To our Shareholders:
For nearly 160 years, Aetna has successfully adapted to changing marketplace, political and social dynamics as we sought to create value for the people who use our services. In 2010, we again embraced change as we effectively repositioned the company for success.

Success in 2010
We entered 2010 determined to improve our performance, despite ongoing challenges from a slow economy. With our customers at the center, we took decisive action to strengthen our business fundamentals, enhancing productivity and operational excellence. We recalibrated our pricing, and strengthened our medical quality and cost-management processes to reflect changing market conditions. As a result, we realized full-year operating earnings of $1.5 billion, a year-over-year increase of more than 25 percent; and full-year operating earnings per share of $3.68, an increase of 34 percent compared to 2009.

We achieved important operational and strategic objectives, including:

• Expanding our Medicaid business through new contracts in Florida and Pennsylvania, and winning a fully insured Aged, Blind and Disabled contract in Illinois;
• Obtaining a new ActiveHealth business contract in North Carolina covering 500,000 state employees and their beneficiaries. This contract includes facilitating the roll out of a Patient-Centered Medical Home model of care statewide;
• Earning, for the second year in a row, the J.D. Power and Associates* call center certification for providing “An Outstanding Customer Service Experience” at our concierge customer service call center in High Point, N.C., which supports our AetnaOne^® leading-edge integrated platform;
• Entering into a strategic, long-term Pharmacy Benefit Management agreement with CVS Caremark, further enhancing Aetna’s market-leading integrated value proposition for customers; and
• Acquiring Medicity, a leading health information exchange company, to bolster our health care information technology strategy.

We also increased the company’s cash dividend and declared a quarterly dividend of $0.15 per share as part of an efficient capital deployment strategy that allows us to continue to invest in our company while providing a meaningful return to our shareholders.

To help our members become better consumers of health care services, we implemented new consumer tools and technologies. Members can now access their benefits through mobile phone applications, navigate our secure member website with help from “Ann”, Aetna’s virtual assistant, or estimate the cost of health services before they incur them through our Payment Estimator tool.

To help improve the quality of our members’ lives, we also continued to evolve Aetna’s Care Management strategy. Focused on caring for our members at every stage of their health, our Wellness, Disease Management and Case Management programs are designed to help people stay healthy, manage a chronic condition or recover from an illness. For example, in 2010, more than 2.3 million individualized Care Consideration messages were communicated to Aetna members and their physicians, identifying potential opportunities to improve care.

I am proud of our accomplishments and want to thank Aetna’s dedicated employees, who contributed to our success. In 2011, our financial strength and highly respected brand will serve us well as we strategically position the company to capitalize on marketplace opportunities, including international expansion and health care reform.

Health Care Reform Became Law
2010 also marked the historic passage of the Patient Protection and Affordable Care Act, and the beginning of a multiyear implementation process. Although the initial legislation opened up access for millions of Americans, it did not effectively deal with issues of affordability and quality. We must address the way we deliver and pay for health care in this country and move to a system that rewards quality of care delivered rather than just the quantity of services provided.

Aetna has been a leader throughout the reform process, and we continue to work closely with federal and state regulators. We successfully implemented 2010 benefits mandates and additional plan requirements. As we prepare for longer-term market reforms, we are confident in our ability to adapt to a new health care landscape and help our customers do the same.

Our Strategy for the Future
The next 10 years will be a critical time for health care. America will continue to work toward building a better health care system. Globally, the increased prevalence of chronic diseases will put more pressure on health systems, social structures and economies. These challenges, both in the U.S. and abroad, are not going away. Our strategy to empower people around the globe to live healthier lives clearly aligns with these external trends, takes advantage of our strengths and helps us meet a critical societal need. We will strengthen our leadership in the U.S. by providing more affordable solutions to customers. We will capitalize on opportunities that come from reform and the entry of millions of new customers into the marketplace. And we also will explore new businesses and markets that offer the potential for long-term profitable growth such as expanding our roles in health information technology and international markets.

A New Era of Leadership
2010 was indeed a year of change. Mark Bertolini assumed the responsibility of CEO in November; and upon my retirement in April 2011, will assume the additional role of Chairman of the Board. I have every confidence in Mark’s ability to lead Aetna into a new era. He has been closely involved in the company’s strategy, vision and values. His experience and deep knowledge of the industry make him the right leader to steer Aetna on its path to becoming the global leader in health care benefits. I wish him, and everyone at Aetna, great success.

In closing, I want to express how privileged I feel to have led this great company. I am proud of what we accomplished over the last 10 years, which included a historic financial turnaround; sustained industry leadership; and a strong voice in the quest for quality, affordable health care. I leave knowing that Aetna is in good hands with a bright future.

Thank you for your support through the years and continued investment in Aetna.

Ronald A. Williams
Chairman
March 2011