plans do not provide coverage. For
documents to determine which health care a pre-existing condition (conditions for a complete list of exclusions and
services are covered and to what extent. which diagnosis, care or treatment was limitations, refer to plan documents.
recommended or received) is 6 months
The following is a partial list of services prior to the effective date of coverage.
n Dental Services or supplies that are
and supplies that are generally not covered. If the applicant had prior creditable primarily used to alter, improve or
However, your plan documents may contain coverage within 63 days immediately enhance appearance. Negotiated rates
exceptions to this list based on state before the signature on the application, for cosmetic procedures available when
mandates or the plan design or rider(s). then the pre-existing conditions a participating dentist is accessed.
Services and supplies that are generally not exclusion of the plan will be waived. n Experimental services, supplies
covered include, but are not limited to: or procedures
n Nonmedically necessary services or supplies
n All medical and hospital services not n Treatment of any jaw joint disorder,
n Orthotics
specifically covered in, or which are limited such as temporomandibular joint
or excluded by your plan documents, n Over-the-counter medications and supplies disorder
including costs of services before coverage n Radial keratotomy or related procedures n Replacement of lost or stolen
begins and after coverage terminates n Reversal of sterilization appliances and certain damaged
n Cosmetic surgery appliances
n Services for the treatment of sexual
n Custodial care dysfunction or inadequacies including n Services that Aetna defines as not
n Donor egg retrieval therapy, supplies or counseling necessary for the diagnosis, care or
Special or private duty nursing treatment of a condition involved
n Experimental and investigational n
procedures, (except for coverage for n Therapy or rehabilitation other than those
n All other limitations and exclusions in
medically necessary routine patient listed as covered in the plan documents your plan documents.
care costs for Members participating n Rehabilitation and detoxification services 10-day right to review
in a cancer clinical trial)
related to chemical dependency or
Do not cancel your current insurance
n Charges in connection with pregnancy care substance abuse
until you are notified that you have been
other than for pregnancy complications n Weight control services including surgical accepted for coverage. We’ll review your
n Immunizations for travel or work procedures, medical treatments and other application to determine if you meet
n Implantable drugs and certain injectable services and supplies primarily intended to underwriting requirements. If you’re
drugs including injectable infertility drugs control weight or treat obesity denied, you’ll be notified by mail. If
Maternity care and delivery charges you’re approved, you’ll be sent an Aetna
n Infertility services including artificial n
Advantage Plan contract and ID card.
insemination and advanced reproductive
technologies such as IVF, ZIFT, GIFT, If, after reviewing the contract, you find
ICSI and other related services unless that you’re not satisfied for any reason,
specifically listed as covered in your simply return the contract to us within
plan documents 10 days. We will refund any premium
you’ve paid (including any contract fees
or other charges) less the cost of any
services paid on behalf of you or any
covered dependent.
1-800-MY Health | www.aetnaindividual.com 13