Welcome 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 www.aetna.com 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 R and sprained ankles New! Teladoc® – 24/7/365 access to doctors by phone or online video for non-emergency care Your doctor – for wellness visits, routine care and chronic illness and injuries Urgent 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. 1 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 www.aetna.com. Step 2: Click on the “Log In/Register” link. 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. 2 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 www.aetna.com. 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 providers ★ 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. 3 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. 4 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 www.aetna.com 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 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 diseases 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 www.itriagehealth.com. 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 www.questdiagnostics.com and click on “MyQuest.” 5 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 www.aetna.com, 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 www.aetna.com to find your closest location. Teladoc Service ■ ■ Call 1-855-Teladoc (835-2362) Visit www.teladoc.com/aetna 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. 6 Primary Care Physician Office Visit To find an in-network provider, log in to www.aetna.com. Specialist Office Visit To find an in-network provider, log in to www.aetna.com. Urgent Care Clinic Log in to Aetna Navigator at www.aetna.com to find your closest location. Emergency Room Log in to Aetna Navigator at www.aetna.com 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 www.aetna.com 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. 7 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 www.aetna.com 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 Life ■ Heart-Healthy ■ Live Well with Asthma ■ Sleep Well ■ Eat Healthier ■ Stress Less ■ Get Active ■ Weigh Less ■ Healthy Back Cholesterol ■ 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. 8 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. 9 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 ■ ■ 10 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 www.globalfit.com – 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 www.aetna.com. 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 program. 11 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 www.caremark.com or at www.carmax.com/benefits. ■ 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 www.caremark.com 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 pharmacy. ■ Have medications mailed directly to your home address up your maintenance medications at a local CVS/pharmacy Register at www.caremark.com to sign up for mail order and provide payment information ■ Pick ■ 12 Questions about prescription benefits? Call CVS Caremark Customer Care at 1-855-361-8564 or check out www.caremark.com. 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 www.mylifevalues.com, 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 13 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.
© Copyright 2018