Medical/Prescription Drugs
Your State Medical/Prescription Drugs Plan

Aetna

Two Plans to choose from:

Aetna HMO Plan
Local and National Network Access - It's simple to access care from Aetna's large network of providers in DE, PA, SNJ, MD and across the country! Primary Care Physician Selection is required – Your PCP will assist in coordinating your care with your other Health Care providers. Referrals are required for certain services and are obtained through your primary care physician.

Aetna CDH Gold Plan (Open Choice PPO) with an HRA **New**
You can see any doctor you want, without a referral!
Most Preventive Care is covered at 100% when rendered in-network.
Your employer provides you with a fund to help cover eligible health expenses.

Here's how your fund would work with the Aetna CDH Gold Plan, there are three parts – the fund, the deductible and the health plan. Here's how they work:

The Fund:

Each year, your employer funds a health reimbursement account – the fund- for you. You can use fund dollars to pay eligible out-of- pocket health care costs. Fund dollars can even pay partial amounts of these costs. If you don't use the whole fund in one year, no worries, unused amounts can roll over to the next year. However, if you change employers or leave the CDH Gold Plan, you can't take the fund with you.

Your Deductible:

This is an amount you must pay for eligible expenses. Once you pay the full deductible, your health plan begins to pay benefits. As you use the fund, the payments count toward your deductible. That means you have less to pay out of your own pocket!

Tip: Considering an HMO?

Go to the Statewide Benefits Office, OMB website at www.ben.omb.delaware.gov, under Group Medical Plans, select carrier (Blue Cross or Aetna). Select "Find a Health Care Provider" for BCBSD OR select "Locate Participating Providers - Doc Find" for 6 Open Enrollment - State of Delaware 2011 Aetna to check on which health care professionals are on their approved provider lists.

Your Health Plan:

Once you meet your deductible, your health plan pays its share for eligible expenses. You pay a smaller share of these costs from your own pocket.

No matter which Aetna plan you choose, you can SAVE with AETNA DISCOUNT PROGRAMS ! Aetna offers discounts such as: Vision Dis- counts, Gym and Gym Equipment Discounts, Vitamin Discounts, Hearing Aid Discounts, Massage Therapy Services and many more. Join Aetna and Begin Saving!

Call customer service at 1-877-542-3862 to learn more about how the Aetna HMO Plan and Aetna CDH Gold Plan has everything you need to help you be your healthiest. Additional information can be viewed at www.ben.omb.delaware.gov/medical/Aetna.

Blue Cross Blue Shield of Delaware

Blue Cross Blue Shield of Delaware: First State Basic Plan
In-network services will have a deductible of $500 per individual and $1,000 per family. The plan will then pay at 90% of the BCBSD allowable charge. The out-of-pocket maximum is $2,000 per individual and $4,000 per family (including the deductible) per plan year. The out-of-pocket maximum applies to medical services only. Copays for prescription medications are not applied to the out-of-pocket maximum. Preventive serv- ices are covered in network at 100% of the allowable charge and are not subject to a deductible or coinsurance.

Out-of-network services will be subject to a deductible of $1,000 per individual and $2,000 per family and then the plan will pay at 70% of the allowable charge. The out-of-pocket maximum is $4,000 per individual and $8,000 per family per plan year.

Blue Cross Blue Shield of Delaware: Comprehensive Preferred Provider Organization (PPO) Plan
Using in-network services you will pay a small copay/coinsurance with no deductible. If you use out-of-network providers, you must meet a $300 per person/$600 per family plan year deductible unless otherwise noted. The out-of-pocket maximum is $1,800 per person/$3,600 per family (including the deductible) per plan year. The out-of-pocket maximum applies to medical services only. Copays for prescription medica- tions are not applied to the out-of-pocket maximum.

Blue Cross Blue Shield of Delaware: Blue Care ® HMO
Blue Care ® is BCBSD's HMO-Managed Care plan in which each member must select a primary care physician (PCP) to coordinate his/her health care needs. Referrals are required for certain services and are obtained through your primary care physician.

Blue Cross Blue Shield of Delaware: CDH Gold **New**
BCBSD's CDH Gold Plan offers many of the features of a Preferred Provider Organization (PPO) plan with the added advantage of a State-funded Health Reimbursement Account (HRA).

The plan includes a $1,500 deductible for employee only (Individual) coverage and $3,000 for Family coverage. The HRA pays the first $1,250 in deductible expenses for Individuals and $2,500 for Families. The member is financially responsible for the remaining in-network deductible ($250 for Individuals and $500 for Families). When the deductible is satisfied, in-network health care services are paid at 90 percent, with an in-network coinsurance maximum of $3,000 for Individuals and $6,000 for Families. When the deductible is satisfied, out-of-network health care services are paid at 70 percent, with an out-of-network coinsurance maximum of $6,000 for Individuals and $12,000 for Families.

Benefits are subject to a single plan year deductible, combining in- and out-of-network deductible amounts. In- and out-of-network coinsurance amounts accumulate together toward the coinsurance maximums.

In addition, preventive care services are covered at 100 percent and are not subject to a deductible or coinsurance. Prescriptions are provided through the prescription benefits manager, Medco, and prescription copays are not applicable to the medical deductible or out-of-pocket maximum.

NOTE: BCBSD's allowable charges are based on the price BCBSD determines is reasonable for care or services provided.

*Complete information on all Blue Cross Blue Shield of Delaware plans, including a summary plan description, can be found at www.ben.omb.delaware.gov/medical/bcbs.

The HRA

• The State provides the funds in your HRA on a tax-freebasis and at no cost to you.
• The amount allocated to your HRA is based on your level of coverage. For the 2011-2012 plan year, if you enroll in employee coverage, the State will provide $1,250 in your HRA; if you enroll for employee & spouse, employee & child(ren) or family coverage, the State will provide $2,500 in your HRA.
• When you have an eligible healthcare claim expense, the allowable claim expense will be automatically deducted from your HRA fi rst. Then you are responsible for paying the rest of the deductible before the plan begins to pay a portion of your expenses.
• If you don't use all the money allocated for your HRA, the balance rolls over from year to year, provided you continue to enroll in a CDH plan.

Separate Prescription Drug Coverage

Prescription drug copays will remain the same for the 2011 - 2012 plan year. Your prescription copays do not apply to your deductible or coinsurance maximums.

Coverage for Adult Children Under Age 26 Effective July 1, 2011

Effective July 1, 2011, the State Group Health Insurance Plan (GHIP) will include coverage for adult children up to age 26. Your adult dependent children may be enrolled in the plan, up to age 26, with no requirement or restriction on marital, employment, student, resident or tax status. In other words, you may enroll an otherwise eligible adult child, up to age 26, whether or not the child is married, employed, a student, a tax eligible dependent or living with you.* Coverage of eligible adult children may continue until the end of the month in which the adult child turns age 26.

* The new federal health insurance law relating to dependent coverage of children requires the State of Delaware to offer group health coverage to an employee's children who have not reached age 26.

Copyright ©2006-2010 Valley Forge Benefits Consulting, Inc.