1. Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Health Care Reform – The Journey Continues This document provides a high level summary of the Affordable Care Act (ACA). Information contained in this document is subject to change as regulations are issued. This information contained within this document should not be considered to be legal guidance regarding ACA or its potential impact and should not be distributed beyond intended audience.

2. Aetna Inc. Health Care Reform – The Journey Continues Health Care Reform will impact every individual, plan sponsor and employer Aetna is committed to helping the people we serve understand and navigate the new health care landscape We will continue to advocate for a marketplace that delivers value and promotes affordability, competition, choice, and flexibility Our Vision for a Sustainable, Affordable Health Care System 2

3. Aetna Inc. Health Care Reform – The Journey Continues 3 Source: Gallup Well-Being, Costs Still Keep 30% of Americans From Getting Treatment: http://www.gallup.com/poll/166178/costs-keep-americans-getting treatment.aspx?utm_source=alert&utm_medium=email&utm_campaign=syndication&utm_content=morelink&utm_term=All%20Gallup%20Headlines http://www.gallup.com/poll/166178/costs-keep-americans-getting treatment.aspx?utm_source=alert&utm_medium=email&utm_campaign=syndication&utm_content=morelink&utm_term=All%20Gallup%20Headlines Kaiser Family Foundation, 2013 Employer Health Benefit Survey: http://kff.org/private-insurance/report/2013-employer-health-benefits/ http://kff.org/private-insurance/report/2013-employer-health-benefits/ U.S. Uninsured Rate Continues to Fall: http://www.gallup.com/poll/167798/uninsured-rate-continues-fall.aspx?ref=morehttp://www.gallup.com/poll/167798/uninsured-rate-continues-fall.aspx?ref=more 2014 Milliman Medical Index: http://www.washingtonpost.com/blogs/wonkblog/files/2014/05/MMI2014.pdfhttp://www.washingtonpost.com/blogs/wonkblog/files/2014/05/MMI2014.pdf Annual U.S. Healthcare Spending Hits $3.8 trillion : http://www.forbes.com/sites/danmunro/2014/02/02/annual-u-s-healthcare-spending-hits-3-8-trillion/http://www.forbes.com/sites/danmunro/2014/02/02/annual-u-s-healthcare-spending-hits-3-8-trillion/ A Call to Action - Why Reform is Needed Those Americans who report putting off medical care in 2013 because of cost. 30% 57% 15.9% $23,215 $3.8 trillion Percentage of firms offering health benefits to employees, down from 69% in 2010. Percentage of Americans without health insurance in 2014. Typical cost of healthcare for a family of four with employer-based insurance. Annual U.S. Healthcare Spending.

4. Aetna Inc.Health Care Reform – The Journey Continues Aetna’s Path to Implementation & Compliance

5. Aetna Inc. Health Care Reform – The Journey Continues Patient Centered Outcomes Research fee MLR reporting goes “live” Administrative Simplification begins to phase in Summary of Benefits and Coverage (SBC) Women’s Preventive Services Guaranteed issue Individual coverage mandate Individual subsidy Public Exchange launch for individual and small group Essential health benefits Medicaid expansion Risk management mechanisms Employer “Pay or Play” Mandate and related definition of Full Time Employees (enforcement delayed until 2015) Annual reporting of carrier & employee coverage (optional until 2015 plan year) Rating rules Insurer taxes 90-Day maximum waiting period Auto-enrollment of newly hired, newly eligible full- time employees (delayed) Wellness incentives Medicare Advantage MLR Requirements Source: Patient Protection and Affordable Care Act Minimum MLR requirements Medicare Advantage plans begin to have payments frozen Medicare Advantage cost sharing limits effective for certain covered services Pharmaceutical fee Rate review implementation Increased penalties on individual mandate Increased insurer taxes States must allow groups of up to 100 employees into Exchanges (2016) “Cadillac tax” (2018) 201020112012201320142015-2019 Medical Device fee Exchange coverage notice FSA Cap Tax deduction for employers for Medicare Part D subsidy eliminated 5 Benefit coverage changes – Preventive Care with no cost share in network – Dependent children < age 26 – No pre-ex < age 19 – Prohibits rescissions except fraud / intentional misrepresentation – No lifetime / annual dollar limits on essential benefits – Patient protections – Appeals and External Review updates Temporary high-risk pool Uniform MLR definition (NAIC) HHS Plan Finder Health Care Reform Timeline Key provisions that take effect in 2014 and beyond: Large employers need to be contemplating these provisions as part of their benefit strategy.

6. Aetna Inc.Health Care Reform – The Journey Continues Levies taxes and fees against health insurers and other groups to fund subsidies and risk management mechanisms Institutes penalties for failing to purchase health insurance Prominent ACA Provisions Prohibits health plans from denying coverage or rating applicants based on their health status Levels the playing field between health plans and mitigates the impact of guaranteed issue and pricing uncertainty in the short term Institutes penalties for employers who fail to offer affordable comprehensive coverage Lowers the cost of coverage for the low and middle income populations in the Individual market Creates government regulated Individual and Small Group health insurance marketplaces Source: Congressional Budget Office Taxes and Fees Employer Mandate Insurance Exchanges Guaranteed Issue (GI) and Rating Changes Risk Management Mechanisms Tax Credits and Subsidies Individual Mandate Prominent ACA Provisions in 2014 6

7. Aetna Inc.Health Care Reform – The Journey Continues Public Exchanges

8. Aetna Inc.Health Care Reform – The Journey Continues The introduction of exchanges is highlighting the significant changes underway in the marketplace: 8 Increased Regulation The Changing Marketplace Need To Control Health Care Costs Demand for a Simpler Consumer Experience

9. Aetna Inc. Health Care Reform – The Journey Continues Types of Exchanges 9 Public Exchange - Individual Managed by federal or state government Travelocity®-style shopping experience Provides access to tax credits and subsidies to promote affordability Public Exchange - Small Group (SHOP) Target population is employer groups with up to 100 lives; states can opt to limit to up to 50 until 2016 Managed by federal or state government Small businesses shop for insurance for their employees States will decide on the degree of choice and contribution models offered to employees Private Exchanges Exist today; interest is growing Managed by third parties, not the government; not mandated by the ACA No access to tax credits and/or subsidies

10. 10 Aetna Inc. Health Care Reform – The Journey Continues Aetna’s 2014 National Footprint for Individual Public Exchanges Individual exchange products available statewide * Individual exchange products offered to limited geographies *“Statewide” is defined as having products (either Aetna or Coventry or both) available in all rating areas. *Map represents Public Exchanges presence for the combined Aetna/Coventry business

11. Aetna Inc. Health Care Reform – The Journey Continues 11 What We’re Seeing The experience is improving Federal Marketplace Although launch was rocky, Open Enrollment ended with a significant surge of enrollments. Initial exchange enrollment of over *8 million exceeded Congressional Budget Office estimate by 1M. Aetna continues to work with the Marketplace to address technical issues and advocate for implementation of viable, long term strategic solutions. State Based Exchanges Some have performed strongly since they launched (e.g., CT and CA). Others have been plagued with issues. (e.g., OR, HI and VT). The state-based exchanges where Aetna/Coventry is participating (DC and MD**) have had some issues; we continue to work with state based-teams, as we do with the Federal Marketplace, to drive improvements. *5/1/14 announcement by Health and Human Services secretary, Kathleen Sebelius. ** Only Aetna is on the DC state-base exchange. Both Aetna and Coventry are on the MD state-based exchange.

12. Aetna Inc. Health Care Reform – The Journey Continues 12 What We’re Seeing Our exchange experience to date Call Volume Record call volume and enrollment as open enrollment ended, especially with the “accommodation” that extended open enrollment into April. Adding additional staff to support membership influx We continue to use outbound calls and emails to reinforce the importance of making the first month’s premium payment, so coverage can be activated. Primary consumer call drivers:  Benefits  Premium payment/billing  Network

13. Aetna Inc. Health Care Reform – The Journey Continues 13 What We’re Seeing Supporting our new public exchange members Supporting New Members Strong focus on helping members activate their benefits (via initial binder payment) and then understand how their plan works. Emphasis on convenient self-service capabilities and online resources such as our secure member website and mobile app; critical success factor on private exchange as well:  View claims and benefits information  Research cost of claim  Look up providers Additional work planned this year to continue to improve the member experience through simple, convenient communications that help members understand how to get the most from their plan. Primary focus: advocate for regulations that will increase access, drive simplicity and improve affordability and choice.

14. Aetna Inc. Health Care Reform – The Journey Continues Public Exchange Membership Projected to Grow Significantly by 2016 14 20142015 2016 7 million 13 million 22 million Number of consumers who are expected to purchase on the individual public exchanges between 2014 and 2016* *Congressional Budget Office Projections as of May 2013

15. Aetna Inc. Health Care Reform – The Journey Continues Health Care Reform Resources

16. Aetna Inc. Health Care Reform – The Journey Continues ACA Compliance 16  Implement and comply with all facets of the Affordable Care Act  Act as advocates for our customers, members and employees in shaping regulations to avoid unintended consequences  Help customers effectively navigate through the new health care landscape  Collaborate with our strategy and business areas to inform and shape ongoing strategic discussions and decisions  Flawless execution of the Affordable Care Act Goals Mission Health Care Reform Project Management Office Guiding Principles  Keep customers and members at the center of all we do  Follow a disciplined, comprehensive approach to implementation  Achieve full compliance with the law and help our customers do the same  Help Aetna lead the way in making a better health care system for all Americans

17. Aetna Inc. Health Care Reform – The Journey Continues ©2010 Aetna Know what we stand for: ‒Getting and keeping everyone covered ‒Reducing health care costs and improving quality ‒Maintaining the employer-based system Get the facts: Visit Health Care Reform: The Journey Continues on AetnetHealth Care Reform: The Journey Continues To ask further questions on reform visit the HCR Resource CenterHCR Resource Center Learn how we keep our constituents informed: Visit Health Reform Connection on www.aetna.comHealth Reform Connectionwww.aetna.com Stay in touch: Join ACAN (Aetna Citizen Action Network) today to get regular updates (visit: AetNet’s Health Care Reform: The Journey Continues to access the ACAN website)Health Care Reform: The Journey Continues 17 What you can do

18. Aetna Inc. Health Care Reform – The Journey Continues HCR Video Series The ACA video series was launched on 10/1/13 This series replaces the annual HCR tutorial that was located in the Learning Center. All four videos are located under course 157246. Our external customers may view it, by going to Health Reform Connection Aetna Facebook Aetna YouTube Field Communication AetNet article 18

19. Aetna Inc. Health Care Reform – The Journey Continues Aetna remains focused on transforming the health care delivery system such that all Americans have a choice of affordable, simple health care options Aetna remains committed to fostering compliance with the ACA and helping our customers achieve the same As constructive advocates for the people who use our services, we continue to work with HHS, NAIC and other agencies to shape regulations and avoid unintended consequences We all have a role to play; get and stay informed Take Home Messages 19