It also has examples of how much you might pay out of pocket for certain health services. @ {(6ZHFF@$Gy"?[_ i Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Aetna EPO Basic Plan. Select your state, county and plan name below to find your: Evidence of Coverage (EOC) Summary of Benefits. Applicable FARS/DFARS apply. When you purchase through our links we may earn a commission. Aetna handles premium payments through Payer Express, a trusted payment service. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Formulary - Prescription Drug Coverage. %PDF-1.6 % To qualify for the free weight management membership, members need to: Have a body mass index (BMI) of 25 or greater. Treating providers are solely responsible for dental advice and treatment of members. Eligible members age 18 and up can receive a voucher to cover digital weight management support. 1627 0 obj <>stream Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Aetna is one of the largest providers of health insurance products in the United States, and the company also provides Medicare coverage for members who qualify to take part in the program. Your doctor is in charge of sending us prior authorization requests for medical care. Coverage Period: 01/01/2022 - 12/31/2022 Coverage for: Self Only, Self Plus One or Self and Family | . The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. CPT only Copyright 2020 American Medical Association. Supplemental materials are supported for SBCs with a coverage effective date of 1/1/2014 or later. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Coverage for: Individual + Family | Plan Type: POS. All Rights Reserved. Coverage Period: 01/01/2022 -12/31/2022 . 2400 0 obj <>stream The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. %PDF-1.6 % License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. The SBC shows you how you and the plan would share. 1557 0 obj <> endobj Were bringing you to our trusted partner to help process your payments. Reprinted with permission. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Individual Medicare Prescription Drug (PDP) and MAPD plans cover diabetic supplies under Part D, including: *Some items may require prior authorization from your medical benefit. Unlisted, unspecified and nonspecific codes should be avoided. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. plan. Sometimes you need a referral or prior authorization before you can get care. Coverage for: Individual + Family | Plan Type: POS. Aetna Choice POS II. Outofnetwork/noncontracted providers are under no obligation to treat Aetna Medicare members, except in emergency situations. You'll find a link to the SBC on each plan page when you preview plans and prices. CPT is a registered trademark of the American Medical Association. Understand your options for health screenings and vaccines so you can better. )G(YC%3J 0,BfGIr3BdVqTjEjf%0r\R7I){/@qd1cDG =3^k(M(g|8zLO,B/g,1HY[LK?xX~o\$2t9Gve^eb7:}Xc4G48/_W#jH5D4ZyN3Zf {\| v] vSm&EtOrI pvsIz@9ML$I2(0i=v`?*MgiG".]/g!IzKO;>b)FJB#qxXvK) Fd_`6dc?1JL"*tG63HoN'-,9M"{x[ps*Wk?'q2-K=)49S~}M:8(xC]$GY\Ps,SHGe7Y)`M8x'-O@Y,4!Jj\F+ o9m$4qFj)Y7U.p uZQZvg6c Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. If youre immunocompromised (like people who have had an organ transplant and are at risk for infections and other diseases), Visit AetnaMedicare.com to learn more about the 2022. Disclaimers. endstream endobj startxref The information you will be accessing is provided by another organization or vendor. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. You can find the pharmacy plan name on your SBC. If you get coverage from an outofnetwork provider, your plan wont cover their charges. Dual Eligible Special Needs Plans (D-SNP). Includes PPO, HMO, HMO-POS medical plans with or without drugs. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. hbbd```b``"H+XDrH f IM0VY"96 &XM/XD!@DFDAlP`Y0:[@~&Fe`30C?; %%EOF &@A2HP c Pp,! Our plan selection pages will be down for maintenance starting Friday, April 16, at 9 p.m. and returning by 1 p.m. Saturday, April 17. FL, GA, MO, NC, NV, TX: 1-844-374-5217 (TTY: 711), AZ (Non Banner|Aetna): 1-844-374-5217 (TTY: 711), AZ (Banner|Aetna): 1-844-374-5218 (TTY: 711), VA (Non Innovation Health): 1-844-374-5217 (TTY: 711), VA (InnovationHealth): 1-844-374-5219 (TTY: 711), Off exchange (non-HMO): 1-888-802-3862 (TTY: 711), Off exchange (HMO): 1-866-529-2517 (TTY: 711). Legal entity, plan terms and benefits, including cost sharing, may vary from your actual coverage based on the plan selected and state mandates which are not reflected in this sample document. No fee schedules, basic unit, relative values or related listings are included in CPT. Select a state below to update coverage details. Htj ,ERn6-M $*Cf9,96Fu:ggcv[v=xql\AJ?R8EPf+`$z|_b;0.X*ey WNjD4WM NAi$zdr'J/%Cg9ww He_L|-:\g| w Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. See a list of covered drugs for your plan. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. You can get some diabetic supplies, including durable medical equipment (DME), with your Medicare Advantage (MA) and Medicare Advantage Prescription Drug plans (MAPD). NEWYORK-PRESBYTERIAN/QUEENS : Aetna Choice POS II - CORE OPTION. You can link from the SBC to your plan documents which contain the complete details about the health plan. It may be different from your Aetna secure member site login. Some subtypes have five tiers of coverage. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. You are now leaving the Aetna Dental Web site and linking to ClaimConnect*. Youll need to get a referral from your PCP for covered, nonemergency specialty or hospital care, except in an emergency and for certain directaccess service. (-CR$c%nf;yO0!g Doctors and health care companies continuously develop new technologies. Remember, the SBC is only a summary. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. This is a Summary of Benefits and Coverage (SBC) document. You are now being directed to the CVS Health site. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". A referral is a kind of preapproval from your primary care doctor to see a specialist. Continuous Glucose Monitors (CGM) and supplies, Insulin infusion pump and most insulins used in the pump, Therapeutic shoes* and inserts* for diabetics, FreeStyle Libre, Dexcom and Medtronic iPro, Blood Glucose Meters (BGM) and testing supplies exclusively OneTouch, To avoid rejections on Part B-covered supplies like test strips, ensure they are OneTouch brand, Insulin needles, pens and syringes (when used for injecting insulin), Base our decisions on appropriateness of care, service and plan coverage, Use nationally recognized guidelines and resources to make changes, Dont pay or reward providers, employees or others for denying coverage or care, Focus on reviewing the risks of members who arent fully using certain services, Carefully review the latest information and ask experts for their opinions, Compare the information with well-known standards, Base all of our decisions on making sure you have the right care and services. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. Treating providers are solely responsible for medical advice and treatment of members. Just check your plans Evidence of Coverage (EOC) for details and limitations. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Copyright 2015 by the American Society of Addiction Medicine. Aetna Dental works with ClaimConnect TM offered by EDI Health Group (EHG) to provide easy access to check patient eligibility, file a claim, check claim status, view patient rosters and Electronic Remittance Advice.. "/>. *dod HW"\A6^0h3U>kDEo'~rsCfyY fM-(Q5Xh9_G1oGQ|p| E:]a+\tY*{t`$0SsO!$J)pj 5Tj;Rtx^\C[9f!Kn& \JVXQ_B#q/TS:{rs{%-16U2jlu]@qG;!4!kHM|e u_Imyc+F~QY7pf-`Von]mx+liMZt6[YzKi|BRvJ82(?DE;wv)[u*s{2u'8:j'PEUV[(5TxWpMZ#Kfoaog*^Z,fpH+'hI3]g\fX+WueE Please call us or see your Evidence of Coverage for more information, including the cost share for outofnetwork services. They issue these when a services or drugs coverage rules change. If you're an individual covering yourself or your family member(s): Individual Elect Choice Open Access (EPO) sample policy (PDF), Individual Health Maintenance Organization (HMO) sample policy (PDF). If you do not intend to leave our site, close this message. You are now being directed to CVS Caremark site. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. According to the Department of Health and Human Services, Medicare Part D plans cover all vaccines that are: While Medicare Part B generally covers most vaccines that Medicare patients need, Medicare Part D generally covers vaccines that Medicare Part B does not cover. Treating providers are solely responsible for medical advice and treatment of members. Check your plans Evidence of Coverage (EOC) to see if or how these rules apply. SCHOOL EMPLOYEES RETIREMENT SYSTEM OF OHIO : Aetna Choice POS II - HCPII. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. The SBC includes the name of your health plan. Your benefits plan determines coverage. NOTE: Information about the cost of this plan . This Agreement will terminate upon notice if you violate its terms. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. . You also can look up drug coverage without logging in. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). 1. All services deemed "never effective" are excluded from coverage. The AMA is a third party beneficiary to this Agreement. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. hb```V'!10p\`PLwA@$LNdxU5k'F^~.}Cf/*d 4,kL)06 (!*eXLO>WEGYq[M~:'LfCCm1j^q`( - D-@Zm:6ti> 3MP VP2 ?^
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