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Section 3 - Proposed Benefits 1 <br />is City of Sunny Isles <br />Health Maintenance Organization (HMO) <br />Provider Network Yes <br />PCP required/role PCP selection required/PCP provides <br />routine care and coordinates all specialty <br />referrals. <br />Member cost sharing - Copay applies to all covered services <br />rendered, coordinated or referred by a <br />PCP <br />- Copay percentage may apply on <br />inpatient hospital stays and outpatient <br />surgical services; annual out -of- pocket <br />maximum limits member's financial <br />risk <br />Claim forms required No <br />Available funding Full- risk, prospectively rated; also available <br />options self- funded for 250+ life groups <br />0 Includes* <br />• <br />A <br />Healthy Outlook Program <br />A <br />External Review Policy <br />A <br />Fitness Program <br />A <br />Informed Health® Line <br />A <br />Member Health Education <br />A <br />Women's Health for Life <br />Programs <br />Options* <br />A Employee Assistance Program <br />♦ National Medical Excellence <br />Program <br />A Natural Alternatives- <br />A Safety Net <br />A Vision One® discount program <br />*Described in the Programs section of this proposal; brochures also available from your Aetna U.S. Healthcare representative. <br />HMO benefits are provided or administered by: Aetna U.S. Healthcare, Inc., Aetna U.S. Healthcare, Inc. (DE), Aetna <br />U.S. Healthcare of California, Inc- Aetna U.S. Healthcare of the Carolinas, Inc., Aetna U.S. Healthcare of Georgia, Inc., Aetna <br />U.S. Healthcare of Illinois, Inc., and/or Aetna U.S. Healthcare of North Texas, Inc. <br />Visit our website: www.actnaushc.com 11/17/2000 <br />