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Quality health plans & benefitsHealthier livingFinancial well-beingIntelligent solutionsYour path to healthy starts hereAetna Student HealthSM2014-2015 Plan GuidePolicy Year: 2014-2015Policy Number: 474935Customer Service (Toll Free): (866) 725-4433www.aetnastudenthealth.comThis booklet gives a general idea of how your Planoffered by Aetna Student Health works. Plus, you’lllearn how to get the most out of it.15.02.402.1-CTVersion 135742

Tools toto helphelp you get the most out of your nAetnaAetnamember,member,youyougetgettoolstools andand resourcesresources dandyouryourbenefits.benefits. PlanPlan lsareareininoneoneplaceplace—— youryour AetnaAetna Navigator ’re mobilemobile —— soso areare we.we. ��re on thethe gogoThe Aetna MobileMobile appapp aturesfeaturesatatyour fingertips.fingertips. It’sIt’s availableavailableforforiPhoneiPhone andandAndroid Android mobilemobiledevices. VisitVisit avigator.Navigator. SheShe cancan help ostcostofofservices,services,answeranswer questionsquestions boutaboutyouryourplan,plan, MemberMember ServicesServices .m.EST,EST,MondayMonday throughthrough Friday,Friday, etworkproviderproviderisiseasyeasyFinding UsethetheDocFindDocFind asy-to-use searchsearch tooltool eraname,ZIPcode,you find the right provider in a snap. Just enter a name, ZIP ialtyininthethesearchsearch box.box. You’llYou’ll alsoalso indatmaps, directions and more. Try DocFind y.The Trinity College Student Health Insurance Plan is underwritten by Aetna Life Insurance Company (Aetna) and administered by Chickering ClaimsThe Trinity College Student Health Insurance Plan is underwritten by Aetna Life Insurance Company (Aetna) and administered by Chickering ClaimsAdministrators, Inc.Administrators, Inc.Aetna Student HealthSM is the brand name for products and services provided by Aetna Life Insurance Company (Aetna) and CCA and their applicableAetna Student HealthSM is the brand name for products and services provided by Aetna Life Insurance Company (Aetna) and CCA and their applicableaffiliated companies (Aetna).affiliated companies (Aetna).2 12 1

Your health planYour student health plan offered by Trinity CollegeCheck out the Plan Design and Benefits Summary for valuableinformation such as: Medical care received when you are no longer able to use TheTrinity College Health Center due to a change in your studentstatus; Maternity care and OB/GYN care; or Preventive/Routine Services.PLEASE NOTE: Your Plan may not require a referral for additionaltreatments - please refer to your Plan Design and BenefitsSummary for additional information. Your eligibility to join the Plan The coverage periods The premium rates The description of benefits Exclusions Other important informationThe Plan Design and Benefits Summary can be found y.If the covered person does not obtain a referral from School HealthServices a penalty of 20% of the benefit up to a maximum of 500per condition per policy year will apply.How to enrollYour Aetna Student Health Plan allows you to choosewhere to receive care- from a network provider1, or aprovider outside the network.Please refer to the Plan Design and Benefits Summary for planspecific enrollment information.Looking for detailed plan information?For details like Copays and what’s covered, check your Plan Designand Benefits Summary. You’ll also find general benefits andexclusions specific to the Plan. You can also see the Master Policyfor a complete description of the benefits and full terms andconditions. If there’s any discrepancy between this Plan Guide, thePlan Design and Benefits Summary and the Master Policy, theMaster Policy will govern and control the payment of benefits. TheMaster Policy can be found y.This student health plan fulfills the definition of CreditableCoverage explained in the Health Insurance Portability andAccountability Act (HIPAA) of 1996. If you’d like a certification ofcoverage, just call Member Services at 866-725-4433.How your plan worksThe Trinity College Health Center will act as yourPrimary Care Provider (PCP) — referrals may beneededYour covered spouse/domestic partner or child(ren) are not eligibleto use the services of The Trinity College Health Center and are;therefore not subject to the referral requirements and penalties.Option 1: Visit The Trinity College Health Center or a networkprovider2Network providers contract with Aetna to offer you rates that areoften much lower than their regular fees. This helps you save. Yournetwork provider will provide care and: Get approval from Aetna before giving you certain services3; File claims for you.To find a provider in the network, use Aetna’s online directory,DocFind, y. You canalso request a printed directory. Just call member services at866-725-4433 and we’ll send you a printed directory.You’ll pay less with this network option.Option 2: Go to a provider outside the network2You can visit any licensed provider. Your out-of-network providerwill provide care; however, you may be responsible to: Get approval from Aetna before receiving certain services3; File your own claims;Pay the difference between the amount paid by your Plan and theamount charged by your provider.This out-of-network option typically costs you more.Your health care needs are best managed under one healthsystem. Because Aetna wants you to get the best care possible,Aetna will pay your covered benefits when you get a referralfor your care. A referral is not required in the followingcircumstances: Treatment is for an Emergency Medical Condition (a referral fromThe Trinity College Health Center may be necessary for follow-upcare); You are more than 20 miles away from the campus; The Trinity College Health Center is closed; When you get service at another facility during break or vacationperiods;3

When does my coverageunder the student healthplan end?Important provisions ofthe student health planYou’ll get benefits as long as the Master Policy is active with TrinityCollege and you are in an eligible class. You’ll also need to be sureyour premiums are paid. No benefits are payable for expensesincurred after the date the insurance terminates, except as may beprovided under the Extension of Benefits provision described inthis guide. To review coverage periods, premium rates and anyapplicable deadlines, please refer to the Plan Design and BenefitsSummary.Aetna will pay benefits in accordance with applicable ConnecticutState Insurance Law(s).Know when your coverage endsYour student coverage will end when one of the followinghappens: The date the Plan year ends; The last day for which any required premium has been paid; or, The day you withdraw from school because you enter the armedforces for any country. Your premiums will be refunded on a prorated basis within 90 days of the date you withdraw;Please refer to the Plan Design and Benefit Summary for moreinformation about eligible individuals under the Plan.If you withdraw from school within the first 31 days of acoverage period, you will not be covered under the Policy andthe full premium will be refunded, less any claims paid. After31 days, you will be covered for the full period that you havepaid the premium for, and no refund will be allowed. (Thisrefund policy will not apply if you withdraw due to a coveredAccident or Sickness).Important note regarding coverage for a newborn infant ornewly adopted child:A newborn child shall be insured for preventive care, injury;sickness; premature birth; and medically diagnosed congenitaldefects; and birth abnormalities from the moment of birth; for aninitial period of 61 days.Coverage is provided for preventive care, injury; sickness;premature birth; and medically diagnosed congenital defects; andbirth abnormalities for a child legally placed for adoption with acovered student from the moment of placement; for an initialperiod of 61 days; provided the child lives in the household of thecovered student; and is dependent upon the covered student forsupport.If you need information or have general questions on dependentenrollment, just call Member Services at 866-725-4433.4State mandated benefitsRecovery of overpaymentIf Aetna pays more than the benefit amount based on theguidelines of the contract with your school, Aetna has the right: to require the return of the overpayment on request; or, to reduce by the amount of the overpayment, any future benefitpayment made to or on behalf of you or another person in yourfamily.Such right does not affect any other right of recovery Aetna mayhave with respect to such overpayment.Reimbursement and subrogationWhen a covered person’s injury appears to be someone else’s fault,benefits otherwise payable under this Policy for Covered MedicalExpenses incurred as a result of that injury will not be paid unlessthe covered person or his legal representative agrees:(a) to repay Aetna for such benefits to the extent they are forlosses for which compensation is paid to the covered person byor on behalf of the person at fault as allowed by anyConnecticut law;(b) to allow Aetna a lien on such compensation and to hold suchcompensation in trust for Aetna; and(c) to execute and give to Aetna any instruments needed to securethe rights under (a) and (b).Further, when Aetna has paid benefits to or on behalf of the injuredcovered person, Aetna will be subrogated to all rights or recoverythat the covered person has against the person at fault. Thesesubrogation rights will extend only to recovery of the amountAetna has paid. The covered person must execute and deliver anyinstruments needed and do whatever else is necessary to securethose rights to Aetna.