This plan is being offered for the first time and provides the freedom of choice you experience with a Preferred Provider Organization (PPO) that allows you to receive both in and out of network benefits.

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. Copayments for prescription medications are not applied to the out-of-pocket maximum. Preventive services are covered in network at 100% of the allowable charge and are not subject to a deductible or co-insurance.

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 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 Care members have access to the BCBS provider network for covered services and the nationwide network for emergency care

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. Copayments for prescription medications are not applied to the out-of-pocket maximum

• 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!
• Get Smart About Your Health-Aetna's HMO includes your own Personal Health Record (PHR).
• Save with Aetna Discount Programs-Aetna offers: Vision Discounts, Gym Discounts, Vitamin and Gym Equipment Discounts, Hearing Aid Discounts, Massage Therapy Services and more.

Referrals are required for certain services and are obtained through your primary care physician.
Call customer service at 1-877-542-3862 to learn more about how Aetna HMO has everything you need to help you be your healthiest.

AETNA Reminder...

* Lab Corp is a Non-Participating Provider

* Quest Diagnostics is a Participating Provider

This plan supplements Medicare. Unless otherwise indicated on the Benefits Highlights pages in the Open Enrollment booklet, benefits will be paid as noted only after Medicare pays its full amount.

Summary Plan Description (SPD) for BCBSD’s Group Special Medicfill plan

Note:
Delaware Law mandates that you, your spouse and eligible dependents, elect Medicare Parts A & B when eligible.

When you enroll in a health care plan you will automatically be enrolled in the prescription drug plan managed by Medco Health Solutions, Inc. (Medco). The only exception is the Special Medicfill plan without Prescription coverage for those pensioners who have chosen to enroll in Medicare Part D for their prescription coverage. The Coordination of Benefits (COB) policy also applies to prescription coverage. If your spouse or dependents have other health coverage that is primary (pays first), the prescription coverage provided through the State’s plan for the spouse or dependents will become secondary.

2007 Prescription Copay Rates
State of Delaware Prescription Coverage	Tier 1 Generic	Tier 2 Preferred	Tier 3 Non-Preferred
30-DAY Supply	$8.50	$20.00	$45.00
90-DAY Supply	$17.00	$40.00	$90.00
*No Changes to CoPays in 2010		"Preferred" = Formulary