the attached files were developed and intended for use as ... · enrolling is easy! enrollment in...

The attached files were developed and intended for use as a

complete enrollment package; by distributing or posting the

attached materials, you agree that the components may not be

modified, omitted or used independently of one another.

Your distribution and/or posting also memorializes your

agreement that Aetna Inc. is not responsible for any

miscommunication resulting from the separation of these

materials.

Inventory Code

Valuable benefits.

Affordable program.

Healthy extras.

Special discounts.

Aetna Affordable Health ChoicesSM

A Limited Accident & Sickness PPO Insurance Plan

12.02.301.1 (7/06)B

You want health insurancebenefits. But you need aplan you can afford.

Be well. Stay well. Enroll today.You know how important it is stay well —not only for yourself, but for familymembers who may depend on you. NowAetna can help, with a health insuranceplan especially for you.

Aetna Affordable Health Choices is alimited accident and sickness insuranceplan. We call it limited because it containscaps on benefits. It delivers the mostrequested benefits at affordable prices. It’s the health care coverage you need — at a cost you can afford.

What’s more, as a member, you willhave access to the Aetna network ofhealth care professionals, plus valuabletools, information and discounts to helpyou maintain a healthy lifestyle.

We look forward to welcoming you as a member!

Visit a Preferred Provider■ Aetna’s network includes over 735,000

health care professionals nationwide.†

These doctors, therapists and othercaregivers meet Aetna standards andgive special rates to our members,which is why we call them preferred.†

■ When you visit a preferred provider for covered medical needs, you willeither make a copayment or you willneed to cover the annual deductibleout of pocket, before your benefitsbegin. Your Aetna insurance will thenpay the balance up to your plan's limits.

■ You can quickly find a preferredprovider by using a computer to visitour DocFind® directory online or bycalling customer service.

Or, Go Outside the Network■ You don’t have to stay in the network.

You can visit any qualified caregiver for covered medical needs. However,your payment for the office visit maybe higher.

■ Also, you may need to pay an annualdeductible. This is the amount ofmedical costs you pay out of pocket,before your benefits begin.

■ Once you meet your deductible, youwill receive coinsurance benefits. You pay a part of the covered medicalexpense, and Aetna will pay thebalance up to your plan limits.

Aetna Affordable Coverage you nee

Language Assistance

If you need assistance in anylanguage, please call MemberServices at 1-888-772-9682.

Si necesita asistencia en cualquieridioma, por favor llame a Servicios al Cliente al 1-888-772-9682.

Insurance Plans are underwritten by Aetna Life Insurance Company.Plans are administered by Strategic Resource Company (SRC).

How to use your Aetna Affordable Health Choices

†Aetna Corporate Controller figures, 05/31/06

Welcome to Wellness…with Aetna AffordableHealth Choices.

Special Discounts

As an Aetna member, you are entitled toall these discounts.* It’s one more waywe help to protect your health.

Hearing Discount Program – Receive a 40% discount** on hearing exams and services with HearPO® at 1,500participating locations nationwide.

Oral Health Care Discounts – Receivesavings on products and services to helpimprove dental and overall health.

There are more Special Discounts onthe back page...

DocFind

Our online directory helps you choose the doctors and other health careprofessionals that meet your needs, 24 hours a day, 7 days a week. Visitwww.aetna.com/docfind/custom/aahc.

Health Choices.d. Coverage you can afford.

Aetna AffordableHealth Choices

Coverage you need.Coverage you canafford.

12.02.301.1 (7/06) Available in Spanish. Disponible en Español. ©2006 Aetna Inc.

If you need assistance in any language, please call Member Services at 1-888-772-9682.

Si necesita asistencia en cualquier idioma, por favor llame a Servicios al Cliente al 1-888-772-9682.

This material is for informational purposes only and is neither an offer of coverage nor medical advice.It containsonly a partial, general description of plan benefits or programs and does not constitute a contract. Aetna doesnot provide medical/ dental care or treatment. Consult the plan documents (Schedule of Benefits, Certificate ofCoverage, Evidence of Coverage, Group Agreement) to determine governing contractual provisions, includingprocedures, exclusions and limitations relating to the plan. Health insurance plans contain exclusions and somebenefits are subject to limitations or visit maximums. With the exception of Aetna Rx Home Delivery® service,all participating physicians, hospitals and other health care providers are independent contractors and areneither agents nor employees of Aetna. Aetna Rx Home Delivery, LLC, is a subsidiary of Aetna Inc. Theavailability of any particular provider cannot be guaranteed, and provider network composition is subject tochange. Notice of the change shall be provided in accordance with applicable state law. Aetna PharmacyManagement refers to an internal business unit of Aetna Health Management, LLC. Vision One is a registeredtrademark of Cole Vision Corporation. LASIK surgery discounts are offered by the U.S. Laser network. Providersare independent surgeons and are not agents or representatives of EyeMed, Aetna Health Inc. and/or itsaffiliates. The oral health care discount promotions do not constitute medical/ dental advice or any endorsementby Aetna of any specific product, drug or pharmaceutical; nor is it a guarantee of any outcomes or medical/dental results. Aetna may receive a fee related to the referenced discount. Epic, Philips and Aetna areindependent contractors and are neither employees nor agents of the other.This material is subject to change.

More Special Discounts

With your medical membership,you are also entitled to:Aetna Pharmacy Management – In addition to prescription discounts, we help protect your health by providinginformation to help control certainmedical conditions.

Alternative Health Care Programs■ Natural Alternatives – Discounts

on alternative therapy services such as acupuncture therapy, chiropracticmanipulation, massage therapy andnutritional counseling. (Use AetnaDocFind to locate alternative healthcare professionals.)

■ Natural Products – Discounts on natural health products such as aromatherapy, biomagnetics,homeopathy, natural body care, yoga tools and more.

■ Vitamin Advantage – Discounts on vitamins, nutritional and herbalsupplements.

Fitness Program – Enjoy discounted rateson memberships at participating healthclubs contracted with GlobalFit™ as wellas savings on home exercise equipment.

Vision One® – Discounts** on eyewear,contact lenses, LASIK eye surgery and eye care accessories. Participating opticalcenters include Sears Optical®, Lenscrafters®,Target Optical® and many Pearle Vision®

locations.

To learn more about these Programs and Discounts… After you enroll, get more information byvisiting www.src-web.com or calling theMember Services number on your ID card.

* These discount programs are rate-access programsand may be in addition to any plan benefits. Discount and other similar health programs offeredhereunder are not insurance. Program features are not guaranteed under the plan contract and may bediscontinued at any time. Program providers are solely responsible for the products and servicesprovided hereunder. Aetna does not endorse anyvendor, product or service associated with theseprograms. It is necessary to be a member of an Aetnaplan to access the program participating providers.

** Discounts are from the provider's usual fee for theservice (retail price). These discount programs are notinsured benefits, but provide access to discountprograms maintained by Aetna Inc. and its affiliates.

B

RE: Aetna Affordable Health ChoicesSM insurance plans

Young Life knows how important you are to our success. We also know that finding affordable health care isn’t always easy; that’s why wehave teamed up with Aetna* to offer health insurance.

This limited accident and sickness insurance plan offers you and your dependents the following coverage:

■ Medical■ Hospital Indemnity■ Dental

Premium payments for your benefits will be deducted directly from your paycheck.

Enclosed Materials (Your enrollment kit includes:)

■ Temporary Member Identification (bottom of this letter): Once you enroll, you should use this until you receive your permanent IDs. ThisTemporary Identification is valid following your first payroll deduction.

■ How to Enroll Guide (back of letter): Use this guide to walk you through the enrollment process.

■ Plan Brochure (color): Contains information on available tools and discounts that you receive for participating.

■ Benefits Summary: Describes the specific benefits associated with your plan.

■ Election Form: Use to capture your benefit elections.

■ Important Disclosure Information: Provides information on the rules associated with your plan.

If you are missing any of the contents of this kit, please see your site manager or call Customer Service at 1-888-772-9682.

Remember, you only have a limited time to enroll; if you choose not to enroll, you cannot participate until the next open enrollment, unless youhave a qualifying life event.

Si necesita ayuda en español, por favor llame al Centro del Servicio al Cliente al 1-888-772-9682 (presione el número dos) de lunes a viernes de8:00 a.m. a 8:00 p.m. horario del Este.

Young Life Open Enrollment: March 1 - March 31, 2007

Newly-hired employees will have 30 days from their date of eligibility to enroll.

AETNA AFFORDABLEMEDICAL/DENTAL PPO HEALTH CHOICESSM PPO

BIN# 610502 RX

YOUNG LIFECOMPANY NO.: 800577

EMPLOYEE NAME: _________________________________________________________________AND COVERED DEPENDENTS

FOR MEMBER SERVICES CALL 1-888-772-9682

PAYOR NUMBER 57604 0039

DOI

* Insurance Plans are underwritten by Aetna Life Insurance Company.Plans are administered by Strategic Resource Company (SRC). Material is subject to change. For OK residents only, policy forms issued include GR-9 and GR-29.

Key Terms:

Deductible: the amount you pay annually for covered services before yourplan starts paying.

Member Coinsurance: your portion of the cost of covered services after thedeductible has been met.

Preferred Provider Organization (PPO): a network of doctors and facilitieswho provide discount services to plan members.

Copayment (Copay): The set amount you pay for each covered service – forexample: doctor’s office visits and prescription drugs.

Inpatient: services that require a minimum of 24 hours in the hospital; allother services are considered ‘outpatient.’

Cut out your Temporary Member Identification along the dotted line.

www.aetna.com/docfind/custom/aahc

HEALTH CARE PROVIDER: The person listed on the front of this card hasbeen enrolled under a limited major medical plan sponsored by theemployer listed on the front of this card. Covered members are entitledto benefits under the applicable plan, subject to exclusions andlimitations. This card does not guarantee coverage. For verification ofcoverage, filing a claim or for questions other than the discountprograms, contact us at the number printed on the front of this card ormail us at the address below.

INSURED: Network physicians, hospitals, and other health care providersare independent contractors and are neither agents nor employees of AetnaLife Insurance Company.

EMERGENCY URGENT CARE: Call your local emergency hotline (ex.911) or goto the nearest emergency facility. For VISION ONE call 1-800-793-8616.For LASIK call 1-800-422-6600. For CONTACTS DIRECT call 1-800-391-5367.

Strategic Resource CompanyP.O. Box 23759

Columbia, SC 29224-3759

Enrolling is easy!Enrollment in this limited accident and sickness insurance plan is quick and easy – review the following steps to sign up today.

Step One - Review the enclosed materials and ask questions – if you need more information or don’t completely understand something,give us a call. We’re here to answer questions before you enroll!

Step Two - Make your decisions and complete the Election Form.

Step Three - Turn in your completed Election Form to your employer.

Employees electing medical and/or dental will receive plastic identification (ID) cards at their home address along with important membershipinformation. ID Cards are not needed to access any of the other benefit elections.

Notice to Members Concerning Health Care Services: Your share of the payment for health care services may be based on the agreementbetween your health plan and your provider. Under certain circumstances, this agreement may allow your provider to bill you for amounts upto the provider’s regular billed charges.

Making changes:

If you are within your open enrollment period, you may make changes toyour elections by completing and turning in an Election Form to youremployer. If you are outside of your open enrollment period, there arecertain events that will allow you to make changes to your elections. Log into the SRC website or see your employer. You will be provided with theinformation to determine if you are eligible to make such changes.

Contact us:

1-888-772-9682 (Monday-Friday, 8 a.m. to 8 p.m. ET) or

www.src-web.com

PLAN FEATURES

Physician Office Visits(includes chiropractic visits)Preventive VisitsMaximum Annual BenefitDeductible (per coverage year)1

Inpatient CareOutpatient Care

Maximum Annual Benefit

PRESCRIPTION DRUG BENEFIT

Generic DrugsBrand-name DrugsMaximum Monthly Benefit

20%40%40%

Other hospital services are certain hospital charges other than room and board. They include but are not limited to, pharmacy, medical and surgical supplies and devices, lab and x-rays and operating and recovery room expenses.

3 Where benefit is expressed as a percentage, the lower of the recognized charge(s) or the discounted PPO charge(s) will be the basis of payment.

$400 Family2

$100 Individual

$200 Family2

$200 Individual

$1,500 in or out of network$1,500 in or out of network

Outpatient expensesOther hospital services

Out-of-area employees -- covered expenses reimbursed at the in network level. If you live in an area that does not have an in network health care provider, you will be considered out-of-area and receive in network benefits for eligible expenses. Please note that if you travel to an area that has an in network health care provider but use an out of network health care provider, you will not be eligible for in network benefits.

Member Coinsurance3 (applies to all expenses unless otherwise stated.)

$15,000 in or out of network, per covered person

Non-Preferred Provider(out of network)

Preferred Provider(in network)

Benefit Specific Limits (in or out of network - subject to deductible)

20%

Covers only medical prescriptions, except for dental prescriptions issued in connection with treatment resulting from a covered accident.

Members receive a discount at the point of sale and pay the applicable copay (and any balance over the monthly limit). There are no claims to file.

1All covered expenses accumulate toward both the preferred and non-preferred Deductible. Unless otherwise indicated, the Deductible must be met prior to benefits being payable.2Once Family Deductible is met, all family members will be considered as having met their Deductible for the remainder of the coverage year. You will have met your Family Deductible when two covered family members have each paid their own deductibles in a coverage year.

$15 copay; deductible waived

Young Life800577

PLAN DESIGN AND BENEFITS

$15 base deductible; 50%3 thereafter

$100 in or out of network

PROVIDED BY AETNA LIFE INSURANCE COMPANY

Preferred Provider(in network)

Non-Preferred Provider(out of network)

$15 copay; deductible waived 50%3; deductible waived

NET PREMIER

$10 copay; deductible waived 50%3; deductible waived50%3; deductible waived$20 copay; deductible waived

$35 in or out of network

01/26/2007 Page 1

Young Life800577

PLAN DESIGN AND BENEFITSPROVIDED BY AETNA LIFE INSURANCE COMPANY

YOUR MEDICAL BENEFITS ALSO INCLUDE:

Aetna's Informed Health® Line gives you and your family access to registered nurses 24 hours a day, seven days a week. This toll-free line connects you to a team of nurses experienced in providing information on a variety of health topics. Informed Health Line nurses use the Healthwise® Knowledgebase, one of the most advanced health databases, to provide information about health issues, medical procedures and treatment options, and help you and your family communicate more effectively with your doctors. You can also choose to listen to certain health topics of interest through Aetna's new audio health library, which is available in English and Spanish. Contact Aetna's Informed Health Line at 1-800-556-1555.

EYEWEAR DISCOUNT PROGRAM*

PRESCRIPTION DRUG DISCOUNT PROGRAM*

*Discount programs provide access to discounted prices and are not insured benefits.

Aetna’s Vision One® discount program, a nationwide network of vision care providers, offers you and your family glasses, contact lenses, nonprescription sunglasses, contact lens solutions and other eye care accessories at a discounted price. Plus, you can receive discounts on eye exams and LASIK eye surgery. For exams and eyewear call (800) 793-8616. For contacts call (800) 391-5367. For LASIK customer service call (800) 422-6600. You can also locate a local provider by visiting www.aetna.com/docfind/custom/aahc.

AETNA'S INFORMED HEALTH®LINE

The Prescription Drug discount program gives you and your family access to more than 52,000 retail pharmacies across the continental U.S., Puerto Rico, and the Virgin Islands (as of 1/1/05). You can also use our Aetna Rx Home Delivery® service; a fast, easy way to fill the prescriptions you take regularly. To locate a participating pharmacy, call toll-free (888) 772-9682 or visit www.aetna.com/docfind/custom/aahc.

01/26/2007 Page 2

Young Life800577


Lump-sum benefitDaily benefit

DENTAL PLANDeductibleCoverage Maximum

Preventive Services(includes checkups and cleanings)

Basic Services (includes fillings, oral surgery, and denture, crown and bridge repair)

Major Services (includes Perio and Endodontics, crowns, bridges, and dentures)

Medical Pre-existing Condition Limitation:

$100 per day of hospital confinement for up to 100 days per year

None

HOSPITAL INDEMNITY PLAN

$50

If you or a covered dependent are confined in the hospital as an inpatient and charged for room, board, and general nursing services for private, semi-private, or intensive care accommodations

SUPPLEMENTAL PLANS

$1,000 for one confinement per year

This is a summary list. Coverages, features, limitations and exclusions may vary by state. This is not a contract. Only the insurance policy can provide the actual terms, coverages, amounts, conditions, limitations and exclusions. Except to the extent coverage for such benefit is specifically provided in your Booklet-Certificate, coverage is not provided for the following charges:

Waiting Period of Continuous Enrollment Before Plan Pays

Maximum Percent of Recognized Charges the Member Pays†

50%

20%

3 Months

12 Months

40%

† Receive additional savings by using one of the 76,000+ available PPO network dentists nationwide. Percent could be lower based on PPO provider and location. The dental PPO network is not available in Alabama, Arkansas, Idaho, Hawaii, Louisiana, Mississippi, New Mexico, or Puerto Rico. To locate a preferred provider, call toll-free (888) 772-9682 or visit www.aetna.com/docfind/custom/aahc.

$500

This is an overview of the covered dental services.

EXCLUSIONS AND LIMITATIONS

Medical expenses for a pre-existing condition are not covered (full postponement rule) for the first 365 days after the enrollee’s effective date. The lookback period for determining a pre-existing condition (conditions for which diagnosis, care and treatment was recommended or received) is 180 days prior to the effective date. The pre-existing limitation period may be reduced by the number of days of prior creditable coverage the member has as of the effective date. In order to reduce or possibly eliminate your exclusion period based on your creditable coverage, you should provide us a copy of any certificates of creditable coverage you have. Please contact Member Services at 1-888-772-9682 if you need assistance on obtaining a certificate of creditable coverage from your prior carrier or if you have any questions regarding the pre-existing condition exclusion. The pre-existing condition limitation does not apply to newborn or adopted children, or to any pregnancy. As used above, “creditable coverage” means a person’s prior medical coverage as defined in the Federal Health Insurance Portability and Accountability Act (HIPAA) of 1996.

01/26/2007 Page 3

Young Life800577


Medical Exclusions:

Hospital Indemnity Plan Limitations and Exclusions:

Charges made by a hospital or treatment facility owned or run by the U.S. government unless a charge is made for such services in the absence of insurance; Charges made to treat an illness or injury sustained while flying as a pilot or crew member of any aircraft or travel or flight. This includes boarding or alighting in any vehicle or device while being used for any test or experimental purposes or while bring operated by; for; or under; the direction of any military authority other than the Military Airlift Command of the United States or similar air transport service of any other country; Charges made by a hospital which does not unconditionally require payment (this does not apply to charges billed by Veterans Administration Hospitals); Charges made by a physician for non-surgical medical treatment given to a covered person while confined in an inpatient facility; Charges made for outpatient services and supplies that are not deemed to be physician office visits; emergency room visits; diagnostic and surgical services; or prescription drugs and medicines; Voluntary sterilization procedure or the reversal of a sterilization procedure; Weight Control services including: surgical procedures, medical treatments, weight control/loss programs; food supplements; or exercise programs; Furnished, paid for, or for which benefits are provided or required under any law of a government; Those made for prescription drugs and medicines prescribed by a physician [on an inpatient and/or outpatient basis]; Charges in excess of the Recognized Charge, based on the 80th percentile of the Medicode Medical Data Research Tables.

The same limitations and exclusions apply as those listed for the Medical and/or Dental Coverage (if offered under your plan).

Routine physical exams, routine vision exams, routine dental exams, routine hearing exams, immunizations, or other preventive services and supplies, except to the extent coverage for such exams, immunizations, services, or supplies is specifically provided in your Booklet-Certificate; Marriage, family, child, career, social adjustment, pastoral, or financial counseling; Acupuncture therapy, except when its performed by a physician as a form of anesthesia in connection with surgery that is covered under this Plan; Speech therapy, except to restore speech to a person who has lost existing speech function as the result of a disease or injury; Inpatient or outpatient treatment of alcoholism, drug abuse and mental disorders; Private duty nursing; An injury sustained while the covered person was legally intoxicated or under the influence of alcohol as defined by the jurisdiction in which the injury occurred; An injury sustained while the covered person was voluntarily using any drug, narcotic or controlled substance unless as prescribed by a physician;

Dental Care and treatment, except that required by injury and rendered within 6 months of the injury; Educational testing, or training related to learning disabilities or developmental delays; Services of a resident physician or intern rendered in that capacity; Made only because there is insurance or a person is not legally obligated to pay; Custodial care; Any expense incurred before the effective date of the policy or after the date the policy terminates; Eye surgery mainly to correct refractive errors; Education, special education, or job training whether or not given in a facility that also provides medical or psychiatric treatment; Therapy, supplies, or counseling for sexual dysfunctions or inadequacies that do not have a physiological or organic basis; Any drugs or supplies used for the treatment of erectile dysfunction, impotence, or sexual dysfunction or inadequacy; Performance, or lifestyle enhancement drugs or supplies; Artificial insemination, in vitro fertilization, or embryo transfer or any related procedures except where required by law to be covered;

Services and supplies not necessary, as determined by Aetna, for the diagnosis, care, or treatment of the disease or injury involved; Service or supply rendered by someone who is related to a covered person by blood) e.g. sibling, parent, grandparent, child), marriage (e.g., spouse or in-law) or adoption or is normally a member of the covered persons household; Injury arising out of or in the course of employment or which is compensable under any Worker’s compensation or occupational Disease Act or Law; Care, treatment, services or supplies that are not prescribed, recommended, or approved by the person’s attending physician or dentist; Experimental or investigational services, drugs, or supplies except to the extent required by law; Cosmetic or Reconstructive Surgery: This does not apply to reconstructive surgery incidental to or following surgery resulting from trauma, infection, or other diseases of the involved part; or because of congenital disease or anomaly of a covered person; or reconstructive surgery on a non-diseased breast to restore and achieve symmetry between two breasts following a mastectomy;

01/26/2007 Page 4

Young Life800577


Dental Exclusions:

Insurance plans are underwritten by Aetna Life Insurance Company. Plans are administered by Strategic Resource Company (SRC).

Cosmetic procedures unless needed as a result of injury. Any treatment that is elective or primarily cosmetic in nature and not generally recognized as an accepted dental practice by the American Dental Association. Facing on crowns, or pontics, posterior to the second bicuspid shall always be considered cosmetic. This includes dental care of a congenital or developmental malformation, unless benefits for orthodontic services are specifically provided; Initial placement of any prosthetic appliance or fixed bridge unless such placement is necessitated by the extraction of one or more functioning natural teeth while insured, provided such tooth was not an abutment for a prosthetic appliance installed during the proceeding 5 years of a fixed bridge installed during the preceding 7 years. The extraction of a third molar does not qualify. Any such appliance or fixed bridge must include the replacement of the extracted tooth or teeth; Replacement of lost or stolen appliances; Replacement of bridges unless the bridge cannot be made serviceable;

This material is for information only and is not an offer or invitation to contract. Insurance plans contain exclusions and limitations. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location. Discount programs provide access to discounted prices and are not insured benefits. Material is subject to change.

Any procedure that is not necessary; Any procedure begun or appliance installed before a covered person became insured; Any procedure begun after Your insurance terminates, or for any prosthetic dental appliance finally installed or delivered more than 30 days after Your insurance policy terminates; Orthognathic surgery; Prescribed drugs; pre-medication; or analgesia; Any instruction for diet, plaque control and oral hygiene; Treatment of malignancies, cysts and neoplasms; Services provided for any type of temporomandibular (TMJ) or related structures, or myofascial pain; Failure to keep a scheduled visit or charges for the completion of any claim forms; Service or supply rendered by someone who is related to a covered person by blood (e.g. sibling, parent, grandparent, child), marriage (e.g., spouse or in-law) or adoption or is normally a member of the covered persons household; Charges in excess of the Recognized Charge, based on the 80th percentile of the Medicode Medical Data Research Tables; or injury arising out of or in the course of employment or which is compensable under any Worker’s compensation or occupational Disease Act or Law.

In addition to the Medical Exclusions and Limitations listed above, the following charges are not covered under the Dental Plan Coverage, and they will not be recognized toward satisfaction of any Deductible amount.

Replacement of full or partial dentures unless the prosthetic appliance is more than 5 years old and cannot be made serviceable; Replacement of crowns, inlays, or onlays unless the prior placement is more that 7 years old and cannot be made serviceable; Appliances, services or procedures relating to the change or maintenance of vertical dimension, restoration of occlusion, splinting, correction of attrition or abrasion, bite registration or bite analysis; Cast restorations and crowns for teeth that are not broken down by extensive decay or accidental injury or for teeth that can be restored by other means; Any procedure, service or supplies that are included as covered medical expenses under another group medical expense benefit plan; Prescribed drugs, pre-medication, analgesia or general anesthesia; Orthodontic treatment; Charges for implants of any type, and all related procedures, removal of implant, precision or semi-precious attachments, denture duplication, over-dentures and any associated surgery or other customized services or attachments;

For OK residents only, policy forms issued include GR-9 and GR-29.

01/26/2007 Page 5

EF: ED002 (03/05) This Election Form is not Proof of Coverage.

Aetna Affordable Health ChoicesSM Election Form

Young LifeGroup No. 800577

Complete this form and make a copy for yourself. Give the original to your employer. IF YOU ARE NOT CHANGING YOUR EXISTING COVERAGE, YOU DO NOT NEED TO COMPLETE THIS FORM.

A. INFORMATION ABOUT YOU Print Your Name (First, Middle Initial, Last)

Mailing Address City State Zip Code

Home Phone ( )

Date of Birth (MM/DD/YYYY) Social Security Number

B. YOUR ELECTION (Check the appropriate box.)

I am not currently enrolled and I elect to…. Enroll in the coverage choice(s) selected below. Decline this opportunity to participate.

I am currently enrolled and I elect to…. Change my current coverage with the choice(s) selected below. Change my personal and/or dependent information. Drop all of my current coverage choice(s).

By selecting the coverage choice(s) below, I authorize my employer to deduct from my paycheck, before taxes are deducted, any required contributions.

Your Signature Today’s Date (MM/DD/YYYY)

C. YOUR COVERAGE CHOICES

For each coverage you wish to adjust: 1) Check the appropriate box ( ) for the action you wish to make (add/drop/change to); and 2) Check the appropriate box ( ) for whom this action applies.

MEDICAL Add Drop Change To

(List Dependents on the back of this form) Semi-Monthly Monthly Cost Cost

Yourself Only .................................................................................................. $ 60.62 ...............................$ 121.24 Yourself Plus One............................................................................................ $ 153.88 ...............................$ 307.76 Yourself and Family......................................................................................... $ 220.70 ...............................$ 441.40

HOSPITAL INDEMNITY

Add Drop Change To



DENTAL Add Drop Change To



FOR YOUR EMPLOYER’S USE ONLY Employee ID: Hire Date (MM/DD/YYYY): Pay Type: Total Deduction:

$

Location or Site Code: Authorized Signature: Today’s Date (MM/DD/YYYY):

EF: ED002 (03/05) This Election Form is not Proof of Coverage.

E. DEPENDENT INFORMATION Check here if you have more dependents and provide all requested information on a separate sheet and attach it to this form.

Print Dependent’s Name (First, Middle Initial, Last) Social Security Number

Sex Male Female

Relationship Date of Birth

If over 18, is your child: Full-time student? Disabled?

Enrolled in the following coverage(s): Medical Hospital Indemnity Dental

Add Drop Change To

If this dependent has a different address than you, list it here:

Street Address City State Zip Code


Sex Male Female




Add Drop Change To




Sex Male Female




Add Drop Change To




Sex Male Female




Add Drop Change To



QUALIFYING LIFE EVENTS Check the box of the description that identifies your LOC.

Divorce, legal separation or death Termination of employment of a dependent Reduction of a dependent’s hours Termination of your or your dependents’ COBRA rights Loss of employer’s contribution to spouse’s coverage Dependent child losing eligibility as a dependent Other loss of coverage

A. LOSS OF OTHER COVERAGE (LOC): If you previously declined health coverage because you or your dependents were already covered under another health plan and you or your dependents have lost that other coverage, you may be allowed to enroll yourself and your dependents. You must submit this form, together with documentation, to your employer within 31 days of the LOC. If you are entitled to this special enrollment, complete sections A & B (on the front) then go to the list on the right and check the box next to your LOC, supply the date of the LOC, and finish completing the form through section D When finished, make a copy of this form and give it to your employer with your documentation attached.

Date of the LOC:

Check the box of the description that identifies your FSC. Divorce, legal separation or death Marriage Birth or adoption of a dependent Other

B. FAMILY STATUS CHANGES (FSC): Whether you are currently enrolled or previously declined coverage, you may be allowed to add, increase, decrease or drop coverage when you experience certain FSC events. You must submit this form, together with documentation, to your employer within 31 days of the FSC. If you are so entitled because of a recent FSC, complete sections A & B (on the front) then go to the list on the right and check the box next to your FSC, supply the date of the FSC, and finish completing this form through section D When finished, make a copy of this form and give it to your employer with your documentation attached.

Date of the FSC:

Record keeping by Strategic Resource Company (SRC). Insurance plans are underwritten by Aetna Life Insurance Company.

112.28.301.1-SRC C (1/07)

PPllaann ooff BBeenneeffiittssYour plan of benefits will be determined by your plansponsor and underwritten by the Aetna Life InsuranceCompany, 151 Farmington Avenue, Hartford, Connecticut,06156. The benefits and main points of the Group Policyfor persons covered under your plans of benefits will be setforth in the Description of Coverage Booklet which will beprovided to you at a later date.

CCoosstt SShhaarriinnggYou are responsible for any copayments, coinsurance anddeductibles for covered services. You will need to satisfyany applicable cost sharing before the plan will begin topay benefits. Copayment, coinsurance and deductibleamounts are listed in your benefits summary and plandocument.

HHooww AAeettnnaa CCoommppeennssaatteess YYoouurr HHeeaalltthhCCaarree PPrroovviiddeerr All the participating physicians are independent practicingphysicians that are neither employed nor exclusivelycontracted with Aetna. Individual physicians are in thenetwork by either directly contracting with Aetna and/oraffiliating with a group or organization that contracts withus.

Participating physicians, hospitals and other providers inour network are compensated in various ways for theservices covered under your plan.

■ Per individual service or case (fee for service atcontracted rates).

■ Per hospital day (per diem contracted rates).

CCllaaiimmss PPaayymmeenntt ffoorr NNoonnppaarrttiicciippaattiinnggPPrroovviiddeerrss aanndd UUssee ooff CCllaaiimmss SSooffttwwaarreeIf your plan provides coverage for services rendered bynonparticipating providers, you should be aware thatAetna determines the usual, customary and reasonable feefor a provider by referring to commercially available datareflecting the customary amount paid to most providers fora given service in that geographic area or by accessingother contractual arrangements. If such data is not

commercially available, our determination may be basedupon our own data or other sources. Aetna may also usecomputer software and other tools to take into accountfactors such as the complexity, amount of time neededand manner of billing. You may be responsible for anycharges Aetna determines are not covered under yourplan.

MMeeddiiccaallllyy NNeecceessssaarryy ““MMeeddiiccaallllyy nneecceessssaarryy”” means that the service or supply isprovided by a physician or other health care providerexercising prudent clinical judgment for the purpose ofpreventing, evaluating, diagnosing or treating an illness,injury or disease or its symptoms, and that provision of theservice or supply is:

■ Clinically appropriate in accordance with ggeenneerraallllyyaacccceepptteedd ssttaannddaarrddss ooff mmeeddiiccaall pprraaccttiiccee in term oftype frequency, extent, site and duration,

■ Considered effective in accordance with ggeenneerraallllyyaacccceepptteedd ssttaannddaarrddss ooff mmeeddiiccaall pprraaccttiiccee for theillness, injury or disease; and

■ Not primarily for the convenience of you, or for thephysician or other health care provider; and

■ Not more costly than an alternative service orsequence of services at least as likely to produceequivalent therapeutic or diagnostic results as to thediagnosis or treatment of the illness, injury ordisease.

““GGeenneerraallllyy aacccceepptteedd ssttaannddaarrddss ooff mmeeddiiccaall pprraaccttiiccee””means standards that are based on credible scientificevidence published in peer-reviewed medical literaturegenerally recognized by the relevant medical community. Inthe absence of such credible scientific evidence, the Plan’sdeterminations of whether a service or supply meets“generally accepted standards of medical practice” shall beconsistent with physician specialty societyrecommendations and otherwise shall be based on theviews of physicians practicing in relevant clinical areas andany other relevant factors.

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Important Disclosure InformationFFoorr AAeettnnaa AAffffoorrddaabbllee HHeeaalltthh CChhooiicceessSSMM PPllaannss

* Aetna is the brand name used for products and services provided by oneor more of the Aetna group of subsidiary companies.

CClliinniiccaall PPoolliiccyy BBuulllleettiinnss ((““CCPPBBss””))Aetna’s CPBs describe Aetna’s policy determinations ofwhether certain services or supplies are medicallynecessary, based upon a review of currently availableclinical information. Clinical determinations in connectionwith individual coverage decisions are made on a case-bycase basis consistent with applicable policies.

Aetna’s CPBs do not constitute medical advice. Treatingproviders are solely responsible for your medical advice andtreatment. You should discuss any CPB related to theircoverage or condition with their treating provider.

While Aetna’s CPBs are developed to assist in administeringplan benefits, they do not constitute a description of planbenefits. Each benefit plan defines which services arecovered, which are excluded, and which are subject todollar caps or other limits. You and your providers willneed to consult the benefit plan to determine if there areany exclusions or other benefit limitations applicable to thisservice or supply.

CPBs are regularly updated and are therefore subject tochange. Aetna’s CPBs are available online atwwwwww..aaeettnnaa..ccoomm.

CCoommppllaaiinnttss,, AAppppeeaallss aanndd EExxtteerrnnaallRReevviieeww FFiilliinngg aa CCoommppllaaiinntt oorr AAppppeeaall

Aetna is committed to addressing your coverage issues,complaints and problems. If you have a coverage issue orother problem, call Member Services at the toll-freenumber on your ID card. If Member Services is unable toresolve your issue to your satisfaction, it will be forwardedto the appropriate department for handling.

If you are dissatisfied with the outcome of your initialcontact, you may file an appeal. If you are not satisfiedafter filing a formal appeal, you may request a second levelappeal of the decision. Your appeal will be decided inaccordance with the procedures applicable to your planand applicable state law. Refer to your plan documents forfurther details regarding your plan’s appeal procedure.

EExxtteerrnnaall RReevviieeww

Aetna established an external review process to giveeligible members the opportunity of requesting anobjective and timely independent review of certaincoverage denials. Once the applicable appeal process hasbeen exhausted, eligible members may request an externalreview of the decision if the coverage denial, for which themember would be financially responsible, involves morethan $500*, and is based on lack of medical necessity oron the experimental or investigational nature of the

proposed service or treatment. Standards may vary bystate, if a state-mandated external review process existsand applies to your plan.

An independent review organization (IRO) will assign thecase to a physician reviewer with appropriate expertise inthe area in question. After all necessary information issubmitted, an external review generally will be decidedwithin 30 calendar days of the request.

Expedited reviews are available when a member’s physiciancertifies that a delay in service would jeopardize themember’s health. Once the review is complete, the planwill abide by the decision of the external reviewer. The costfor the review will be borne by Aetna (except where statelaw requires members to pay a filing fee as part of thestate-mandated program).

Certain states mandate external review of additionalbenefit or service issues; some may require a filing fee. Inaddition, certain states mandate the use of their ownexternal review process for medical necessity andexperimental/ investigational coverage decisions. Thesestate mandates may not apply to self-funded plans. Forfurther details regarding your plan’s appeal process and theavailability of an external review process, call the MemberServices toll-free number on your ID card where you mayobtain an external review request form. You also may callyour state insurance or health department or consult theirwebsite for additional information regarding state-mandated external review procedures.

CCoonnffiiddeennttiiaalliittyy aanndd PPrriivvaaccyy NNoottiicceess Aetna considers personal information to be confidentialand has policies and procedures in place to protect itagainst unlawful use and disclosure. By “personalinformation,” we mean information that relates to amember’s physical or mental health or condition, theprovision of health care to the member, or payment for theprovision of health care to the member. Personalinformation does not include publicly available informationor information that is available or reported in asummarized or aggregate fashion but does not identify themember.

When necessary or appropriate for your care or treatment,the operation of our health plans, or other relatedactivities, we use personal information internally, share itwith our affiliates, and disclose it to health care providers(doctors, dentists, pharmacies, hospitals and othercaregivers), payors (health care provider organizations,employers who sponsor self-funded health plans or whoshare responsibility for the payment of benefits, and otherswho may be financially responsible for payment for the

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*Does not apply in some states, including North Carolina.

services or benefits you receive under your plan), otherinsurers, third-party administrators, vendors, consultants,government authorities, and their respective agents.

These parties are required to keep personal informationconfidential as provided by applicable law. Participatingnetwork providers are also required to give you access toyour medical records within a reasonable amount of timeafter you make a request.

Some of the ways in which personal information is usedinclude claims payment; utilization review andmanagement; medical necessity reviews; coordination ofcare and benefits; preventive health, early detection, anddisease and case management; quality assessment andimprovement activities; auditing and antifraud activities;performance measurement and outcomes assessment;health claims analysis and reporting; health servicesresearch; data and information systems management;compliance with legal and regulatory requirements;formulary management; litigation proceedings; transfer ofpolicies or contracts to and from other insurers, HMOs andthird party administrators; underwriting activities; and duediligence activities in connection with the purchase or saleof some or all of our business. We consider these activitieskey for the operation of our health plans. To the extentpermitted by law, we use and disclose personalinformation as provided above without member consent.However, we recognize that many members do not wantto receive unsolicited marketing materials unrelated totheir health benefits. We do not disclose personalinformation for these marketing purposes unless themember consents. We also have policies addressingcircumstances in which members are unable to giveconsent.

To obtain a hard copy of our Notice of Privacy Practices,which describes in greater detail our practices concerninguse and disclosure of personal information, please write toStrategic Resource Company (SRC) Post Office Box 23759,Columbia, SC 29224.

You can also visit wwwwww..aaeettnnaa..ccoomm for a direct link to theNotice of Privacy Practices by selecting the ‘Privacy Notices’link at the bottom of the page.

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GGeeoorrggiiaaMembers can call 1-888-772-9682 (toll-free) to confirmthat the preferred provider in question is in the networkand/or accepting new patients.

Members have direct access to the participating primaryOb/Gyn provider of their choice and do not need a referralfrom their PCP for a routine well-woman exam, including aPap smear when appropriate and an unlimited number ofvisits for gynecologic problems and follow-up care.

Members also have direct access to the participatingdermatologist provider of their choice and do not need areferral from their primary care physicians to accessdermatologic benefits covered under their health plan.

A summary of any agreement or contract between Aetnaand any health care provider will be made available uponrequest by calling the Member Services telephone numberon your ID card. The summary will not include financialagreements as to actual rates, reimbursements, charges, orfees negotiated by Aetna and the provider. The summarywill include a category or type of compensation paid byAetna to each class of health care provider under contractwith Aetna.

CCoonnssuummeerr CChhooiiccee OOppttiioonn

The Consumer Choice Option is available for Georgiaresidents enrolled in certain Aetna managed care plans.

Under this benefit option, with certain restrictions requiredby law and an additional monthly premium cost, membersof certain Aetna managed care plans may nominate anout-of-network provider to provide covered services forthemselves and their covered family members. Yourbenefits and any applicable copayments will be the sameas for in-network providers. The out-of-network providermust agree to accept the Aetna compensation, to adhereto the plan’s quality assurance requirements, and to meetall other reasonable criteria required by the plan of its in-network participating providers. It is possible the provideryou nominate will not agree to participate.

This option is available for an increased premium inaddition to the premium you would otherwise pay. Yourincreased premium responsibility will vary depending onwhether you have a single plan or family coverage, and onthe type of insurance, riders, and coverage. Exact pricingand any additional information can be obtained by calling1-888-772-9682. Please have your Aetna member ID cardavailable when you call.

HHaawwaaiiiiIInnffoorrmmeedd CCoonnsseenntt

Members have the right to be fully informed prior tomaking any decision about any treatment, benefit, or non-treatment.

Your provider will:

■ discuss all treatment options, including the option ofno treatment at all;

■ ensure that persons with disabilities have an effectivemeans of communication with the provider andother members of the managed care plan; and

■ discuss all risks, benefits, and consequences oftreatment and non-treatment.

Your provider will also discuss with you and yourimmediate family both living wills and durable powers ofattorney in relation to medical treatment.

IInnssuurraannccee DDiivviissiioonn TTeelleepphhoonnee NNuummbbeerr::

You may contact the Hawaii Insurance Division and theOffice of Consumer Complaints at 1-808-586-2790.

IIlllliinnooiissWhile every provider listed in the provider directorycontracts with Aetna to provide primary care services, notevery provider listed will be accepting new patients.Although Aetna has identified those providers who werenot accepting patients as known to Aetna at the time theProvider Directory was created, the status of the physician’spractice may have changed. For the most currentinformation regarding the status of any physician’spractice, please contact either the selected physician or callMember Services at the toll-free number on your ID card.

Illinois law requires health plans to provide the followinginformation annually to enrollees and to prospectiveenrollees upon request: a complete list of participatinghealth care providers in the health care plan’s service areaand a description of the following terms of coverage:

1. The service area;

2. The covered benefits and services with all exclusions,exceptions and limitations;

3. The pre-certification and other utilization reviewprocedures and requirements;

4. A description of the process for the selection of a PCP,any limitation on access to specialists, and the plan’sstanding referral policy;

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State Variations*

*In some states, Aetna provides additional consumer disclosures in documents also posted on our website at ww ww ww..aaeettnnaa..ccoomm.

5. The emergency coverage and benefits, including anyrestrictions on emergency care services;

6. The out-of-area coverage and benefits, if any;

7. The enrollee’s financial responsibility for copayments,deductibles, premiums, and any other out-of-pocketexpenses;

8. The provisions for continuity of treatment in the eventa health care provider’s participation terminates duringthe course of an enrollee’s treatment by the provider;

9. The appeals process, forms, and time frames forhealth care services appeals, complaints, and externalindependent reviews, administrative complaints, andutilization review complaints, including a phonenumber to call to receive more information from thehealth care plan concerning the appeals process; and

10. A statement of all basic health care services and allspecific benefits and services to be provided toenrollees by a State law or administrative rule.

Additionally, upon written request, the health plan willprovide enrollees with a description of the financialrelationship between the health plan and any health careprovider, including, if requested, the percentage ofcopayments, deductibles, and total premiums spent onhealth care related expenses and the percentage ofcopayments, deductibles and total premiums spent onother expenses, including administrative expenses.

KKaannssaassKansas law permits you to have the following informationupon request:

1. A complete description of the health care services, itemsand other benefits to which the insured is entitled in theparticular health plan which is covering or being offeredto such person;

2. A description of any limitations, exceptions or exclusionsto coverage in the health benefit plan, including priorauthorization policies, restricted drug formularies orother provisions which restrict access to covered servicesor items by the insured;

3. A listing of the plan’s participating providers, theirbusiness addresses and telephone numbers, theiravailability, and any limitation on an insured’s choice ofprovider;

4. Notification in advance of any changes in the healthbenefit plan which either reduces the coverage orbenefits or increases the cost to such person; and

5. A description of the grievance and appeal proceduresavailable under the health benefit plan and an insured’srights regarding termination, disenrollment, non-renewal or cancellation of coverage.

KKeennttuucckkyyAny provider who meets our enrollment criteria and who iswilling to meet the terms and conditions for participationhas a right to become a participating provider in ournetwork.

EEmmeerrggeennccyy MMeeddiiccaall CCoonnddiittiioonn DDeeffiinniittiioonn

A medical condition manifesting itself by acute symptomsof sufficient severity, including severe pain, that a prudentlayperson would reasonably have cause to believeconstitutes a condition that the absence of immediatemedical attention could reasonably be expected to resultin: placing the health of the individual or, with respect to apregnant woman, the health of the woman or her unbornchild, in serious jeopardy; serious impairment to bodilyfunctions; or serious dysfunction of any bodily organ orpart; or with respect to a pregnant woman who is havingcontractions, a situation in which there is inadequate timeto effect a safe transfer to another hospital before delivery;or a situation in which transfer may pose a threat to thehealth or safety of the woman or the unborn child.

LLoouuiissiiaannaaAetna will not in any way use the results of genetic testingto discriminate against applicants or enrollees.

MMaarryyllaannddBBeehhaavviioorraall HHeeaalltthh CCaarree EExxppeennssee FFoorrmm

To obtain a copy of the Behavioral Health Care ExpenseForm, please call the number located on the back of yourID card.

MMiicchhiiggaannContact the Michigan Department of Consumer andIndustry Services at 1-517-373-0220 to verify participatingproviders’ licenses or to access information on formalcomplaints and disciplinary actions filed or taken againstparticipating providers.

Upon request, pursuant to Michigan law, the followinginformation can be supplied to you:

1. date of provider certification by applicable nationallyrecognized board or other organization;

2. names of licensed facilities where providers haveprivileges;

3. prior authorization requirements and limitationsincluding medication formulary restrictions;

4. information about financial relationships betweenproviders and the health plan.


IInnttrraaccttaabbllee PPaaiinn CCoovveerraaggee

Aetna provides benefits for the evaluation and treatmentof intractable pain when it is determined to be medicallynecessary and otherwise eligible by Aetna. Intractable painmeans “a pain state in which the cause of the pain cannotbe removed or otherwise treated and which, in thegenerally accepted practice of allopathic or osteopathicmedicine, no relief of the cause of the pain or cure of thecause of the pain is possible or none has been found afterreasonable efforts, including, but not limited to, evaluationby the attending physician and by one or more otherphysicians specializing in the treatment of the area, system,or organ of the body perceived as the source of the pain.”

To obtain this and further information on the health plan,you may call Member Services at 1-888-772-9682.

TTeexxaassPlease refer to the plan design overview and summary ofriders contained in your pre-enrollment packet for a briefdescription of the services and benefits covered under yourparticular plan, as well as those services and benefits thatare excluded. After enrollment, you can refer to your plandocuments for a more complete description of yourcovered services and benefits and the exclusions underyour plan. For information on whether a specific service iscovered or excluded, please contact Member Services atthe toll-free number on your ID card.

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SSppeecciiaall EEnnrroollllmmeenntt RRiigghhttssIf you are declining enrollment for yourself or yourdependents (including your spouse) because of otherhealth insurance or group health plan coverage, you maybe able to enroll yourself and your dependents in this planif you or your dependents lose eligibility for that othercoverage (or if the employer stops contributing towardsyour or your dependents’ other coverage). However, youmust request enrollment within 31 days after your or yourdependents’ other coverage ends (or after the employerstops contributing toward the other coverage).

In addition, if you have a new dependent as a result ofmarriage, birth, adoption or placement for adoption, youmay be able to enroll yourself and your dependents.However, you must request enrollment within 31 daysafter the marriage, birth, adoption or placement foradoption.

To request special enrollment or obtain more information,contact your benefits administrator.

RReeqquueesstt ffoorr CCeerrttiiffiiccaattee ooff CCrreeddiittaabblleeCCoovveerraaggeeMembers of insured plan sponsors have the option torequest Certificates of Prior Health Coverage. This appliesto terminated members, and it applies to members whoare currently active but who would like a certificate toverify their status. Terminated members can request acertificate for up to 24 months following the date of theirtermination. Active members can request a certificate atany time. To request a Certificate of Prior Health Coverage,please contact Member Services at the telephone numberon the back of your ID card.


*While this Member Notice is believed to be accurate as of the publication date, it is subject to change. Please contact the Member Services departmentif you have any questions.

Health Insurance Portability andAccountability Act Member Notice*TThhee ffoolllloowwiinngg iinnffoorrmmaattiioonn iiss pprroovviiddeedd ttoo iinnffoorrmm tthhee mmeemmbbeerr ooff cceerrttaaiinn pprroovviissiioonnssccoonnttaaiinneedd iinn tthhee GGrroouupp HHeeaalltthh PPllaann,, aanndd rreellaatteedd pprroocceedduurreess tthhaatt mmaayy bbee uuttiilliizzeedd bbyy tthheemmeemmbbeerr iinn aaccccoorrddaannccee wwiitthh FFeeddeerraall llaaww..

While this information is believed to be accurate as of theprint date, it is subject to change.

This material is for informational purposes only and isneither an offer of coverage nor medical advice. Itcontains only a partial, general description of plan benefitsor programs and does not constitute a contract. Aetnaarranges for the provision of health care services. However,Aetna itself is not a provider of health care services andtherefore, cannot guarantee any results or outcomes.Consult the plan documents [Group Agreement, GroupInsurance Certificate, Group Policy] to determine governingcontractual provisions, including procedures, exclusionsand limitations relating to the plan. The availability of aplan or program may vary by geographic service area andby plan design. These plans contain exclusions and somebenefits are subject to limitations or visit maximums.

With the exception of Aetna Rx Home Delivery®, allparticipating physicians, hospitals and other health careproviders are independent contractors and are neitheragents nor employees of Aetna. Aetna Rx Home Delivery,LLC. is a subsidiary of Aetna Inc. The availability of anyparticular provider cannot be guaranteed, and providernetwork composition is subject to change. Notice of thechange shall be provided in accordance with applicablestate law. For up-to-date information, please visit ourDocFind® online provider directory atwwwwww..aaeettnnaa..ccoomm//ddooccffiinndd//ccuussttoomm//aaaahhcc.

Aetna is the brand name used for products and servicesprovided by one or more of the Aetna group of subsidiarycompanies. The company that underwrites benefitscoverage is Aetna Life Insurance Company. Aetna offerspart-time and hourly workers access to affordable healthand preventive care services through Strategic ResourceCompany (SRC), an Aetna company.


Notice to Members

IIff yyoouu nneeeedd tthhiiss mmaatteerriiaall ttrraannssllaatteedd iinnttoo aannootthheerr llaanngguuaaggee,, pplleeaassee ccaallll MMeemmbbeerr SSeerrvviicceess aatt 11--888888--777722--99668822..

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