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Section 3 - Proposed Benefits 3 <br />City of Sunny Isles <br />Quality Point of Service (QPOS®) <br />Provider network Yes <br />PCP required/role PCP selection encouraged/PCP can render <br />and coordinate care, and make specialty <br />referrals; members may self -refer to any <br />recognized in- network or out -of- network <br />provider <br />Member cost sharing <br />- Copay applies to all covered services <br />rendered, coordinated or referred by a <br />PCP <br />- Referred copay percentage may apply <br />on inpatient hospital stays and <br />outpatient surgical services; annual <br />referred out -of- pocket maximum limits <br />member's financial risk <br />- Deductible/coinsurance applies to all <br />self- referred; in- network or out-of- <br />network covered services <br />Claim forms required <br />Possible for self - referred services <br />Available funding <br />Full -risk, prospectively rated; also available x <br />options <br />self-funded for 250+ life groups <br />Includes* <br />1 Healthy Outlook Program <br />A External Review Policy <br />Fitness Program <br />A Informed Health" Line <br />A Member Health Education <br />Options* <br />A National Medical Excellence <br />Program ®. <br />L Natural Alternatives" Program <br />A Safety Net <br />A Vision One °discount program <br />A Women's Health for Life <br />Programs <br />A Employee Assistance Program <br />•*Described in the Programs section of this proposal; brochures also available from your Aetna U.S. Healthcare representative. <br />QPOS referred benefits may be provided or administered by: Aetna U.S. Healthcare, Inc., Aetna U.S. Healthcare, Inc. (DE), <br />Aetna U.S. Healthcare of California, Inc., Aetna U.S. Healthcare of the Carolinas, Inc., Aetna U.S. Healthcare of Georgia, Inc., <br />Aetna U.S. Healthcare of Illinois, Inc., Aetna U.S. Healthcare of North Texas, Inc, Aetna U.S. Healthcare of Washington, Inc. <br />Visit our website: www.actnaushc.com 11/17/2000 <br />