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Version 22 09 2020 TPID 30007382 Page 1

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PLAN FEATURES Deductible (per calendar year) Member Coinsurance Copay Maximum (per calendar year) Lifetime Maximum Primary CPLAN FEATURES Deductible (per calendar year) Member Coinsurance Copay Maximum (per calendar year) Lifetime Maximum Primary CAetna Health Inc. PLAN FEATURES Deductible (per calendar year) Plan Coinsurance* Maximum Out-of-Pocket (per calendar year, iAetna Health Inc. PLAN FEATURES Deductible (per calendar year) Plan Coinsurance* Maximum Out-of-Pocket (per calendar year, iAetna Medicare Plan (PPO) 2023 Schedule of Cost SharingAetna Medicare Plan (PPO) 2023 Schedule of Cost SharingUTILIZATION CHART – TRADITIONAL MEDICARE, & MEDICARE ADVANTAGE (MA)PLANS INITIAL PREVENTIVE PHYSICAL EXAM (G0402) ANNUAL WUTILIZATION CHART – TRADITIONAL MEDICARE, & MEDICARE ADVANTAGE (MA)PLANS INITIAL PREVENTIVE PHYSICAL EXAM (G0402) ANNUAL W2023 Aeta Open Choice PPO Benefits Summary2023 Aeta Open Choice PPO Benefits SummaryPLAN FEATURESPLAN FEATURESCA MC $750 80/50/50 Plan Design and Benefits - AetnaCA MC $750 80/50/50 Plan Design and Benefits - AetnaAetna Health Inc. PLAN FEATURES Deductible (per calendar year) Member Coinsurance Out-of-Pocket Maximum (per calendar year,Aetna Health Inc. 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Medicare Covered Immunizations Pneumococcal, Flu, Hepatitis B $0 Routine GYAetna PPO Plan Highlights | Fresno Unified BenefitsAetna PPO Plan Highlights | Fresno Unified Benefits2023 Aeta Open Choice PPO Benefits Summary2023 Aeta Open Choice PPO Benefits SummaryAetna Life Insurance Company PLAN FEATURES Deductible (per calendar year) $2,000 Individual $6,000 Family Unless otherwise iAetna Life Insurance Company PLAN FEATURES Deductible (per calendar year) $2,000 Individual $6,000 Family Unless otherwise iKaty Independent School District Effective Date: 01-01-2021 Aetna Choice® POS II -- ASC Choice POS II Plan PLAN DESIGN &Katy Independent School District Effective Date: 01-01-2021 Aetna Choice® POS II -- ASC Choice POS II Plan PLAN DESIGN &Government of the District of Columbia Proposed Effective Date: 01-01-2017 PLAN DESIGN & BENEFITS PROVIDED BY AETNA HEALTH IGovernment of the District of Columbia Proposed Effective Date: 01-01-2017 PLAN DESIGN & BENEFITS PROVIDED BY AETNA HEALTH ICDHP SPD ScheduleCDHP SPD ScheduleUNIVERSITY OF PENNSYLVANIA POSTDOCTORAL INSURANCE Ef fective Date: 01-01-2023 PLAN DESIGN & BENEFITS PROVIDED BY AETNA HEALUNIVERSITY OF PENNSYLVANIA POSTDOCTORAL INSURANCE Ef fective Date: 01-01-2023 PLAN DESIGN & BENEFITS PROVIDED BY AETNA HEALWelcome Federal Employees | Aetna Vision plan for Federal employeesWelcome Federal Employees | Aetna Vision plan for Federal employeesHow Much Will Physical Therapy Cost with Aetna | CORHow Much Will Physical Therapy Cost with Aetna | CORFASHION INSTITUTE OF TECHNOLOGY Effective Date: 01-01-2023 Aetna Choice® POS II – ASC Korea Plan PLAN DESIGN & BENEFITS AFASHION INSTITUTE OF TECHNOLOGY Effective Date: 01-01-2023 Aetna Choice® POS II – ASC Korea Plan PLAN DESIGN & BENEFITS ACITY OF HOUSTON Aetna Medicare SM Plan (PPO) Premier ESA PPO Plan Rx $2/$10/$40/$75/$75 Benefits and Premiums are effective JanuCITY OF HOUSTON Aetna Medicare SM Plan (PPO) Premier ESA PPO Plan Rx $2/$10/$40/$75/$75 Benefits and Premiums are effective JanuAetna Choice® POS II Medical PlanAetna Choice® POS II Medical PlanAetna Medicare℠ Plan (PPO) Annual Notice of Changes for 2017Aetna Medicare℠ Plan (PPO) Annual Notice of Changes for 2017Your Plan at a GlanceYour Plan at a GlanceMedicare Wellness Visit or Physical Exam? 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