CarMax Aetna Medical Plan Welcome Guide 2015

to your CarMax Medical Plan
Your guide to specialized services, wellness
programs and online resources
You are an important part of CarMax’s success, and
we’re proud to offer you benefits that fit your life.
From medical and prescription drug coverage to
wellness programs and extra support, you’ll get what
you need to live your healthiest. In this guide, you’ll
find ways to get the most from your benefits, tips
for saving money and resources to help you take
ownership of your health.
Questions? Not sure where to start?
Call your Aetna Health Concierge at 1-866-498-5004
No matter your question or need, start here. Your Aetna Health Concierge is
the first person you should speak with about benefits. He or she will help
you put all the pieces together — benefits, services, programs and tools.
Get answers to questions about your medical, dental and life insurance,
as well as your leave of absence and disability benefits.
Ask about a claim, request an Aetna member ID card or learn about the free
wellness programs that are available as part of the CarMax Medical Plan.
Whenever you need help navigating your CarMax Medical Plan, call Aetna
at 1-866-498-5004, Monday through Friday, 8 a.m. to 6 p.m. Or log in
to your secure Aetna Navigator® member website at and
click on “Contact Us” to send an e-mail. Use the one toll-free number to
reach all of the great resources available to you.
Get the most from your CarMax Medical Plan
Your CarMax Medical Plan is so much more than health benefits. In fact, you and your covered family members have access to programs and services
that are designed to make the most of your plan, and even save you money. These programs and services are available at no extra cost.
Start using them today!
Aetna Navigator – a centralized location for your Aetna benefits.
Find a doctor, complete your online health assessment, get claims
information, access tools to help you save on health care costs and
join free wellness programs. Learn more on page 2.
Get your mobile apps
Learn about your health on page 5
Choose the right place for care on page 6
24-Hour Aetna Nurse Line – for quick medical questions
etail walk-in clinic – for minor illnesses and injuries like the flu
and sprained ankles
New! Teladoc® – 24/7/365 access to doctors by phone or online
video for non-emergency care
doctor – for wellness visits, routine care and chronic illness
and injuries
care center – for more serious illnesses and injuries like
fever and fractures
E mergency room – for serious, life-threatening illness and injuries
like chest pain and uncontrolled bleeding
Get and stay healthy
■ Take
a Health Assessment – learn more about your health and
how to improve it as well as ways to earn premium credits in your
paycheck. See page 8 for more information.
T alk with a Healthy Lifestyle Coach – for help reaching a health
goal like losing weight or quitting smoking. Personalized coaching
helps keep you motivated. See page 9.
Manage your health on the go with free apps.
Aetna Mobile lets you access your health
information so you can check coverage, search
for a provider, view your claims and more.
The iTriage® app gives you quick and easy
access to medical information, including
searching symptoms.
The Aetna Resources For Living app gives you access to support
and resources to help you manage issues that impact your work,
life and well-being.
You can schedule appointments, check your results, share information
and more using the MyQuest® mobile app.
The CVS app lets you refill a prescription, check drug costs and find
a nearby MinuteClinic®.
Download these free apps from the App StoreSM or Google Play™ for Android™.*
*Android and Google Play are trademarks of Google, Inc. The App Store is a trademark of Apple, Inc.
Prescription drugs – get information about your coverage on
page 12.
Aetna Resources For LivingSM – from counseling and discounts to legal
and financial services, you can get extra support where you need it
most. Learn more on page 13.
Aetna Navigator secure
member website
Aetna Navigator helps you save time and make informed
decisions about your health
On your personalized Aetna Navigator Dashboard, you get an at-a-glance view of your
most important information. And the more you use it, the more the Aetna Navigator
Dashboard changes to fit your needs.
Use self-service features
Find network doctors
Order a new ID card or print a temporary one
See what’s covered by your plan
Track your health care spending
Find answers
Learn about symptoms or a specific diagnosis
Estimate your share of costs with online tools
Access your Personal Health Record to print records of preventive shots
and checkups (page 4)
Get involved in your health
Take a Health Assessment (page 8)
Join online health improvement programs (page 8)
Monitor your health activity score in your Personal Health Record (page 4)
Send and receive messages with your Aetna health team
Know before you go
Not all doctor bills look the same. Your choices can make a difference in how
much you pay out of pocket for your healthcare. So know before you go. Before
your next office visit or procedure, find estimated health care costs by logging
in to Aetna Navigator.*
Member Payment Estimator
For even more personalized cost estimates, use the Member Payment Estimator.
This tool lets you search for and compare actual costs for common procedures,
treatments and physician services. You can find the link to “Use Member Payment
Estimator” right on your Aetna Navigator home page.
*Estimated costs not available in all markets or for all procedures. Actual costs may differ
for a number of reasons, including if other or different services are performed by the doctor
or facility at the time of your visit, and/or additional claims/member payments are processed
before the actual claim for the estimated service is processed.
Register once.
Log in anytime.
Have your Aetna member ID card
ready when you register.
Step 1: Go to
Step 2: Click on the “Log In/Register”
Step 3: Follow the simple prompts.
Be sure to provide a valid e-mail address
when you register, so you’ll be able to get
Explanation of Benefits (EOBs), updates
and information electronically. Stay up to
date on your coverage and claims details
by agreeing to receive e-mail notices.
Find quality doctors and hospitals
When you’re an Aetna member, finding quality health care is a snap with the
DocFind® search tool. With just a few clicks, you can find an in-network doctor,
dentist or facility. You can also find the closest walk-in clinic or urgent care center,
or even locate an emergency room. Your results are personalized, and you can search
by city, state, specialty and gender. Remember as you choose your provider that you
save money when you stay in network.
To access DocFind, follow these quick steps:
Step 1: Log in to Aetna Navigator at
Step 2: Click on “Find a Doctor” in the left menu bar.
Step 3: Fill in the prompts to search for a provider.
When you’re on the move, Aetna Mobile goes with you
Life takes you many places. No matter where you are, you still want easy
access to your health information and tools to make the best decisions
you can. Aetna Mobile web and the Aetna Mobile app put the most
popular online features at your fingertips.
You can:
Search for a doctor, hospital or pharmacy
■ Log in to Aetna Navigator to:
– View claims and coverage
– View your Personal Health Record (PHR)
– Get contact information, and more
Look for quality
★ These doctors have
been designated as Aexcel®
specialists because they
have a track record for
excellent clinical performance
and lower costs.
The Aetna Performance
Network includes hospitals
and other health care facilities
that are shown to have great
performance and lower
costs as well. Like the Aexcel
specialists, the checkmark next
to the facility’s name tells you
they have been approved for
their quality and efficiency, too.
Keep your health information
in one easy place
It’s not always easy to remember the
specifics of your Aetna health history.
Your Aetna Personal Health Record gives
you fast, easy access to your health
history. You can review it, use it to fill out
health forms or share it with your doctor.
Research the smart way with Aetna SmartSourceSM
Your Personal Health Record (PHR) is automatically updated
Need to learn more about a specific health condition or upcoming surgery?
The Aetna SmartSource search tool can help you research conditions, symptoms,
illnesses and more.
Your PHR stores information about your family health history, immunizations,
prescription and over-the-counter medications, tests and procedures, and more.
Whenever you visit the doctor, Aetna will automatically add the information to
your PHR. You can also include other information, like family history or medications,
at your convenience.
It delivers information that’s specific to you based on where you live and the
Medical Plan you are in.
Let Aetna SmartSource show you:
Doctors in your area that treat the researched condition
Commonly prescribed medications and treatment options
Estimated health care costs
Aetna discounts that can help you manage your condition
Easy-to-understand health articles and tips
You’ll find Aetna SmartSource under the “Care & Treatment” tab on your
Aetna Navigator home page.
Use your PHR to provide your doctor with your most complete health history.
Link to your PHR on Aetna Navigator:
Step 1: Log in at or through the Aetna Mobile app.
Step 2: Look in the “I want to …” menu.
Step 3: Click on “View Personal Health Record.”
Learn about your health
iTriage helps you find the care you need, wherever you are. The app gives you
quick and easy access to medical information, including searching symptoms.
It helps answer two questions: “What can be wrong with me?” and “Where can
I go for care?” Using the app, you can:
C heck symptoms and find possible causes
Research tests, treatments, procedures and
Learn which treatment path may be appropriate for you
Find the closest medical provider, book an appointment and get directions
Look up ER wait times
To get started, simply download the free app from Google Play or the App Store.
You can also text “iTriage” to 31996 or visit Standard
text messaging rates may apply.
Save money by using
Quest Diagnostics®
Quest Diagnostics is the preferred
in-network provider for lab work.
Aetna negotiates rates with Quest
Diagnostics labs, so you’ll pay the
least when you use them for
services. Quest Diagnostics also has
a free mobile app that you
can use to check your results,
schedule appointments and more.
To download, search your app store
or visit
and click on “MyQuest.”
Choose the right place for care
Where should you go when you need care?
Naturally, if you have a severe or life-threatening medical emergency, the emergency room is where you need to go. But for many other medical issues,
there are other options that could save you time and money. Use the following chart to choose where to get the care you need.
In-Network Providers (Finding a Doctor)
For help finding a provider in your area, visit,
click “Find a Doctor” and select Aetna Choice® POS II (Open Access).
Or call 1-866-498-5004.
24-Hour Aetna Nurse Line
Call 1-800-556-1555 and select the option to speak with a nurse.
In-network providers for the Medical Plan include those physicians and hospitals
that participate in Aetna’s Choice POS II (Open Access) network. Choosing in-network
providers gives you the most value from your Medical Plan benefits. Using an
out-of-network provider will increase your out-of-pocket costs through deductibles
and coinsurance amounts and a higher out-of-pocket maximum.
Aetna offers Plan Members a free 24-hour nurse line (Informed Health® Line) to help
you anytime day or night. The nurses can help you:
Retail Walk-In Clinic
Log in to Aetna Navigator at to find your
closest location.
Teladoc Service
Call 1-855-Teladoc (835-2362)
Use Teladoc on the go
Now you can access your account, manage your health record and
request an appointment from anywhere with the Teladoc app. To get
started, download the free app from Google Play or the App Store.
Learn about medical procedures and treatment options
Prepare for a conversation with your doctor
Determine if you need immediate care (e.g., the emergency room) or if you can
wait to see your doctor during normal business hours
Walk-in clinics are typically found in retail businesses such as CVS® pharmacies,
Target® stores or Walgreens® pharmacies. These clinics are run by registered nurses,
nurse practitioners or physician assistants.
You should consider a retail walk-in clinic when you have the need for immediate care
that is not urgent — examples include the treatment of cold/flu symptoms, rashes or
basic infections. You can also get many wellness exams and routine physicals. And CVS,
Target and Walgreens clinics are all in the Aetna network!
Aetna members have access to the Teladoc program which provides you with 24/7/365
access to doctors by phone or online video. To access the Teladoc program, you need
to set up an account on the Teladoc website, then you can request an appointment
anytime and from any place where you have access to a phone or online video.
Teladoc is a convenient and affordable option that allows you to talk to a doctor who
can diagnose you, recommend treatment and prescribe medication, when appropriate,
for many of your medical issues. You should consider Teladoc when you have sinus
problems, allergies, cold and flu symptoms, ear infections, etc.
Teladoc may not be available in all states.
Primary Care Physician Office Visit
To find an in-network provider, log in to
Specialist Office Visit
To find an in-network provider, log in to
Urgent Care Clinic
Log in to Aetna Navigator at to find your
closest location.
Emergency Room
Log in to Aetna Navigator at to find your
closest location. Call 911
for emergency care.
You should always talk with your primary care physician (PCP) about all your health
issues so that he or she can understand and help you manage your overall health.
Your PCP should handle your annual physical, any health concerns and coordinate
treatment plans.
Although referrals are not required by the Plan, before going to a specialist, you
should talk with your PCP to make sure you are seeking care from the right provider.
When seeking a specialist, remember to look for the blue star in the DocFind section
of the website. This designates the provider as a member of the
Aexcel Network, which means they have been recognized by Aetna as a high quality,
cost-effective provider.
Urgent care is treatment for non-life-threatening injuries or illnesses such as
fractures, whiplash, sport injuries, cuts and minor lacerations, allergies, infections,
flu, gallstones, burns or rashes. Urgent care clinics are freestanding buildings in busy
areas. They typically have a physician onsite and accept walk ins. Costs are typically
higher than retail walk-in clinics, Teladoc or a PCP office visit, but are much less than
an emergency room visit.
Emergency room visits should be limited to significant medical emergencies like:
broken bones, head injury, knife/gunshot wound or a severe burn; critical
life-threatening situations (e.g., heart attack, stroke, acute asthma attack, etc.);
sudden onset of symptoms that suggest a serious or life-threatening situation could
develop if left untreated (loss of consciousness, paralysis, shock, coughing blood,
trouble breathing, chest pain, choking, etc.); and life-endangering mental health
or substance abuse situations.
If you get care in an emergency room and your symptoms did not indicate an
emergency, no benefits will be paid. If you are admitted to the hospital or surgery
is performed, you must notify Medical Management of an emergency admission
within 48 hours or you will be subject to a Precertification Penalty.
Emergency room visits will vary widely in cost, based on the services rendered.
Commit to your health — get and stay healthy
Start with a Health Assessment
Move toward a healthy lifestyle
What does good health mean to you? It all depends on where you are right now —
and where you want to be. Whatever your situation, we want to help you take that
first step — and keep going.
Answer questions about your health history, habits and more. It takes about 20 minutes
and is part of fulfilling your Commitment to Health as a CarMax Associate. After
completing the Health Assessment, you’ll get a Personal Health Report that will help
you understand where you are today and how to make improvements for tomorrow.
Simple Steps To A Healthier Life® program
■ Have
This self-guided online health and wellness program gives you easy-to-follow steps
to achieve your health goals. The program can help you lose weight, eat better,
lower your cholesterol and more.
your Aetna member ID card and biometric screening numbers (blood pressure,
glucose, cholesterol and other health screening results) ready before you begin
Log in to Aetna Navigator at
Under the “I want to …” menu, click on “Take a Health Assessment”
If you’re at risk for metabolic syndrome, or if you use tobacco, you’ll need to work
with a Healthy Lifestyle Coach to keep your medical plan credit. You can also
enroll in a free online wellness program to get even more support and help to live
your healthiest.
Take action with your own online wellness plan.
Once you complete your Health Assessment, you’ll get a recommendation
for online health programs, called “Directions.” You can click on “Follow your
HealthMap” to see the Directions recommended based on your answers.
You can also access all of the Directions by clicking on “HealthMap” in the
left navigation. Directions include:
■ Be
Tobacco Free
■ Blood
Pressure in Check
■ Diabetes
■ Heart-Healthy
■ Live
Well with Asthma
■ Sleep
■ Eat
■ Stress
■ Get
■ Weigh
■ Healthy
■ Health
in a Hurry
Within each Direction there are several “Journeys” you can take, which allows you take
steps to better health at your own pace.
Get to know a personal health coach
The Healthy Lifestyle Coaching program offers personal coaching and support from
experts who specialize in a wide range of healthy topics. Your personal health coach
will help you set the goals that are most important to you and help you stay
motivated. Your coach is available for daytime, evening and even some weekend
appointments, so you can schedule a time that’s convenient for you. Even better —
your personal coach is provided at no cost to you!
Remember, Healthy Lifestyle Coaching is an important part of the CarMax
Commitment to Health Program. If your biometric screening indicates that you are
at risk for metabolic syndrome, or if you use tobacco, you will need to complete two
coaching sessions by October 15 in order to keep your medical plan credit.
Your coach can help you:
■ Discover
ways to put better nutrition on your plate
Find ways to add physical activity to your day
Practice disease prevention
Contact a
health coach
If the answers in your Health
Assessment show you could
benefit from Healthy Lifestyle
Coaching, a coach may call you
directly. But, you don’t have
to wait — sign up or contact
a coach at 1-866-213-0153.
Coaches are available Monday
through Friday, 8 a.m. to 8 p.m.
local time.
Your coach will be there for you
Once you start working with your coach, you will always stay connected to the
same person. They are with you to help you make the changes — and celebrate
your successes! Your personal coach will help you make a plan for the health issues
that are most important to you, and help you stay motivated. Examples of coaching
programs include:
Weight Management — coaching to help you find your motivation to get to and
maintain a healthy weight. Create your own success story and improve the way you
feel, every day. Learn that it’s not just what you eat, but how you eat. And learn
how to change your relationship with food and exercise for the long term.
Tobacco Cessation — coaching to help you kick the habit, for good. Learn successful
quitting strategies as your coach helps you recognize and manage your triggers for
tobacco use. Plus, learn about healthy alternatives to replace the feeling you get from
tobacco use, so you can feel your best each day — without tobacco.
Stress Management — coaching to help you understand and better cope with
stress. Learn what your stressors are and how you can respond to them to restore
your balance. By learning to be more mindful, you’ll reduce stress, improve
communications, sleep better and live a more fully engaged life.
Nutritional Counseling — coaching to help you address particular dietary needs.
If the results of your biometric screenings suggest that you could benefit from a
specialized diet, this free service is a great place to start. Work with a registered
dietitian to learn about your diet, dietary needs, eating behaviors, caloric needs
and meal planning, as well as shopping tips and strategies for improving your
nutrition. Whether you need to focus on a low-sodium diet, heart-healthy foods or
smarter choices for a chronic condition like diabetes, you can improve your eating
habits and move toward a healthier you with this specialized coaching.
Sign up today
If an Aetna In Touch Care nurse is calling,
be sure to take the call. Or if you have
been diagnosed with a chronic condition,
don’t wait for the phone to ring! Call your
Aetna Health Concierge at 1-866-498-5004
and ask to sign up for the Aetna In Touch
Care program.
Let an Aetna In Touch CareSM nurse help with your case
One nurse — one member
When your records show you have an upcoming hospital stay or if you have a chronic
condition, like diabetes, high blood pressure or asthma, an Aetna In Touch Care nurse
or consultant will call to offer support. While an In Touch Care nurse won’t replace
your doctor, he or she will become your advocate. You’ll get someone you can trust
to talk about your health condition and how to navigate the health care system.
One specific nurse will work with you every time you need help. That way, you can
build a relationship while the nurse gets to know your unique health history. If any
other covered family members have health risks, they may choose to work with the
same nurse, or a different one if they prefer.
You can choose to work one-on-one with your assigned nurse or use the online
programs that your nurse suggests. You can even try both options to see which works
best for you. Even if you use the online programs, you can still connect with your
nurse when you have a question or issue.
This single-point-of-contact approach helps you feel more comfortable when
discussing issues.
The Aetna In Touch Care nurse can:
■ Provide
education and information regarding all your health issues
Direct you to the most appropriate health care
Better coordinate multiple layers of care, and more
Give your baby a healthy beginning
Take advantage of health-related discounts
The Beginning Right® maternity program can help you learn about what to expect
before and after delivery, prenatal care, preterm labor symptoms, how to care for
newborns and so much more. There are also educational materials for fathers-to-be.
All information is available in English and Spanish.
As an Aetna member, you’ll have access to discounts on health-related products and
services that aren’t normally covered by your Medical Plan.
When you join the Beginning Right maternity program, you can receive an incentive*
to help with those extra expenses when your baby arrives. You can earn:
■ $50
when you join by your 16th week of pregnancy
$100 when you participate in the program and complete a post-partum survey
Resources for high-risk pregnancies
The Beginning Right maternity program can help you find out if you’re at risk for
pregnancy-related conditions. If you’re eligible, an Aetna nurse will help manage
your care and guide you through your pregnancy so you can avoid anything that
could harm you or your baby.
You’ll also have access to the NeoCare SolutionsSM program. If you have a child in
the neonatal intensive care unit (NICU) for three days or longer, you’ll get access
to the NeoCare mobile platform. The program gives you live support from a Neo Coach,
digital tools and personalized resources to help you navigate the complexity of
having a child in the NICU. This program can be used for the first year of your
child’s life, if desired.
*Incentives will be paid to the Associate whose coverage includes the Beginning Right
participant. Payment(s) will be included in the Associate’s paycheck after completion of the
incentive requirements. The Associate must be an Active Associate to receive the incentive.
If the Associate terminates employment, any remaining incentive will not be paid. Incentive
payments are subject to ordinary income taxes. Allow up to eight weeks for processing
depending on when the incentive requirement was completed.
Discounts include:
■ Extra
pairs of glasses or contact lenses
■ Hearing aids and batteries
■ Fitness club memberships for thousands of gyms in the GlobalFit® network. Many
national chain and independent gyms belong to the GlobalFit network. To find a
gym close to you:
– Visit
– Call 1-800-298-7800
■ Home exercise equipment
■ Weight-loss programs like Jenny Craig® and Nutrisystem®
■ Massage therapy, aromatherapy and other natural health products and services
■ And so much more
There are no claims, referrals or limits on how often you can take advantage of these
discounts. And these discounts are available to your family members enrolled in the
plan as well.
Start saving today
Step 1: Log in to Aetna Navigator at
Step 2: Mouse over the “Health Programs” tab.
Step 3: Click on “See the discounts” under the “Get discounts” section.
Join the program
Call 1-866-498-5004 to join the
program. Sign up as soon as
you know you or your spouse is
pregnant. Follow the prompts to
the Beginning Right maternity
CVS CaremarkTM Prescription Drug Plan
Your prescription drug benefits are administered by CVS Caremark.
Go to any licensed pharmacy
Visit one of nearly 67,000 pharmacies in the CVS network, including:
■ More
than 7,300 CVS/pharmacy® stores
major pharmacy chains like Walgreens and Rite Aid
Pharmacies located in large retail stores and grocery chains
Local and independent pharmacies in your area
See which drugs are covered
The plan covers drugs at different benefit levels depending on whether they are
generic, preferred brand-name drugs or nonpreferred brand-name drugs. The
Performance Drug List shows which drugs are covered at what level. You can find
a copy of the list at or at
■ Other
Save 20% on CVS-brand health products
MinuteClinic® is a walk-in medical clinic and is staffed by nurse practitioners and
physician assistants* who specialize in family health care. This non-emergency
health facility cares for children and adults, every day with no appointment needed.
When you join the plan, CVS will send you an ExtraCare Health Card so you can save
20% on all CVS-brand health-related purchases. Already have a CVS ExtraCare Rewards
Card? Link the ExtraCare Health Card with your current CVS ExtraCare Rewards Card for
even more savings. Look for details when you receive your ExtraCare Health Card.
*MinuteClinic employs physician assistants in select states.
If you don’t have an ExtraCare Health Card, call Caremark to get one!
On the move
Find a participating pharmacy
The CVS/pharmacy app lets you refill a prescription, check your
rewards and find a nearby pharmacy or MinuteClinic.
Log in to or use the CVS Caremark app to find a location
near you.
Save on prescription drug costs with Maintenance Choice®
Do you take maintenance medications regularly? These are drugs that treat conditions
like arthritis, asthma, diabetes or high cholesterol. With Maintenance Choice, you can
fill your maintenance medications through mail order or at your local CVS/pharmacy.
Either way, you’ll get a 90-day supply for the same cost as a 60-day supply at a retail
■ Have
medications mailed directly to your home address
up your maintenance medications at a local CVS/pharmacy
Register at to sign up for mail order and provide
payment information
■ Pick
Questions about
prescription benefits?
Call CVS Caremark Customer Care
at 1-855-361-8564 or check out
Enjoy more time for what matters most
Aetna Resources For Living, formerly the Aetna Employee Assistance
Program (EAP), is more than your typical EAP. It’s a total work-life solution for busy
people like you.
Counseling services include resources and information on issues like:
■ Mental
health and well-being
Personal and professional relationships
Substance abuse
Family life
Daily stress
Services are always free and confidential. They are available to you and all members
of your household, even if they are not Aetna members.
Get support
Aetna Resources For Living is
available 24/7 either by phone
or online.
Call 1-866-498-5004 toll-free
and follow the prompts.
V isit,
then enter MYKMXEAP as your
Company ID.
When you contact Aetna Resources For Living, a trained professional will help
assess your needs. You can also ask for a referral to a local counselor. Community
and professional services, such as psychologists, marriage and family therapists,
and substance abuse counselors, are available to help you balance your work and
home life.
Aetna Resources For Living offers more than just counseling. You can also access
specialized services and discounts, including:
Financial, legal and other support services
■ Free
confidential consultation with a lawyer or financial adviser
will kits and other legal documents
Referrals to community resources, such as credit counseling or career coaching
Free materials and audio recordings on a wide variety of topics
■ Free
Other time-saving services
■ Finding
a day care center
Locating an elder care provider
Searching for a college
Planning your estate
Don’t miss out — put the tools, resources and support
of your CarMax Medical Plan to work for you.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of
subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna).
CCG CARMAX-0050 (2/15)
©2015 Aetna Inc.