Demonstrating social responsibility and integrity2010 Aetna Corporate Responsibility

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“ Our commitment to sustainability is a natural extension of being a health insurer. We’re in the business of helping people live full and healthy lives, and embracing our corporate citizenship is fundamental to our ability to fulfill that mission.”

Ronald A. Williams Aetna Chairman and CEO LEADERS magazine, April 2010

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies (Aetna).

Community involvement

The Aetna Foundation is the independent charitable and philanthropic arm of Aetna. Founded in 1972, the Foundation helps build healthy communities by promoting volunteerism, forming partnerships and funding initiatives that improve the quality of life where our employees and customers live and work. Since 1980, Aetna and the Aetna Foundation have awarded more than $379 million in grants, sponsorships and social investments.

Diversity at Aetna

We recognize the impact and importance of diversity in all aspects of our business.

■ Reflecting the changing face of America, we seek to build a workforce that fully understands the customers we serve.

■ We are diversifying our supplier base, purchasing nearly $120 million in goods and services from small businesses and certified minority-, women- and LGBT (lesbian, gay, bisexual and transgender)- owned business enterprises.

■ We are bringing our health and related benefits to some of the fastest growing segments of our population — the African American, Latino and Asian markets.

Environmental practices

Aetna has been engaged in recycling and energy-use reduction programs for many years at Aetna-owned facilities. In recent years, our accelerated efforts have resulted in numerous distinctions, such as a 2009 Connecticut Climate Change Leadership Award from the state of Connecticut, and Leadership in Energy and Environmental Design (LEED®) Silver certification in 2009 for the environmentally friendly construction of the new Aetna Customer Center. Our teleworker program is reaching some impressive milestones, saving more than 79 million miles of driving per year and reducing carbon dioxide emissions by more than 29,000 metric tons each year.

Corporate governance

Aetna’s reputation, one of the company’s most valuable assets, relies on sound corporate governance policies, which are publicly available on our website. We share documents — our Code of Conduct and our Corporate Governing Guidelines — with our key stakeholders. In doing so, we help ensure our commitment to excellence, integrity and accountability.

Executive summary

Public policy leadership

Aetna is committed to transforming health care in America by playing a leadership role in advancing model solutions to health care system problems and by developing innovative business initiatives that make a difference in the lives of our members nationally. Our goal will not be reached until health care reform provides all Americans with access to affordable, high-quality health care services.

■ The adoption of health care reform was historic in helping to widen access to health care coverage, but much more must be done to help improve the quality of health care outcomes and help restrain escalating costs. We will continue to lead the way in advocating solutions that fill this gap.

■ We support transforming the payment system into one that aligns provider reimbursement incentives with achieving high-quality outcomes for patients. We must work together to test and identify new payment models.

■ We need a renewed focus on wellness and preventive care. Investments should be made in programs that help consumers become more engaged in their health.

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Our ValuesAt Aetna, we put the people who use our services at the center of everything we do, and we live by a core set of values:■ Integrity■ Quality Service and Value■ Excellence and Accountability■ Employee Engagement

At Aetna, we believe that being a leader in the health care industry means not only meeting business expectations but also exercising ethical business principles and social responsibility in everything we do. Responsibility and integrity are woven into our corporate fabric and demonstrated through our commitment to:

Nothing speaks to our commitment to responsible leadership more visibly and resolutely than the activities of Aetna’s independent charitable and philanthropic arm, the Aetna Foundation. Founded in 1972, the Aetna Foundation is a national health foundation that promotes wellness, health and access to high-quality health care for everyone, while supporting the communities we serve.

Promoting wellness, health and access to high-quality care

Since 1980, Aetna and the Aetna Foundation have awarded more than $379 million to community programs across the country. The Foundation has identified the following program areas as key priorities for grant making in 2010 and beyond:

■ Addressing the rising incidence of obesity among U.S. residents, including children

■ Promoting racial and ethnic equity in health and health care for common chronic conditions and infant mortality

■ Advancing integrated health care by improving coordination and communications among health care professionals, creating informed and involved patients, and promoting cost-effective, affordable care

Community involvement

an early age. In December 2009, Georgia Governor Sonny Perdue issued a commendation to Aetna for the company’s diligence in improving health in the state. The commendation reads in part:

“Aetna’s efforts to promote health and equality and its commitment to reducing the incidence of diabetes and childhood obesity in Georgia, demonstrate its outstanding corporate citizenship.”

Racial and ethnic health care equity To promote racial and ethnic equity in health and health care and to reduce disparities in infant mortality, we support efforts that identify connections between where people live and receive health care, and the quality and equity of the care they receive.

A $40,000 Aetna Foundation award to the Fund for Public Health New York, Inc. is supporting “text4baby” in New York City, a public-private partnership that delivers important health information to pregnant women and new mothers living in underserved communities. It works by sending text messages to mobile phones. Subscribers receive three text messages each week, in English or Spanish. Each is tailored to the mother’s stage of pregnancy and/or the age of her baby. This free service will provide women with critical information about health during pregnancy, as well as infant health and well-being.

In 2009, Aetna and the Aetna Foundation contributed over $20 million in grants and sponsorships to nonprofits across the nation, addressing a variety of health issues and other community needs. Aetna employees, retirees and directors donated an additional $4.4 million through the company’s matching gift program. Employee contributions were further enhanced through volunteer efforts — more than 317,000 hours of personal time and commitment.

Addressing critical health issues: philanthropy’s role

ObesityObesity has become a national epidemic. It undermines people’s health as well as their financial well-being. To address the rising incidence of obesity among Americans, including children, we fund efforts to understand obesity’s root causes, particularly among minority populations, and ways to support better choices to stave off overeating and reduce inactivity.

Since 2006, Aetna and the Aetna Foundation have awarded more than $6 million in support of efforts to combat obesity, including an award to the Foundation for Public Broadcasting in Georgia, Inc./Georgia Public Broadcasting (GPB) in support of Healthy Kids & Communities.

This multi-pronged, community-outreach initiative is addressing childhood obesity by offering content that encourages good nutrition, exercise and the development of healthy lifestyle habits, starting at

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Since 2001, Aetna and the Aetna Foundation have awarded more than $30 million to support initiatives that address these disparities while promoting greater health care equity for underserved minority populations.

Integrated health carePromoting high-quality, cost-effective, affordable care is important to Aetna and the Aetna Foundation. To advance integrated health care, we fund efforts that improve coordination and communications among health care professionals, create informed and involved patients, and promote cost-effective, affordable care — centered on strong primary care.

In Philadelphia, a $460,000 Aetna grant to the University of Pennsylvania is supporting evaluation efforts designed to better understand whether adopting the Advanced Medical Home/Chronic Care Model in primary care practices decreases costs and improves quality and the delivery of care.

We also sponsored “Bending the Cost Curve,” a thematic issue of Health Affairs, the preeminent national health policy journal devoted to real-world solutions that are helping to control rising health care costs and explore innovations that may lead to a higher quality of care.

■ Donate thousands of units of blood

■ Spend hundreds of hours each year refurbishing homes for people with medical needs and other special needs

■ Have made thousands of colorful headscarves known as CUREchiefs for cancer patients and others with medical conditions resulting in hair loss

■ Serve as tutors and mentors to youth

Aetna employees work regularly to improve their communities, one volunteer project at a time.

To learn more about our grant programs, and how our grantees are enhancing communities and advancing quality health care, visit www.AetnaFoundation.org.

Volunteerism: a culture of caringAetna strives to be a leading corporate citizen, improving the quality of life in the communities where we live and work. This commitment has created our “culture of caring” — a tradition of volunteerism and employee community involvement that is part of our core values. We have an award-winning program and a national network of highly engaged employee volunteer councils. Nationwide, nearly 50 Aetna Volunteer Councils are the cornerstone of our volunteer efforts. These are employee teams that identify local community needs and respond accordingly. They take part in fundraisers, team projects, disaster relief and a range of other activities. Since 2003, our employees have logged nearly 2 million hours of community service.

Beyond the numbers, Aetna employees:

■ Sign up in higher numbers for the national bone marrow registry, compared with Americans as a whole

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Diversity at Aetna

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■ A “Diversity in Action” lecture series to help employees think about diversity in new and different ways

Our Leadership Development Program initiatives focus on identifying emerging talent among under-represented groups.

We have received wide recognition related to diversity:

■ DiversityInc has named Aetna to its 2010 list of Top 50 Companies for Diversity®. We also ranked fifth on The DiversityInc Top 10 Companies for LGBT Employees and People With Disabilities.

■ Aetna received the New York Urban League’s Champions of Diversity Award in February 2010. The Champions of Diversity Award salutes companies that understand the need for diversity in the job market.

■ Aetna received the 2009 GLMA Achievement Award for its dedication to meeting the health care needs of the LGBT community and for its leadership in promoting an LGBT-friendly workplace.

■ 100 Percent Perfect Score, Human Rights Campaign Corporate Equality Index, 2010.

■ Top 40 Companies for Diversity, Black Enterprise magazine, 2009.

■ Top 10 Companies for Executive Women, National Association for Female Executives, 2010.

■ Providing enterprise-wide and department-specific diversity education integrated into executive, supervisory and employee learning, as well as enhancing cultural competency for Sales, Patient Management and Customer Service areas

■ Partnering with the Racial and Ethnic Disparities in Health Care Task Force, which works to reduce disparities in health care by providing tailored support for our members, and leveraging the Aetna Foundation’s research funding

Workforce and workplace diversity

Reflecting the changing face of America, we seek to build a workforce that fully understands the customers we serve. (See our 2009 Diversity Annual Report for our company demographics.)

Recruitment and retentionWe have a recruiting strategy that aims to attract highly motivated and talented individuals, including under-represented groups, such as people with disabilities; LGBT individuals and veterans, while meeting the unique needs of the multigenerational groups represented in the workforce. Employees are provided with a number of opportunities to learn more about our strategy’s impact, including:

■ Web-based and instructor-led training that raises employee awareness of diversity

■ A cultural competency training program for our health care professionals to increase awareness and improve the way we assist members

Aetna is deeply committed to cultivating and leveraging diversity; we have successfully incorporated an inclusive mindset into all that we do. If you interact with Aetna — no matter from what area of interest — our diversity initiatives and strategies are bound to touch you in some way. Whether you are a customer, a supplier, an employee, a provider or a consultant, we have programs that focus on your needs.

Diversity at Aetna is a business strategy. We recognize the impact and importance of diversity in all aspects of our business, whether it is providing products and services to meet a wide variety of consumer needs, fostering relationships with business owners and suppliers from smaller companies, or developing a diverse workforce that truly understands and speaks the language of our customers.

Diversity priorities at Aetna■ Leveraging diversity as an organizational

initiative in order to increase our business opportunities and partnerships

■ Building a diverse and agile workforce by focusing on recruitment, development and advancement of talent at all levels of the organization

■ Creating an inclusive workplace that fosters full engagement, so our employees do their best work in providing quality service and value

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Employee diversity programsWe value and respect the strengths and differences among employees and recognize that customers, suppliers, strategic partners and communities are increasingly diverse and multicultural.

Central to our diversity program are our employee resource groups (ERGs). These groups are composed of employees who share an affinity, a common background or a similar set of experiences. These ERGs work together to promote each other’s development, while identifying opportunities that support our goals.

Supplier diversity

At Aetna, we take every opportunity to be inclusive in our sourcing activities. We recognize that diversifying our supplier base positions us to leverage innovation, quality, service and price to benefit the products and services we sell. In addition, it strengthens our ability to do business across all cultures and geographies. By utilizing suppliers of various backgrounds, perspectives and experiences, we not only gain access to high-quality goods and services, we also gain valuable insight into multicultural markets.

■ In 2009, we purchased nearly $120 million in goods and services from small businesses and certified minority-, women- and LGBT-owned business enterprises.

■ Our supplier diversity goals for 2010 are to:

> Support our 2010 Supplier Diversity Scorecard for each business area, including first tier and second tier supplier responsibilities

> Implement programmatic improvement to pursue world-class program status

> Leverage the Supplier Diversity Advisory Council to more fully integrate Supplier Diversity into our business processes

■ We maintain a website for potential suppliers: www.aetna.com/about/aetna/sd/

■ We use our online, self-registration tool to provide prospective diverse suppliers with an opportunity to “push” their service offerings to us.

■ Our senior leadership monitors quarterly progress on diversity goals.

Community relations and urban marketing

Over the past 20 years, the evolution of the U.S. marketplace has required us to enhance our local presence. We have created and implemented strategies that concentrate on bringing our health and related benefits to some of the fastest growing segments in the United States.

As part of this business strategy, we have a Community Relations and Urban Marketing organization to facilitate the following components:

■ Drive incremental business through national and local partnerships

■ Align our philanthropic giving to business strategies in key markets

■ Develop communication strategies to more effectively articulate Aetna Corporate Citizenship and our long history of community involvement, volunteerism and impact

■ Provide consulting services to develop appropriate infrastructure (through the development of culturally relevant marketing materials; advertising strategies; open enrollment campaigns; multilingual translations, trans-creations and interpretations; and call center and supplier diversity strategies)

■ Enhance market presence within targeted business communities

To that end, we are focusing our efforts on grassroots strategies that better address the needs of a changing marketplace. We do this by supporting community events, working with community leaders and organizations, helping employers manage their changing workforce, and working with brokers and providers to support their business objectives.

Public policy leadership

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As a health care benefits company, Aetna is committed to helping transform the health care system. As the nation worked its way toward adoption of health care reform in early 2010, we worked more closely than ever with Congress and the Obama administration to offer insights and guidance to help keep the process focused on meaningful change.

We also continue to focus on the development of innovative business initiatives that are already making a difference in the lives of our members nationally while offering model solutions to health care system issues. Our goal will not be reached until health care reform provides all Americans with access to affordable, high-quality health care services.

Working toward health care reform

Aetna was at the forefront of health care reform efforts in the past decade. In 2005, we became the first national health insurer to call for the adoption of a national individual coverage requirement — with subsidies for those who cannot afford coverage — to help get the nation’s 46 million uninsured covered. Since then, we have openly supported significant market reforms, in conjunction with an individual coverage requirement, including support for guaranteed issue in the small group and individual markets with no pre-existing condition exclusions.

Three years ago, we developed and circulated a comprehensive health care reform plan called To Your Health! Aetna’s Proposal for Health Care System Transformation. We put thought into action by working with members of Congress, their staffs and the White House in 2008 and 2009 to provide specific data and advice on the kinds of changes needed to help the system deliver high-quality, affordable care to all Americans.

Aetna Chairman and CEO Ronald A. Williams has been deeply involved in the reform dialogue. He met with President Obama on several occasions, and he has offered testimony and participated in roundtable discussions with members of the Senate Committee on Finance, the Senate Committee on Health, Education, Labor & Pensions and the House Committee on Ways & Means to help establish priorities for reforming the system.

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Going forward, we advocate continued work in several key areas to help make health care reform more effective:

■ Addressing the true drivers of medical costs, which are responsible for rising health care premiums

■ Reforming the medical payment system

■ Harnessing the power of health information technology

■ Improving the quality of health care outcomes

Nationally and in states across the country, we strongly advocate a public-private coordination and collaboration. It is imperative that government and the private sector work together to make the goals of health care reform a reality.

Getting health care reform implementation right

Since the adoption of the Patient Protection and Affordable Care Act in March 2010, we are focusing on helping our constituents understand the operational impact of the new law and on achieving compliance to help fully realize the goals of reform. At Aetna, compliance is a core competency.

We are well positioned to meet the needs of the new health care marketplace, with our diverse array of health care products and services. Our Health Care Reform Project Management Office is working to translate the many provisions of the new health care law into workable business practices across the enterprise. We also continue to offer the benefit of our experience to the rule-making phase of reform implementation, to help ensure that the new law is implemented in a workable fashion.

While the adoption of health care reform was truly historic in helping to widen access to health care coverage, we know that much more can be done to help improve the quality of health care outcomes and help restrain the escalating cost of health care services. We will continue to lead the way in advocating solutions that fill this gap.

Promoting health and wellness

Making the health care system work better also requires a renewed focus on wellness and preventive care. Investments should be made in programs that help consumers become more engaged in their health and adopt sustained behavior changes. Helping people get and stay healthy is an Aetna priority.

■ In early 2010, we launched a team-based fitness and nutrition program for employers nationwide that uses online social networking to encourage people of all health and fitness levels to work together to achieve their optimal health. Later in 2010, we added a Healthy Lifestyle Coaching program to our offerings.

■ Since 2008, we have partnered with Earvin “Magic” Johnson to promote health literacy, wellness and healthy behaviors in major urban markets across the country.

■ Approximately 2.5 million members are in disease management or case management programs that are helping people with chronic conditions and other needs get the treatment and preventive care they need by taking a wider, holistic view on health.

Payment focused on value, rather than volume

Improving health care delivery must include reforming our payment system to focus on quality and value. We support transforming the payment system into one that aligns provider reimbursement incentives with achieving high-quality outcomes for patients.

We must work together to test and identify new payment models and pay-for-performance programs that create incentives for improvements in performance, outcomes and quality of care. We have developed our own new payment structures to help promote a team approach to medicine and improve outcomes. To help focus greater attention system-wide on quality and costs, we committed resources in 2009 to develop and promote a special edition of Health Affairs focused on “Bending the Cost Curve,” and we brought together economists, researchers and public policy experts at a special kick-off event to promote real-world solutions.

The health information technology advantage

It is clear that any comprehensive approach to health care reform must include encouraging the widespread adoption of health information technology (HIT) tools. We need to enhance the delivery of health care by using HIT tools that enable providers and patients to make better use of the right data at the right time to make quality care decisions. HIT can facilitate vast improvements in individuals’ health care experiences by offering them a clearer picture of their own health, a more coordinated interaction with multiple health care providers, and better, safer health outcomes.

We believe the key to unleashing the power of HIT is to make data actionable. Making patient data more visible to physicians helps them make better decisions for their patients. It’s what has driven much of the $1.8 billion we have invested in HIT since 2005. For example, our CareEngine® clinical decision support system sent 16.9 million care alerts (identifying gaps in care, medical errors and quality concerns) to physicians in 2009.

Environmentally friendly practices

“As a health care benefits company, Aetna is dedicated to helping people achieve health and financial security, and we believe fostering a healthy environment is an important part of this mission. We are committed to limiting our environmental impact by reducing our energy consumption and the use of other resources, and we will work to identify emerging environmental issues and address them, to the extent that we can, because we recognize the impact of a clean environment on the health of our members.” – Aetna’s Environmental Policy Statement

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Aetna has been engaged in recycling and energy-use reduction for years. But we have redoubled our efforts to further reduce our carbon footprint and fulfill the goals outlined in our environmental policy statement. This significant commitment of resources has generated award-winning initiatives that are helping to transform our home office campus into an environmentally friendly center for business.

Turning our campus “green”

In 2006, we launched a multi-year construction project to upgrade our home office facilities in Hartford, CT, enabling us to make important new strides in environmental leadership. For example:

■ The complete renovation of the Atrium Building was a certified “green” project. We are seeking prestigious Leadership in Energy and Environmental Design (LEED®) certification from the U.S. Green Building Council for the project, which featured extensive use of renewable materials in construction, flooring and ceiling tiles made from natural materials, energy-saving electrical devices and infrastructure designed to reduce water use.

■ We are generating some of our own power with 240 solar panels on the south face of our Atrium Building and an additional 735 panels on the roof. The system will produce an estimated 237,789 kilowatt hours of power each year.

■ We replaced 1,169 wooden windows in the original building with new, more energy-efficient windows that are helping to reduce our energy consumption.

■ Aetna earned LEED Silver certification in 2009 for the environmentally friendly construction of the Aetna Customer Center within our 78-year-old headquarters building.

Harnessing the power of telework

We also took steps several years ago to encourage carpooling and telecommuting to help reduce commuter traffic and the pollutants it generates. Today, formal teleworking arrangements have increased significantly, and employees have access to more programs that support carpooling and offer financial incentives not to drive.

The results have been impressive. Our teleworkers are reducing our carbon footprint by saving more than 79 million miles per year, which saves more than 3.3 million gallons of gas and reduces carbon dioxide emissions by more than 29,000 metric tons per year.

Other important initiatives and commitments include:

■ We are a participant in the Business Roundtable’s Climate RESOLVE initiative and one of the companies featured in the Business Roundtable’s “Enhancing Our Commitment to a Sustainable Future: 2009 Progress Report.”

■ We are now using a more environmentally friendly, Forestry Stewardship-certified paper for the printing of marketing materials. In addition, many Aetna enrollment materials carry a wind energy logo.

■ At Aetna-owned facilities, we recycle paper, cardboard, glass and plastic bottles, and Aetna uses EnergyStar® devices and automatic shut-off switches to minimize power consumption.

■ We have recycled fluorescent light bulbs since 1994, long before it was required.

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Our reputation is one of our most valuable assets. We have earned this reputation over the course of 157 years by delivering quality products and services, and by adhering to the highest standards of business conduct. These standards include sound corporate governance policies to address the interests of our constituents.

An important principle of good governance is transparency. Therefore, we make our key corporate governance policies and practices publicly available on our website. The site, which can be accessed from Investor Relations on www.aetna.com, contains key information about our corporate governance in one simple, clear and easy-to-navigate location.

Those policies provide a framework for governance of the company consistent with shareholder and other constituent interests, and with the principles behind the 2002 Sarbanes-Oxley Act and the New York Stock Exchange’s corporate governance rules. We believe that sharing our corporate governance principles with all of our key stakeholders will help ensure that our commitment to excellence, integrity and accountability is apparent to all.

Corporate governance

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Our commitment to social responsibility has netted important recognitions. For example, Aetna was honored by FORTUNE as the “most admired” company in the Health Care Insurance and Managed Care category in 2010 for the third straight year, based in part on a number one ranking, in the sector, for social responsibility. Other recognitions include:

■ Our innovative efforts to address global climate change were recognized with a 2009 Connecticut Climate Change Leadership Award by the state of Connecticut.

■ The Clean Air Campaign presented us with a 2008 PACE Spotlight Award for the impact of our telework program in the Atlanta area.

■ We were named DiversityInc’s Top Company for Community Development in 2009 for our support of nonprofits that share our focus on building strong communities, ending racial and ethnic disparities in health care, improving health literacy and promoting disease prevention.

■ DiversityInc has named us to its “2010 DiversityInc Top 50 Companies for Diversity®” list for our demonstrated use of measurable diversity best practices and results. We are also ranked in the top 10 of companies for LGBT employees and for employees with disabilities.

Awards and recognition

■ Black Enterprise magazine named us to its 2009 list of the “40 Best Companies for Diversity,” the fourth consecutive year that we earned this distinction.

■ We have earned the top rating of 100 percent in the 2009 Corporate Equality Index, an annual Human Rights Campaign survey. It’s the 7th straight year we have received a perfect score for service to LGBT employees and consumers.