Enhanced Benefits Program
Questions about who is eligible and how to apply
CONFIDENTIAL – FOR INTERNAL USE ONLY
General
What is the enhanced benefits program?
This program is designed to reduce out-of-pocket medical expenses for employees who qualify,
providing more affordable access to health care for themselves and their families. Eligibility in 2016 will
be primarily based on household income and size, and engagement in wellness activities.
When is it available?
The program is effective January 1, 2016 for eligible employees.
However, to enroll for 2016, you need to meet certain criteria by September 1, 2015 in order to qualify,
including:
• Applying for the program and providing information to show your total household income is
at/below a certain threshold
• Taking or updating your Simple Steps To A Healthier Life® health assessment
• Participating in metabolic syndrome testing (Please note: You don’t have to pass to qualify for
this program, just participate.)
• Completing one of three designated wellness programs
The application process for the enhanced benefits program opens in early April. You can begin your
wellness activities for this program on or after January 1, 2015. You need to complete them by
September 1, 2015.
I received the $16 wage increase this April; does that mean I am automatically eligible for this
program?
No; eligibility for the enhanced benefits program is based on your total household income, not just your
Aetna salary. Check the household income thresholds for your household size to see if you are eligible.
(See Household Income Testing section below.)
How does the program work?
This new enhanced benefits program is designed to help reduce out-of-pocket health care costs for
eligible employees. If you qualify for this program and meet the criteria, here’s how it works:
•
•
You enroll in our richest plan (the plan with the lowest deductible and out-of-pocket limits), but
You pay for our least expensive plan (the plan with the highest deductibles and out-of-pocket
limits).
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Enhanced Benefits Program
Questions about who is eligible and how to apply
CONFIDENTIAL – FOR INTERNAL USE ONLY
Is the program mandatory?
No, the program is voluntary, so you decide if it’s right for you and your family. If you are eligible, we
encourage you to consider the financial and physical benefits the program could offer you and your
family.
Is the program confidential? Will my manager or co-workers know I’m enrolling in this plan?
Yes, the program is confidential. Aetna HR will not share your benefits information with managers.
How do I know if this program is right for me?
We encourage you to check out the tools and resources on the Enhanced Benefits Program page on
Working at Aetna to learn more about the program. These include:
• A tool to quickly test your household income to see if you’re eligible
• Videos that explain the program features and finding the right fit for you
• Detailed FAQs about the program and what to expect
Program eligibility
Who is eligible?
Eligibility for the 2016 enhanced benefits program is based on the following criteria:
1. Household income. Your total household income for 2014 must fall below a certain threshold.
(See the “Household income testing” section below for more detail.)
2. Engagement in wellness activities. You must complete the following wellness activities by
September 1, 2015:
• Take or update your health assessment
• Participate in metabolic syndrome testing (Remember, you don’t have to pass to be
eligible for this program, just participate.)
• Complete one of three designated wellness programs
3. Other criteria: You must be eligible for Aetna medical benefits and based in the U.S. (Employees
living in Hawaii are not eligible.)
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Enhanced Benefits Program
Questions about who is eligible and how to apply
CONFIDENTIAL – FOR INTERNAL USE ONLY
If I qualify and complete all of the criteria by September 1, do I have to enroll in the enhanced benefit
plan?
By submitting an application and completing all of the criteria, you are choosing to participate in the
enhanced benefit program for 2016. During annual enrollment in 2015, only the richest medical plan
will be presented to you as an option.
However, if you wish to enroll in a different plan, you will need to contact the HR Contact Center (1-800238-6247) during annual enrollment.
What medical plan would I be enrolled in, if I qualify for the enhanced benefits program?
You will be enrolled in our richest medical plan, which is our HRA 1000 plan, but you will pay for our
least expensive plan (the plan with the highest deductible and out-of-pocket limits).
Additional detail about this plan is available in our Medical Plan FAQs on the Enhanced Benefits Program
website on Working at Aetna.
Can I qualify if I am on short term disability (STD)?
Yes, you can qualify if you are on short term disability.
Can I qualify if I am on long term disability (LTD)?
No, you are not eligible to participate if you are on long term disability. Employees who are on long term
disability are enrolled in unique medical plans and therefore cannot enroll in this program.
Can I qualify if I am on leave?
Yes, you can qualify if you are on leave.
Can I qualify if I’m part time?
To qualify, you must normally be scheduled to work 20 or more hours per week.
I work for an acquired company (bswift, Prodigy, Healthagen, etc.). Am I eligible?
Yes, you are eligible for the enhanced benefits program, assuming you meet the program criteria.
My spouse isn’t covered on my Aetna plan. If I am eligible for the program, can I add him/her to this
enhanced benefits program next year?
Yes, you can add dependents during annual enrollment. New dependents will be subject to our standard
dependent eligibility verification process.
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Enhanced Benefits Program
Questions about who is eligible and how to apply
CONFIDENTIAL – FOR INTERNAL USE ONLY
I was just hired; can I still apply for the enhanced benefits program for 2016?
It depends on when you were hired, because you need to complete certain wellness activities this year
in order to qualify for the program.
You need to start your wellness program between mid-April and early June (depending on the program
you select), so that you could complete that program by the September 1, 2015 deadline. If you started
after early June, you won’t be able to complete a wellness program in time to meet the program
deadline. However, you would be able to apply for the program in 2016, for a 2017 effective date.
Check out the Wellness Activities FAQs for more information about wellness program options and
timing.
Household income testing
Why is eligibility for the new enhanced benefit program based on my household income, and
not my salary?
We know that affordability means different things, depending on your situation. That’s why, for
our new enhanced benefits program, we’re looking beyond salary, to consider your:
•
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Total household income
Household size
By looking at the total household income and size, we are able to identify our employees who
can financially benefit the most from this program.
How do you define “total household income?”
Total household income is based on your adjusted gross income, which you can find on your 2014
federal income tax return.
Your 2014 total household income, combined with your household size, is used to determine if you are
eligible for the enhanced benefits program. Your total household income must be at or below the
federal benchmark used for this program.
Your total household income includes the income of anyone who is considered part of your household.
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Enhanced Benefits Program
Questions about who is eligible and how to apply
CONFIDENTIAL – FOR INTERNAL USE ONLY
How can I test to see if my 2014 household income meets the criteria for the program?
You can test your 2014 household income by:
• Using the tool available on the Enhanced Benefits Program website on Working at Aetna, or by
• Comparing your income to the table below:
Household size
1
2
3
4
5
6
7
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2014 income must be at/below this
federal benchmark
$35,010
$47,190
$59,370
$71,550
$83,730
$95,910
$108,090
$120,270
What benchmark is used for total household income for this program?
The enhanced benefit program uses 300% of the federal poverty level as the threshold for total
household income. If your income is at or below this benchmark, you qualify for the program.
How do I define my “household” size?
You may include yourself, any individual claimed on your 2014 federal income taxes and certain other
individuals who resided with you during 2014. This includes your domestic or civil union partner,
children of your domestic or civil union partner and children up to age 26 residing with you.
If someone is a dependent on my health plan, can I assume they are also part of my household, when
I apply for this program?
Yes, as long as they reside with you.
My spouse isn’t on my Aetna plan. Is she/he still considered part of my household?
Yes. Your spouse does not need to be on your Aetna plan to be considered part of your household.
If my spouse and I file our taxes separately, is she/he still considered part of my household?
Yes, but if you file separately you will be asked to provide 2014 federal income tax filings for both
yourself and your spouse.
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Enhanced Benefits Program
Questions about who is eligible and how to apply
CONFIDENTIAL – FOR INTERNAL USE ONLY
For this program, does Aetna consider the following as part of my household and eligible for the
program?
Domestic partner
Yes
Same sex spouse
Adult child (over age 26) living at
home
Parent living in my household
Yes
No, unless disabled
Parents living in your household are
considered part of your household when
defining your household size.
However, they are not eligible for coverage
under the medical plan.
If I meet the household income requirement, am I enrolled into the program?
No, you still need to apply and meet the additional program criteria, including the wellness activities.
What if I meet the household income requirement, but decide I don’t want to enroll in this program?
Can I opt out?
Enrollment in the enhanced benefit program is optional. If you meet the household income
requirement, you can still decide not to apply for the program and opt for a different plan during annual
enrollment for 2016 benefits by contacting the HR Contact Center.
Does total household income include a second source of income or just my Aetna salary?
Yes, household income includes all income included in your adjusted gross income reported on your
federal income tax filing.
I don’t think I qualify based on my household income, but I have other circumstances that I think
should qualify me for this program. Are there exceptions to the household income requirement that
would allow me to enroll?
No, household income is one of the criterion you must meet to be eligible for this program.
If I don’t qualify for the program today, but my household income changes mid-year, can I still apply
for the program?
Your eligibility for the 2016 enhanced benefit s program is based on your total household income in
2014. So a change this year to your income would not make you eligible for the 2016 benefits program.
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Enhanced Benefits Program
Questions about who is eligible and how to apply
CONFIDENTIAL – FOR INTERNAL USE ONLY
How to apply
How can I apply for the program?
You can apply by visiting the Enhanced Benefits Program website on Working at Aetna.
What documentation do I need to submit?
You will need a copy of the 2014 federal tax return(s) filed with the IRS to verify your household
income. Examples of acceptable tax forms include the 1040, 1040-A, 1040-EZ and 1040-X.
If you and your spouse filed separately for 2014 or if you include a domestic partner or civil union
partner in your household, you will need to provide copies of both of your returns.
Can I apply over the phone?
We are not able to accept applications over the phone. You will need to submit your application,
available on the Enhanced Benefits Program website on Working at Aetna, either by fax or mailing to the
US Postal Service. The fax number and mailing address are included on the application.
If you have any questions during the application process, you can call the Aetna HR Contact Center
directly at 1-800-AETNA-HR (1-800-238-6247) between 8 a.m. and 8 p.m. Eastern time.
Is it confidential?
Household income is one of the key criteria that help us determine who is eligible for the program. We
understand that this information is sensitive and you may have some concerns about sharing it.
So, we’ve created a process that is both secure and confidential. Your household income data will be
collected by a third party and not shared with Aetna. It will only be used to determine if you are eligible
for the program.
Is it secure?
Yes, the process is secure. All of our vendors must meet rigorous security requirements.
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Enhanced Benefits Program
Questions about who is eligible and how to apply
CONFIDENTIAL – FOR INTERNAL USE ONLY
What’s the deadline to submit my materials?
The deadline to submit your application for 2016 is September 1, 2015. However, we encourage you to
apply early to determine if you qualify.
It’s also important to note that in addition to your application, you also need to complete the following
steps by September 1, 2015 to qualify for the program:
• Take or update your health assessment
• Participate in metabolic syndrome testing
• Complete a designated wellness program
What to expect after you apply
How will I know my application was received?
You will receive a confirmation via your secure mailbox on Working at Aetna when your application is
received. You can also track your progress on the program’s website.
How long will it take to get approval?
Typically it will take 7 to 10 days to process your application and send you a response.
Once I’m told my household income was approved, is that it? Do I qualify?
Household income is just one of the criteria you need to meet to qualify for the program. You also need
to complete the following wellness activities by September 1, 2015:
• Take or update your Simple Steps To A Healthier Life health assessment
• Participate in metabolic syndrome testing (Remember, for this program, you just have to
participate; you don’t have to pass.)
• Complete one of three designated wellness programs
You can learn more about these wellness activities by visiting the Enhanced Benefits Program website
on Working at Aetna. On that site, you can also track your progress as you complete each of these
requirements.
I was told I don’t qualify for the program based on my household income. I don’t agree. Who can I talk
to?
Please contact the HR Contact Center at 1-800-AETNA-HR anytime between 8 a.m. and 8 p.m. Eastern
time.
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Enhanced Benefits Program
Questions about who is eligible and how to apply
CONFIDENTIAL – FOR INTERNAL USE ONLY
Will I receive a confirmation notice in September letting me know I can enroll in the enhanced
benefits program for 2016?
Yes, after the September 1, 2015 deadline, we will confirm that you qualify for the enhanced benefits
program and will be enrolled into that program for 2016, assuming you have met all the criteria for the
program.
That’s in addition to the confirmation you will receive after you initially apply, if your income meets the
threshold.
You will also be able to check your progress throughout the year on the Enhanced Benefits Program
website on Working at Aetna.
What happens if I don’t meet all the program’s criteria by September 1, 2015?
If you don’t meet the program’s criteria by September 1, the enhanced benefits program won’t be
available to you for 2016. You will receive a notice from us letting you know that you didn’t meet the
criteria and therefore cannot enroll in the program for 2016.
Who can I call if I have questions about applying for the program?
Please contact the HR Contact Center. You can:
• Start a web chat with a HR representative by going to the home page of the Working at Aetna
site, or
• Call the Aetna HR Contact Center directly at 1-800-AETNA-HR (1-800-238-6247) between 8 a.m.
and 8 p.m. Eastern time.
For more information
Check out more in these additional FAQs on the Enhanced Benefits Program website on Working at
Aetna:
• Wellness Activities FAQS
• Medical Plan FAQs
Aetna reserves the right to interpret its benefit plans and programs and to make rules and procedures necessary to administer
its plans and programs, including determining eligibility for benefits. Aetna can change or terminate its plans and programs at
any time, for any reason, and can revise the plans or programs and restrict eligibility as it deems necessary to comply with
applicable laws.
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