Aetna: Sustaining the Momentum Ronald A. Williams Chairman and Chief Executive Officer 2009 JP MORGAN HEALTH CARE CONFERENCE January 12, 2009 We want you to know(R) Aetna Logo(R)

-------------------------------------------------------------------------------- Cautionary Statement Aetna Logo -------------------------------------------------------------------------------- CAUTIONARY STATEMENT -- Certain information in this document is forward-looking, including our current estimates and projections as to operating earnings per share, medical membership, health care revenue, medical benefit ratios, medical cost trend, operating expense ratio, pension benefit or expense, 12/31/08 statutory surplus, 12/31/08 debt to capital ratio, 12/31/08 risk based capital ratios, generation of excess capital, need to raise additional capital, ability to hold assets to maturity and investment portfolio declines/losses. Forward-looking information is based on management's estimates, assumptions and projections, and is subject to significant uncertainties and other factors, many of which are beyond Aetna's control. Important risk factors could cause actual future results and other future events to differ materially from those currently estimated by management, including adverse economic conditions in the U.S. and abroad which can significantly and adversely affect Aetna's business and profitability; continued volatility and further deterioration of the U.S. and global capital markets, including fluctuations in interest rates, fixed income and equity prices and the value of financial assets, along with the general deterioration in the commercial paper, capital and credit markets, which can adversely impact the value of Aetna's investment portfolio, Aetna's profitability by reducing net investment income and/or Aetna's financial position by causing us to realize additional impairments on our investments; failure to achieve desired rate increases and/or profitable membership growth due to the slowing economy and/or significant competition, especially in key geographic markets where membership is concentrated; adverse pricing or funding actions by federal or state government payors; and unanticipated increases in medical costs (including increased medical utilization, increases resulting from unfavorable changes in contracting or re-contracting with providers, increased pharmacy costs, changes in membership mix to lower-premium or higher-cost products or membership-adverse selection; as well as changes in medical cost estimates due to the necessary extensive judgment that is used in the medical cost estimation process, the considerable variability inherent in such estimates, and the sensitivity of such estimates to changes in medical claims payment patterns and changes in medical cost trends). Other important risk factors include, but are not limited to: adverse changes in size, product mix or medical cost experience of membership; adverse changes in federal or state government policies or regulation (including legislative proposals that would affect our business model and/or limit our ability to price for the risk we assume and/or reflect reasonable costs or profits in our pricing and other proposals, such as initiatives to eliminate or reduce ERISA pre-emption of state laws, that would increase potential litigation exposure or mandate coverage of certain health benefits); the ability to reduce administrative expenses while maintaining targeted levels of service and operating performance; the ability to improve relations with providers while taking actions to reduce medical costs and/or expand the services we offer; the ability to successfully integrate our businesses (including acquired businesses) and implement multiple strategic and operational initiatives simultaneously; our ability to integrate, simplify, and enhance our existing information technology systems and platforms to keep pace with changing customer and regulatory needs; the outcome of various litigation and regulatory matters, including litigation and ongoing reviews of business practices by various regulatory authorities (including the current industry-wide investigation by the New York Attorney General into certain payment practices with respect to out-of-network providers); reputational issues arising from data security breaches or other means; and increases in medical costs or Group Insurance claims resulting from any acts of terrorism, epidemics or other extreme events. For more discussion of important risk factors that may materially affect Aetna, please see the risk factors contained in Aetna's 2007 Annual Report on Form 10-K and its Quarterly Report on Form 10-Q for the quarter ended September 30, 2008, on file with the Securities and Exchange Commission ("SEC"). You also should read Aetna's 2007 Annual Report on Form 10-K and Quarterly Report on Form 10-Q for the quarter ended September 30, 2008, on file with the SEC for a discussion of Aetna's historical results of operations and financial conditions. 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 2

-------------------------------------------------------------------------------- Key Messages and Agenda Aetna Logo -------------------------------------------------------------------------------- o 2008 Industry Leading Results o Health Business Is Strong and Growing Profitably o High Quality Balance Sheet & Excellent Capital Position o Strategically Positioned for Health Care Reform Opportunities o Sustaining Our Momentum In 2009 and Beyond 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 3

-------------------------------------------------------------------------------- Industry Leading Performance Aetna Logo -------------------------------------------------------------------------------- ----------------------------------------------------------- Successful execution of our strategy drove 2008* results(1) ----------------------------------------------------------- -------------------------------------- -------------------------------------- Segmentation Integration -------------------------------------- -------------------------------------- Industry Leading Organic Industry-Leading Solutions Medical Membership Growth of [~5%] Bank of America Win Double Digit Health Care Revenue Growth Differentiated Brand Experience -------------------------------------- -------------------------------------- Consumerism Operational Excellence -------------------------------------- -------------------------------------- Personal Health Records Total MBR in Line with Transparency Programs Original Guidance Operating Expense Ratio Improvement of 30-40bp *Throughout this document "E" indicates management's current projection 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 4

-------------------------------------------------------------------------------- Industry Leading Performance Aetna Logo -------------------------------------------------------------------------------- ----------------------------------- Industry leading results in 2008(1) ----------------------------------- 2008 Metrics Original Preliminary Commentary Guidance Estimate Operating EPS $4.00 $3.90-$3.95 Industry leading growth; Operatiog EPS Growth +15% 12%-13% competitor growth declines 2%-51(2) Medical Membership Growth >650k ~875k Industry leading organic growth of ~5% Health Care Revenue Growth Double Digit Double Digit In line with original guidance Commercial MBR 80% Slightly Slightly above Sept about 80.2% YTD of 80.2% Total MBR 81.5% ~81.5% In line with original guidance Medical Cost Trend 7.5% +/- 50bps 7.5% +/- 50bps In line with original guidance Operating Expense Ratio ~50bp ~30bp - 50bps Due to higher 1/1 improvement improvement ramp cost 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 5

-------------------------------------------------------------------------------- Key Messages and Agenda Aetna Logo -------------------------------------------------------------------------------- o 2008 Industry Leading Results -------------------------------------------------------------------------------- o Health Business Is Strong and Growing Profitably -------------------------------------------------------------------------------- o High Quality Balance Sheet & Excellent Capital Position o Strategically Positioned for Health Care Reform Opportunities o Sustaining Our Momentum In 2009 and Beyond 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 6

-------------------------------------------------------------------------------- Sustained Profitable Growth Aetna Logo -------------------------------------------------------------------------------- ------------------------------------------------------------------------------- Aetna's Model for Sustaining Profitable Growth ------------------------------------------------------------------------------- o Segmentation Grow the Manage o Differentiation Top Line --> Risk and o Innovation Margins o Integration - | o Revenue Diversification | - o Pricing Discipline Produce Grow o Productivity and Deploy -- Earnings o Investing for the Future Excess o $1 Billion of Excess Capital Capital per Year in 2008 and 2009 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 7

-------------------------------------------------------------------------------- Sustained Profitable Growth Aetna Logo(R) -------------------------------------------------------------------------------- ------------------------------------------------------------------------------- Double digit health care revenue growth(1) is sustainable ------------------------------------------------------------------------------- Commercial ASC o Up-sales and cross-salesles inin traditional products o Increasing interest in integrated solutions Commercial Risk [GRAPHIC OMITTED] o Trend an inherent growth driver o Disciplined growth in traditional markets o Targeted expansion into new geographies o Segmentation strategy drives growth in newer markets o Increased market share in select markets Medicare & Medicaid o Differentiated Medicare strategy o Schaller Anderson now fully integrated, leading to wins in new statesstates 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 8

-------------------------------------------------------------------------------- Sustained Profitable Growth Aetna Logo -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- Segmentation Strategy Continuously Identifies New Opportunities for Future Profitable Growth -------------------------------------------------------------------------------- --------------------------------------------- o Strong growth in newer segments in 2008 o Evidence of the succes of our [GRAPHIC OMITTED] segmentation strategy o Also disciplined, profitable growth in core segments, and contributions from M&A o Combined to drive double digit health care revenue growth in 2008 o Provides significant momentum entering 2009 --------------------------------------------- 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 9

-------------------------------------------------------------------------------- Sustained Profitable Growth Aetna Logo -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- 6.6% Average Annual Medical Membership Growth Leads to Diversified Health Care Revenue Growth -------------------------------------------------------------------------------- 12/31/04 - 13.7 million 12/31/08E - 17.7 million [GRAPHIC OMITTED] [GRAPHIC OMITTED] *Includes Medicare, Medicaid, Global, Individual, Student Health and Other 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 10

-------------------------------------------------------------------------------- Sustained Profitable Growth Aetna Logo -------------------------------------------------------------------------------- --------------------------------------------------- Disciplined Pricing and Rigorous Medical Management Processes Drive Stable and Competitive MBR ---------------------------------------------------- -------------------------------------------------------------------------------- Forecasting 2008 Medical Benefit Ratios o State of the art unit cost projection models o 16 medical cost categories o Major practice categories o Market-by-market analysis Pricing o Peer reviews & delegated authorities [GRAPHIC OMITTED] o Sound underwriting policies Medical Cost Management o Focus on Quality and Total Cost o Network fortification o ActiveHealth CareEngine(R) o Case management o Disease management 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 11

-------------------------------------------------------------------------------- Sustained Profitable Growth Aetna Logo -------------------------------------------------------------------------------- -------------------------------------------------------- Productivity Gains Fund Investments for Future Growth -------------------------------------------------------- Investments for Future Growth Operating Expense Ratio(1) o Expansion into Targeted Growth Markets 18.8% 18.2% 17.8%-17.9% [GRAPHIC OMITTED] o Integrated Solutions 2006 2007 2008E o Network Fortification o Health Information Technology o Brand and Member Experience o Pharmacy Capabilities 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 12

-------------------------------------------------------------------------------- Key Messages and Agenda Aetna Logo -------------------------------------------------------------------------------- o 2008 Industry Leading Results o Health Business Is Strong and Growing Profitably -------------------------------------------------------------------------------- o High Quality Balance Sheet & Excellent Capital Position -------------------------------------------------------------------------------- o Strategically Positioned for Health Care Reform Opportunities o Sustaining Our Momentum In 2009 and Beyond 13

-------------------------------------------------------------------------------- Balance Sheet & Capital Strength Aetna Logo -------------------------------------------------------------------------------- ------------------------------------- -------------------------------------- Strong Balance Sheet Excellent Capital Position ------------------------------------- -------------------------------------- 12/31/08 Estimates Expect to generate ~$1 billion of excess capital ~$5.9 billion of statutory per year in 2008 and 2009 surplus, ~$4.9 billion in excess of ACL No expected need to raise additional capital Debt to Capital ratio of No long term debt ~32% maturing in 2009 or 2010 RBC ratio of ~600% of Untapped $1.5 billion ACL credit facility ------------------------------------- -------------------------------------- 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 14

-------------------------------------------------------------------------------- Investment Profile Aetna Logo -------------------------------------------------------------------------------- High Quality, Well Diversified Investment Portfolio $17.8B Invested Assets as of 11/30/08 Foreign Securities 11% Redeemable Preferred 2% U.S. Corporate Securities 33% Mortgage Loans 9% Alternative Investments 6% Other 1% Cash & Cash Equivalents 8% U.S. Government 6% Tax Exempt Municipals 10% MBS, CMBS & ABS 14% [GRAPHIC OMITTED] o Largely a fixed income portfolio with an average credit quality of A+ o Ability to hold assets to maturity o Actual 2008 credit losses minimal o 4Q08E change in portfolio market value has improved significantly vs. December 2008 estimate o 2008 investment performance a testimony to sound risk management principles 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 15

-------------------------------------------------------------------------------- Key Messages and Agenda Aetna Logo -------------------------------------------------------------------------------- o 2008 Industry Leading Performance o Health Business Is Strong and Growing Profitably o High Quality Balance Sheet & Excellent Capital Position o Strategically Positioned for Health Care Reform Opportunities o Sustaining Our Momentum In 2009 and Beyond 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 16

-------------------------------------------------------------------------------- Positioned for Healthcare Reform Aetna Logo -------------------------------------------------------------------------------- Challenges Facing the Healthcare System Graphic Omitted Access Cost & Affordability Quality The healthcare debate reflects a diverse set of values regarding how to best address these challenges 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 17

-------------------------------------------------------------------------------- Positioned for Healthcare Reform Aetna Logo -------------------------------------------------------------------------------- Aetna is at the Forefront of Health Care Reform To Your Health! The Four Pillars of Health Care System Transformation ----------------------------------------------------------------------- 1 2 3 4 ----------------------------------------------------------------------- Get and Maintain the Reorient the Use market keep employer-based system toward incentives to everyone system and export prevention, improve coverage, covered its strengths to value and drive down costs make the quality of care and make the individual market system more function better consumer--oriented 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 18

-------------------------------------------------------------------------------- Positioned for Healthcare Reform Aetna Logo -------------------------------------------------------------------------------- Aetna is Strategically Positioned to Cover the Uninsured [GRAPHIC OMITTED] 45.7M 11.0M Eligible for Medicaid/SCHIP But Not Enrolled 9.7M Not Citizens of the U.S. 4.7M College & University Students 9.1M Income >$75k 13.0M - 16.0M Remaining Uninsured* Schaller Anderson 2007 Aetna Student Health 2003 Individual Market Expansion 2005+ Strategic Resource Company 2005 Small Group ---------------------------- Sources: Total Uninsured, Not a Citizen and Income >$75k: U.S. Census: "Income, Poverty, and Health Insurance Coverage in the United States: 2007" issued August 2008; Eligible-But-Not-Enrolled: Kaiser Commission on Medicaid and the Uninsured, "Characteristics of the Uninsured: Who is Eligible for Public Coverage and Who Needs Help Affording Coverage?", February 2007; College & University Students: GAO, "Most College Students are Covered through Employer-Sponsored Plans, and Some Colleges and States Are Taking Steps to Increase Coverage, March 2008; Estimated number of college students is made up of traditional college students (age18-23) of ~1.7M and non-traditional aged college students of ~3.0M. Note: Non-citizens encompass undocumented persons and others, including lawful permanent residents and refugee/asylum seekers. 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 (*Estimated due to some double counting in the above numbers) 19

-------------------------------------------------------------------------------- Positioned for Healthcare Reform Aetna Logo -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- Sound strategy for participating in government-sponsored programs -------------------------------------------------------------------------------- 2008E Revenue Aetna Strategy -------------------------------------------------------------------------------- Medicare ~$4.9B o Aetna's differentiated Medicare strategy more resilient to potential reimbursement rate changes o Membership is concentrated in network-based Medicare Advantage and Group PFFS - Individual PFFS not a focus - Group PFFS better positioned for reimbursement changes Medicaid ~$0.8B o The acquisition of Schaller Anderson is now fully integrated o Well positioned to capitalize on expansion of the Medicaid market, including growth in ABD and LTC Federal ~$1.3B o Strong track record of providingproviding value Employees added solutions to Federal government employees and their families -------------------------------------------------------------------------------- 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 20

-------------------------------------------------------------------------------- Key Messages and Agenda Aetna Logo -------------------------------------------------------------------------------- o 2008 Industry Leading Performance o Health Business Is Strong and Growing Profitably o High Quality Balance Sheet & Excellent Capital Position o Strategically Positioned for Health Care Reform Opportunities -------------------------------------------------------------------------------- o Sustaining Our Momentum In 2009 and Beyond -------------------------------------------------------------------------------- 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 21

-------------------------------------------------------------------------------- 2009 Outlook Aetna Logo -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- Expected continued economic challenges are factored into our 2009 plan -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- Medical Continued in-group membership attrition Membership assumed in plan Provider Cost Expected provider pricing pressure to offset bad debt, cost of capital, and lower volumes factored into medical cost assumptions Utilization Expected changes in utilization patterns reflected in medical cost assumptions Investments Expected impact of changes in credit spreads and yield curves assumed in investment income projections -------------------------------------------------------------------------------- 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 22

-------------------------------------------------------------------------------- 2009 Preliminary Guidance Aetna Logo -------------------------------------------------------------------------------- Aetna is well positioned for continued success in 2009 ------------------------------------------------------------------------------ Key 2009 Metrics(1) Commentary ----------------------------------------- --------------------------------- Operating EPS o 12%-14% operating EPS growth Excluding Pension 12%-14% Growth excluding year-over-year increase in pension expense of $0.54 per share Reported Basis Slightly Lower o Operating EPS slightly lower than 2008 on a reported basis Medical Membership Greater than 1M o 1/1 growth in National Accounts 1Q09 Growth ASC and upper Middle Market o Medicaid o Open enrollment Medical Cost Trend 8% +/- 50bps o Pricing in line with trend ----------------------------------------- --------------------------------- The year-over-year increase in pension expense remains a non-cash GAAP item; no change in 2009 outlook for the core operations of the business 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 23

-------------------------------------------------------------------------------- Long-Term Growth Outlook Aetna Logo -------------------------------------------------------------------------------- Committed to long term operating EPS growth goal of 15% ------------------------ ---------------------------- Segmentation Integration ------------------------ ---------------------------- Local Market Expansion Differentiated Commercialization of International Expansion Brand the Health Concierge Health Care Reform Experience and Health Advocacy M&A Opportunities Models ------------------------ ---------------------------- Operational Consumerism Excellence ------------------------ ---------------------------- Driving Member Engagement Significant Investments for Future Profitable Growth Quality & Total Cost Management Stable Medical Benefit Ratios 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 24

-------------------------------------------------------------------------------- Summary Aetna Logo -------------------------------------------------------------------------------- Aetna 2008 o Industry leading 12%- 13% operating EPS Growth(1) Performance o Industry leading ~5% organic membership growth o Total MBR in line with original guidance Health Business Is o Double digit health revenue growth model Strong, Well- o Disciplined growth in traditional segments with Diversified and double digit growth in newer segments Growing Profitably High Quality Balance o Strong capital metrics Sheet and Excellent o Estimated change in 4Q08 portfolio market value Capital Position has improved significantly vs. December 2008 estimate o ~$1B excess capital per year in 2008 and 2009 for share repurchases & M&A 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 25

-------------------------------------------------------------------------------- Summary Aetna Logo -------------------------------------------------------------------------------- Strategically o Proactively shaping market-based solutions Positioned for o Well positioned to capitalize on opportunities Health Care Reform to cover the uninsured o Differentiated Medicare strategy Sustaining Our o Projected 12-14% operating EPS growth excluding Momentum In 2009 year-over-year increase in pension expense(1); no change in outlook for core operations of the business o Leading edge integrated platform expected to drive new business wins in 2009 and 2010 Committed to Long Term Operating EPS Growth Goal of 15% 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 26

-------------------------------------------------------------------------------- Footnotes Aetna Logo -------------------------------------------------------------------------------- (1) In order to provide a comparison that Aetna believes provides useful information regarding our underlying performance, certain historical and projected financial metrics, including operating earnings per share, health care revenue and our operating expense ratios exclude net realized capital gains and losses and other items, if any. Aetna uses these measures to assess business performance and to make decisions regarding our operations and allocation of resources among our businesses. Each of the excluded items is discussed below: o Net realized capital (losses) gains of $(232.0) million ($(356.8) pretax), $(47.9) million ($(73.7) pretax) and $24.1 million ($32.2 million pretax) in the nine months ended September 30, 2008 and for the years ended December 31, 2007 and 2006, respectively, arise from various types of transactions, primarily in the course of managing a portfolio of assets that support the payment of liabilities. However, these transactions do not directly relate to the underwriting or servicing of products for customers and are not directly related to the core performance of Aetna's business operations. o Reduction of reserves for anticipated future losses on discontinued products in Large Case Pensions of $28.5 million, after tax, is considered an other item for the nine months ended September 30, 2008 as it represents a reduction of reserves previously established for certain products no longer offered by Aetna that do not benefit ongoing business operations. o As a result of the liquidation proceedings of Lehman Re Ltd. ("Lehman Re"), a subsidiary of Lehman Brothers Holdings Inc., Aetna recorded an allowance against its reinsurance recoverable from Lehman Re of $27.4 million ($42.2 million pretax) in the nine months ended September 30, 2008. This reinsurance was placed in 1999 and is on a closed book of paid-up group whole life insurance business. This is an other item for the nine months ended September 30, 2008 because it does not reflect underlying 2008 performance. o A debt refinancing charge of $8.1 million ($12.4 million pretax), represents the net charge from the write-off of debt issuance costs and the recognition of deferred gains on terminated interest rate swaps in connection with the redemption of Aetna's 8.5 percent senior notes due 2041. This is an other item for the year ended December 31, 2006, as it does not reflect underlying 2006 business performance. o The write-off of a $47.1 million ($72.4 million pretax), insurance recoverable related to a prior-year physician class action settlement as a result of a trial court summary judgment ruling. This is an other item for the year ended December 31, 2006, as it does not reflect underlying 2006 business performance. o As a result of the acquisition of Broadspire's disability business in 2006, Aetna impaired approximately $6.2 million ($8.3 million pretax), of Aetna's previously capitalized software, due to the acquisition of a more multifunctional system. This is an other item for the year ended December 31, 2006 as it does not reflect underlying 2006 business performance. The operating expense ratio is calculated by dividing operating expenses, excluding other items, by total revenue, excluding net realized capital gains or losses. Aetna cannot reconcile the projected operating expense ratio to a comparable GAAP measure, because it cannot project net realized capital gains or losses. In the calculation for projected full-year 2008 operating expense ratio, operating expenses exclude the allowance recorded on the reinsurance recoverable (described above). In the calculation of the full-year 2006 operating expense ratio, operating expenses exclude the debt refinancing charge, physician class action settlement insurance-related charge, and acquisition-related software charge (each of which are described above). Projected full year 2008 and actual 2007 revenue in the Health Care segment excludes net realized capital losses (pretax) of $245.4 million and $33.7 reported by Aetna for the nine months ended September 30, 2008 and for the year ended December 31, 2007, respectively. Projected revenue also excludes any future net realized capital gains or losses (pretax), which are included in the comparable GAAP measure. (2) Competitor EPS growth based upon First Call consensus estimates 2009 ANNUAL JPMORGAN HEALTH CARE CONFERENCE | JANUARY 12, 2009 27