Aetna Golden Medicare Plan

1 More Benefits ThanOriginal MedicareAetna Golden Medicare Plan 7A-20908 (US) (10/02)2We Are Here To Serve YouIn order to make your health care decisions easier, we have providedsome helpful information to assist this brochure are a detailed Summary of Benefits, ProviderDirectory, an Enrollment Form and a postage-paid reply Navigator provides you with an easy-to-use website where you can: Order ID cards. Send e-mail inquiries to Member Services. Access interactive Cool Tools, including a medical dictionary. Review a preventive care planner that includes recommendations for screenings and on to click on the Navigator us directly with any questions you may have at 1-800-832-2640/TDD of this material into another language may be available.

2 For assistance, please call a sales representative at 1-800-832-2640/ TDD estar disponible la traducci n de este material en otro idioma. Por favor, para ayuda llame a un representante del departamento deventas al 1-800-832-2640/TDD 1-800-628-3323. Choosing a health plan is an important teaches us that the well-informed make the wisest choices. With that in mind, we are committed to providing you with accurate andrelevant information that is easy to understand. It s part of our businessphilosophy: Empowering people to make sound many years we have been providing our customers with quality health planoptions to meet their needs. With the Aetna Golden Medicare Plan, we continuewith that same proud tradition.

3 Our Aetna Golden Medicare Plan members enjoy: A wide choice of network physicians and hospitals. Virtually no paperwork when using network providers. Worldwide emergency brochure was designed to help you find the information you need quicklyand easily. We encourage you to take the time to review all of the documentsthat accompany this brochure. If you need further assistance, our dedicated salesprofessionals are always available to help you for considering the Aetna Golden Medicare Plan. We wish you the best of W. Rowe, From theChairman and CEOJohn W. Rowe, , is Chairman and CEO of Aetna Inc. He serves as a Professor of Medicine and Geriatrics at The Mount SinaiSchool of Medicine.

4 Before joining Mount Sinai, Dr. Rowe was a Professor of Medicine and the Founding Director of the Divisionon Aging at Harvard Medical School, and Chief of Gerontology at Boston s Beth Israel GoldenMedicare Plan The Aetna Golden Medicare Plan is a Medicare Advantageplan. That means we can administer health care benefitsfor Medicare beneficiaries through a special contract withthe federal government. When you enroll in the AetnaGolden Medicare Plan, Medicare pays us a set amount ofmoney for your covered care every month. In return, wemanage your Medicare coverage within our network ofhealth care providers. This funding arrangement allows us to provide more health care benefits than OriginalMedicare and many supplements.

5 It s that Call 1-800-832-2640/TDD 1-800-628-3323or visit our website at the PlanSpecialist and Hospital CareAs the coordinator of your care,your PCP will refer you to anetwork specialist or facility whenneeded. You must have a referralfrom your PCP to receive coveragefor any services the specialist orfacility provides, except foremergency and urgent care. Thosebenefits described as direct accessbenefits do not require a your convenience, manyprimary care offices canelectronically forward referralsdirectly to do not need referrals for: Routine visits to Your PCP Ob/Gyn care Annual mammograms Immunizations (pneumococcaland influenza) Emergency and urgent careUsing NetworkProvidersPrimary Care PhysicianAs a member of the Aetna GoldenMedicare Plan, you will need to selecta network primary care physician(PCP).

6 A PCP is an internist or generalpractitioner who knows your medicalhistory and coordinates all of yourcovered care. Your PCP will play a veryimportant role in your health PCP will: Provide routine and preventive care. Treat you for illness and injuries. Help you make important medical the size of our network,your doctor may already beparticipating with us. Just check theProvider Directory that accompaniesthis brochure or ask your salesrepresentative for assistance. If yourdoctor isn t in our network, we ll helpyou find one who meets your may also use DocFind on ourwebsite ( ) to locatea physician close to your you re not happy with your doctor for any reason, you mayalways select another Does It Work?

7 5 Questions? Call 1-800-832-2640/TDD 1-800-628-3323or visit our website at Access CareBecause preventive care and overall wellness are so important,you do not need a referralfromyour PCP to be covered for theservices outlined Access Gynecology Program Our members can visit any network gynecologist without areferralfor routine gynecologic care, including a Pap smear (whenappropriate). Our members may also visit a network gynecologistwithout a referral for gynecologicproblems and follow-up care. Your gynecologist may also issuereferrals for specialized care orspecific your PCP belongs to a physicianmedical group (PMG), you may only visit a gynecologist within thatgroup for routine gynecologic care,gynecologic problems and follow-upcare without a referral.

8 Also, yourgynecologist may only refer you to certain specialists within the may receive influenza andadult pneumococcal vaccines fromany network provider without areferral from your network PCP at no cost to you, although acopayment may apply for thephysician office BenefitsThe plan covers you for visits to your primary carephysician, specialist care andauthorized hospitalization allwith low or no Aetna GoldenMedicare Plan the TravelAdvantage program, you have access to the samebenefits you receive at home when you travel to another plan-approved service area. The Travel Advantage program is available in a limited number of service u re also covered for anyemergency 24 hours a day, 7 days a week, anywhere inthe Health and Wellness ProgramsPreventive care is the key to good health.

9 Take charge of your health by taking advantageof our special health and wellness ProgramsTo assist members in staying hearthealthy, we created Numbers ToKnow to promote blood pressureand cholesterol monitoring. In addition, Aetna mails annual adult preventivereminders for vaccination programsagainst illnesses such as influenza and pneumococcal pneumonia. Healthy Outlook Program Learn more about how to manageasthma, diabetes, heart problems andlow back pain. Our Healthy OutlookProgram provides you and your PCPwith educational materials andinformation resources to help youlearn how to develop healthier habitsand improve your quality of ScreeningsIt s a fact .. early detectiondramatically improves the chancesof successfully treating s why we send our memberstimely reminders to have regularscreenings for breast, colorectaland cervical cancers.

10 National MedicalExcellence Program Through this unique program, weprovide you access to nationallyrespected physicians and facilities if the appropriate treatment foryour complex illness or injury is not available locally. Whenprecertified, your care will becovered (less any applicablecopayments), as well as yourrelated transportation is also an allowance for acompanion. These programservices must be precertified under the National MedicalExcellence s CoveredFor a full explanationof benefits andlimitations, pleaserefer to the Summaryof Benefits located inthe back pocket ofthis Call 1-800-832-2640/TDD 1-800-628-3323or visit our website at Health Line Staying informed is one step youcan take toward meeting thechallenge to stay healthy.