The Strategic Benefits Department would like to take this opportunity to thank the hundreds of Annual Enrollment Site Coordinators throughout the United States who have contributed to making the 2010 Annual Enrollment period one of our most successful communications campaigns to date.  Your hard work in hanging posters, distributing messages, and serving as a point-of-contact in directing employees to the Workplace Solutions Center has been truly invaluable! 

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Questions about your employee benefits or other Human Resources issues? Contact the Workplace Solutions Center at (888) 471-2271.

• -  Georgia
• -  Colorado
• -  Minnesota
• -  Utah
• -  Washington
• -  South Dakota
• -  Yreka, California
• -  Portland, Oregon

To find out if your doctor is in the Aetna network, follow these steps:

1. Go to www.aetna.com and click on “Find a Doctor”.

2. Enter the type of search and requested information.

3. Under Aetna Open Access Plans, select Aetna Choice POS II.

To find providers in the Cigna network, follow these steps:

            1. Go to www.cigna.com and click on “Find a Doctor”.

            2. Enter the doctor’s name and location or your zip code.

            3. Select the Open Access Plus plan and choose “Primary Care Physician” or “Specialist.”

 Note:  If you live in Oregon, click here to find a CIGNA provider.

Here’s a summary of how the ACS PPO Plan works.

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Questions about your employee benefits or other Human Resources issues? Contact the Workplace Solutions Center at (888) 471-2271.

• - Blended, cosmetic, coated, laminated, oversize, progressive multifocal, tinted (other than Pink 1 or 2), or UV-protected lenses. However polycarbonate and scratch-resistant lenses are covered.
• - Costs for services and/or eyewear (frames, lenses) that exceed the plan allowances.
• - Optional cosmetic processes.

In addition, this plan does not cover the following services or materials:

• - Orthoptics or vision training, and any associated supplemental testing.
• - Plano lenses (less than ±.50 diopter power).
• - Two pairs of glasses in lieu of bifocals.
• - Replacement of lost or broken lenses and frames furnished under this program except at the normal intervals when services are otherwise available.
• - Medical or surgical treatment of the eyes.
• - Corrective vision services, treatments and materials of an experimental nature.

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Questions about your employee benefits or other Human Resources issues? Contact the Workplace Solutions Center at (888) 471-2271.

Under the Vision Plan, you and your eligible dependents may each receive, subject to the payment provisions and frequency guidelines outlined in the chart below, the following:

• - A comprehensive eye exam, including a refraction test to determine the need for glasses, binocularity analysis and testing the overall health of the eyes and related optic structures.
• - Additional testing for glaucoma and depth perception.
• - Necessary prescription lenses and frame, or contacts in lieu of lenses and a frame. (If you obtain contact lenses, you will be eligible for new lenses after 12 months and a new frame after 24 months.)

Vision Plan at a Glance

Elective vs. Medically Necessary Contact Lenses

When buying elective contact lenses, you receive a $150 allowance toward the total cost of the lenses, which includes evaluation exams, fitting costs and materials. You are reimbursed the same amount whether you go to a participating or non-participating doctor. If you buy your prescription contacts from a participating doctor, charges for professional services may be discounted. You pay the difference between the total cost of the contact lenses (including exams and fitting costs) and the allowance.

Elective contact lenses are those that are not medically necessary. Medically necessary contact lenses are only those prescribed for any of the following:

• Following cataract surgery,
• To correct extreme problems that cannot be corrected by eyeglasses, or
• Due to anisometropia (a significant difference in vision between the two eyes) or keratoconus (a disease of the cornea).

[1] If you purchase lenses and frames at the same time, only one $15 copay applies.

[2] If you select a frame that is not paid in full by the vision plan, you pay the difference between the retail allowance the claims administrator provides and the claims administrator’s discounted retail cost of the frame.

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Questions about your employee benefits or other Human Resources issues? Contact the Workplace Solutions Center at (888) 471-2271.

Below is a listing of limitations that apply to the Dental Plan, followed by a listing of services for which no benefits are paid.

Alternate Benefits

In dentistry, there is often more than one method of treating a particular dental condition. If more than one service can be used to treat a covered person’s dental condition, the claims administrator may decide to authorize coverage only for a less costly covered service provided that both of the following terms are met:

· The service selected must be deemed by the dental profession to be an appropriate method of treatment; and

· The service selected must meet broadly accepted national standards of dental practice.

This means the following, for:

· Inlays, Onlays, Crowns and Gold Foil—If a tooth can be repaired by a less costly method than an inlay, onlay, crown or gold foil, benefits will be based on the adequate method of repair that costs the least.

· Crowns, Pontics, and Abutments—Veneer materials may be used for front teeth or bicuspids. However, benefits will be based on the adequate veneer materials that cost the least.

· Bridgework and Dentures—Benefits will be based on the adequate method of treating the dental arch that costs the least. In some cases removable dentures may serve as well as fixed bridgework. If dentures are replaced by fixed bridgework, benefits will be based on the cost of a replacement denture unless adequate results can only be achieved with fixed bridgework.

These are just a few examples of alternate benefits—there are others. That’s why it’s important you follow the plan’s predetermination of benefits process, as outlined previously. By following this process, you’ll know ahead of time how much the plan will pay for the treatment or services being recommended by your dentist.

Replacement Rule

The replacement of, addition to, or modification of existing dentures, crowns, casts or processed restorations, removable denture, fixed bridgework or other prosthetic services is covered only if one of the following terms is met:

· The replacement or addition of teeth is required to replace one or more teeth extracted after the existing denture or bridgework was installed. This coverage must have been in force for the covered person when the extraction took place.

· The existing denture, crown, cast, or processed restoration, removable denture, bridgework, or other prosthetic service cannot be made serviceable, and was installed at least 10 years before its replacement.

· The existing denture is an immediate temporary one to replace one or more natural teeth extracted while the person is covered, and cannot be made permanent, and replacement by a permanent denture is required. The replacement must take place within 12 months from the date of initial installation of the immediate temporary denture.

Tooth Missing But Not Replaced

The first installation of:

· Removable dentures;

· Fixed bridgework; and

· Other prosthetic services

is covered if:

· Needed to replace one or more natural teeth that were removed while the person is covered by the Dental Plan; and

· Not an abutment to a partial denture, removable bridge or fixed bridge installed during the previous 10 years.

Exclusions and Limitations

Covered dental expenses do not include and no benefits are payable for charges for:

· Bruxing appliances.

· Claims incurred as the result of an accident, which are considered a medical expense.

· Implantology.

· Sealants for dependent children under age 6 and age 14 and over.

· Services or supplies initiated for or received by a covered person before becoming eligible for the dental expense benefits.

· Those for treatment by other than a dentist; except that scaling or cleaning of teeth and topical application of fluoride may be done by a licensed dental hygienist. In this case, the treatment must be given under the supervision and guidance of a dentist.

· Surgery, treatment, services and supplies, which are cosmetic in nature.

· Replacement of a lost, missing or stolen crown, bridge or denture and those for replacement of appliances that have been damaged due to abuse, misuse, or neglect.

· Repair or replacement of an orthodontic appliance.

· Services or supplies which are required as a result of a work related injury.

· Services or supplies received by a covered person for which no charge would have been made in the absence of dental expense benefits for that covered person.

· Services or supplies for which a covered person is not required to pay.

· Services or supplies obtained through a government hospital or covered under a government plan, except as required by federal law.

· Services or supplies which are deemed experimental in terms of generally accepted dental standards as determined by the claims administrator in its sole discretion.

· Services or supplies received as a result of dental disease, defect or injury due to an act of war or a warlike act in time of peace.

· Adjustment of a denture or bridgework which is made within 6 months of its installation.

· Any duplicate appliance or prosthetic device.

· Use of materials to prevent decay other than fluorides and sealants.

· Instruction for oral care, such as hygiene or diet.

· Periodontal splinting.

· Services or supplies to the extent that benefits are otherwise provided under a medical plan.

· Myofunctional therapy.

· Broken appointments.

· The dentist for completing dental forms.

· Services or supplies not specifically listed as covered under the Dental Plan.

· Services or supplies related to missing but unreplaced teeth at the time coverage becomes effective.

· Services received as a result of injury or sickness caused or contributed to by engaging in an illegal act or occupation; by committing or attempting to commit any crime, assault or other felonious behavior, or by participating in a riot or public disturbance unless due to a mental or physical medical condition.

· Services or supplies furnished by a family member.

· The part of an expense for care and treatment of an injury or sickness that is in excess of the reasonable and customary charge.

· Services intended for treatment of any jaw joint disorder (TMJ); except as specifically provided.

· Repair to a damaged or injured tooth that was damaged or injured when the individual was not a participant under the plan.

· Dentures, crowns, inlays, onlays, bridgework, or other appliances or services used for the purpose of splinting, to alter vertical dimension to restore occlusion, or correction attrition, abrasion, or erosion.

· Any of the following services:

○ An appliance, or modification of one, if an impression for it was made before the person became a covered person;

○ A crown, bridge, or cast or processed restoration, if a tooth was prepared for it before the person became a covered person; or

○ Root canal therapy, if the pulp chamber for it was opened before the person became a covered person.

· Space maintainers except when needed to preserve space resulting from the premature loss of deciduous teeth.

· Orthodontic treatment; except as specifically provided.

· General anesthesia and intravenous sedation; unless done in conjunction with another necessary covered service.

· A crown, cast or processed restoration unless:

○ It is treatment for decay or traumatic injury and teeth cannot be restored with a filling material; or

○ The tooth is an abutment to a covered partial denture or fixed bridge.

· Pontics, crowns, cast or processed restorations made with high noble metals; except as specifically provided.

· Surgical removal of impacted wisdom teeth only for orthodontic reasons.

· Services needed solely in connection with non-covered services.

· Services done where there is no evidence of pathology, dysfunction, or disease other than covered preventive services.

· Services done after the termination date of coverage.

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Questions about your employee benefits or other Human Resources issues? Contact the Workplace Solutions Center at (888) 471-2271.

The Dental Plans pay benefits for preventive, basic and major dental care provided by a licensed dentist or doctor (or a dental assistant or hygienist working under the direct supervision of a dentist). The plans also provide coverage for orthodontia treatment, either for dependent children only or for both adults and dependent children.

To be eligible for benefits, the dental services and supplies must (for the condition being treated) be:

· Performed or prescribed by a licensed dentist.

· Necessary based on generally accepted dental standards.

The benefits payable under each of the plans are outlined below. Note the deductibles, coinsurance and benefit maximums are the same for network providers and out-of-network providers. However, charges for network providers are discounted, lowering your total cost. For additional details, you are encouraged to contact Aetna or MetLife.

Preventive Care

To promote good dental health, the dental options cover 100% of the cost of diagnostic and preventive services, with no deductible or copayments. The following services are considered to be diagnostic or preventive:

· Office visit during regular office hours, for oral examinations.

○ Routine comprehensive or recall examination (limited to 2 visits per calendar year); and

○ Problem-focused examination (unlimited).

· Prophylaxis (cleaning) (limited to 2 treatments per calendar year).

· Topical application of fluoride (limited to one course of treatment per calendar year and to children under age 19).

· Sealants on permanent teeth (limited to one application per tooth for children age 6 up to age 14).

· Bitewing X-rays (limited to 2 per calendar year).

· Complete X-ray series, including bitewings if necessary, or panoramic film (limited to 1 set every 60 months).

· Vertical bitewing X-rays (limited to 2 per calendar year).

· Emergency palliative treatment.

· Space maintainers, fixed or removable (up to age 19).

Basic Care

The following services are considered basic care:

· Visits and exams—Professional visit after hours (payment will be made on the basis of services rendered or visit, whichever is greater).

· X-ray and pathology:

○ Periapical X-rays (single films);

○ Intra-oral, occlusal view, maxillary or mandibular;

○ Upper or lower jaw, extra-oral; and

○ Biopsy and histopathologic examination of oral tissue.

· Oral surgery:

○ Extractions

§ Exposed root or erupted tooth;

§ Coronal remnants;

§ and Surgical removal of erupted tooth/root tip.

○ Impacted teeth

§ Removal of tooth (soft tissue);

§ Removal of tooth (partially bony); and

§ Removal of tooth (completely bony).

○ Odontogenic cysts and neoplasms

§ Incision and drainage of abscess; and

§ Removal of odontogenic cyst or tumor.

○ Other surgical procedures

§ Alveoplasty, in conjunction with extractions—per quadrant;

§ Alveoplasty, not in conjunction with extraction per quadrant;

§ Sialolithotomy: removal of salivary calculus;

§ Closure of salivary fistula;

§ Excision of hyperplastic tissue;

§ Removal of exostosis;

§ Transplantation of tooth or tooth bud;

§ Closure of oral fistula of maxillary sinus;

§ Sequestrectomy;

§ Crown exposure to aid eruption;

§ Removal of foreign body from soft tissue;

§ Frenectomy; and

§ Suture of soft tissue injury.

· Periodontics

○ Occlusal adjustment (other than with an appliance or by restoration);

○ Root planing and scaling, per quadrant (limited to 4 separate quadrants every 2 years);

○ Root planing and scaling—1 to 3 teeth per quadrant (limited to once per site every 2 years);

○ Gingivectomy per quadrant (limited to 1 per quadrant every 3 years);

○ Gingival flap procedure, per quadrant (limited to 1 per quadrant every 3 years);

○ Gingival flap procedure—1 to 3 teeth per quadrant (limited to 1 per site every 3 years);

○ Gingivectomy, 1 to 3 teeth per quadrant (limited to 1 per site every 3 years);

○ Periodontal maintenance procedures following active therapy (limited to 2 per year);

○ Osseous surgery (including flap entry and closure)—per quadrant (limited to 1 per quadrant, every 3 years);

○ Osseous surgery (including flap entry and closure)—1 to 3 teeth per quadrant (limited to 1 per site every 3 years); and

○ Soft tissue graft procedures.

· Endodontics

○ Pulp capping;

○ Pulpotomy;

○ Apexification/recalcification;

○ Apicoectomy; and

○ Root canal therapy, including necessary X-rays (limited to once per tooth per lifetime);

○ Retreatment of a root canal including treatment x-rays (limited to once per tooth per lifetime).

· General anesthesia and intravenous sedation (only when provided in conjunction with a covered surgical procedure).

· Restorative dentistry (excludes inlays, crowns—other than prefabricated stainless steel or resin—and bridges. Multiple restorations in one surface will be considered a single restoration).

○ Amalgam restorations.

○ Resin restorations.

○ Sedative fillings.

○ Pins:

§ Pin retention—per tooth, in addition to amalgam or resin restoration.

○ Crowns (when tooth cannot be restored with a filling material):

§ Prefabricated stainless steel; and

§ Prefabricated resin crown (excluding temporary crowns).

○ Recementation:

§ Inlay;

§ Crown; and

§ Bridge.

○ Full and partial denture repairs:

§ Broken dentures, no teeth involved;

§ Repair cast framework; and

§ Replacing missing or broken teeth on complete dentures, each tooth.

○ Adding teeth to existing partial denture:

§ Each tooth; and

§ Each clasp.

○ Repairs:

§ Crowns; and

§ Bridges.

○ Dentures and partials (fees for dentures and partial dentures include relines, rebases, and adjustments within six months after installation. Specialized techniques and characterizations are not eligible):

§ Office reline;

§ Laboratory reline; and

§ Rebase, per denture.

Major Care

The following services are considered major care:

· Restorative dentistry (cast or processed restorations and crowns are covered only as treatment for decay or acute traumatic injury and only when teeth cannot be restored with a filling material or when the tooth is an abutment to a fixed partial denture).

○ Inlays/onlays—metallic, porcelain or ceramic:

§ Inlay, one or more surfaces; and

§ Onlay, two or more surfaces.

○ Inlays/onlays—resin-based composite:

§ Inlay, one or more surfaces; and

§ Onlay, two or more surfaces.

○ Labial veneers:

§ Laminate—chairside;

§ Resin laminate—laboratory; and

§ Porcelain laminate—laboratory.

○ Crowns:

§ Resin;

§ Resin with noble metal and semi-precious metal;

§ Resin with base metal;

§ Porcelain;

§ Porcelain with noble metal and semi-precious metal;

§ Porcelain with base metal;

§ Base metal (full cast);

§ Noble metal and semi-precious metal (full cast); and

§ Metallic (3/4 cast).

○ Core build up, including any pins.

○ Post and core.

· Prosthodontics

○ Fixed partial denture abutments (see inlays and crowns).

○ Pontics:

§ Base metal (full cast);

§ Noble metal and semi-precious metal (full cast);

§ Porcelain with noble metal and semi-precious metal;

§ Porcelain with base metal;

§ Resin with noble metal and semi-precious metal; and

§ Resin with base metal.

○ Removable fixed partial denture (unilateral)

§ One piece casting, chrome cobalt allow clasp attachment (all types) per unit, including pontics.

○ Dentures and partials (fees for dentures and partial dentures include relines, rebases, and adjustments within six months after installation. Specialized techniques and characterizations are not eligible):

§ Complete upper denture;

§ Complete lower denture;

§ Partial upper or lower, resin base (including any conventional clasps, rests, and teeth);

§ Partial upper or lower, cast metal base with resin saddles (including any conventional clasps, rests, and teeth);

§ Stress breakers;

§ Interim partial dentures (stayplate), anterior only;

§ Special tissue conditioning, per denture; and

§ Adjustments to denture more than six months after installation;

Orthodontic Care

Covered orthodontic services include:

· Comprehensive orthodontic treatment;

· Interceptive orthodontic treatment;

· Limited orthodontic treatment;

· Post treatment stabilization;

· Appliance to correct thumb sucking.

Coverage is not provided for an orthodontic procedure if an active appliance for that orthodontic procedure was installed before the effective date of coverage.

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Questions about your employee benefits or other Human Resources issues? Contact the Workplace Solutions Center at (888) 471-2271.

     -  High Value PPO Plan will no longer be available

     -  Select Value PPO Plan will be known as the ACS PPO Plan

     -  Co-pay of $125 for a 30-day supply of specialty drugs through the Medco Specialty Pharmacy

     -  X-ray and lab charges for non-preventive care services will be charged at 80% after deductible. 

     -  Limits on mental health and chemical dependency will be removed.

     -  Increased Health Savings Account contribution maximums

     -  Plan design changes on many HMOs

Please review the plan summaries for your 2010 benefit elections for additional information.

Questions about your employee benefits or other Human Resources issues? Contact the Workplace Solutions Center at (888) 471-2271.