Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). It also has examples of how much you might pay out of pocket for certain health services. Theres no place like Aetna to find the plans, programs, services and administration you need to help keep your business strong and healthy. You are leaving our Medicare website and going to our non-Medicare website. Summary of benefits and coverage The basics about your health coverage Under the Affordable Care Act (ACA), you must receive a Summary of Benefits and Coverage (SBC) document. Sometimes you need a referral or prior authorization before you can get care. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Putting the 'Me' in Medicare Tips and resources on staying healthy and connected during the pandemic. The member's benefit plan determines coverage. The member's benefit plan determines coverage. Health Care Costs Affect Your Pension Payment Aetna Medicare Plan (PPO) SERS.AetnaMedicare.com Toll-Free: 866-282-0631 TDD: 711. Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. In case of a conflict between your plan documents and this information, the plan documents will govern. 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. For a decision about whether well cover an outof-network service, we encourage you or your provider to ask us for a preservice organization determination before you receive the service. Yes, I'm a memberNo, I'm looking for a plan. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. A prior authorization or precertification is when your doctor has to get approval from us before we cover an item or service. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. View your benefits. And you can, too. Links to various non-Aetna sites are provided for your convenience only. 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. CPT is a registered trademark of the American Medical Association. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). You also get access to special discounts on many CVS brand health products. 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. UC Health Accepted Insurance Plans UC Health Accepted Insurance Plans 1 4/8/2015 INSURANCE CARD TYPICAL NAME PRODUCT TYPE. There are exceptions for certain direct access services. Medicare Advantage Prescription Drug (MAPD) Open Enrollment Period. [Larry buckles helmet and pedals bicycle]. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. They offer cash benefits to help you pay for many everyday expenses. 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. Copyright 2015 by the American Society of Addiction Medicine. In case of a conflict between your plan documents and this information, the plan documents will govern. Viv:Actually, to help you out with health expenses or any other bills, you might need some backup like supplemental health insurance. Each main plan type has more than one subtype. Philip: And then we had an Aetna meeting. 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. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. See a list of covered drugs for your plan. Every one. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. We go on cruises. Where are you? Or even if I'm diagnosed with a serious illness? Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Medical costs and other life expenses can pop up suddenly. When billing, you must use the most appropriate code as of the effective date of the submission. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Select your plan to log in to your secure account Medicare Advantage (MA/MAPD) Members with Aetna Medicare Advantage (MA) and Aetna Medicare Advantage with Prescription Drug (MAPD) plans can log in or register for an account below. Im turning 65 or just starting to explore Medicare, request a copy of your 2023 Evidence of Coverage or Formulary, request a copy of your Evidence of Coverage, formulary and pharmacy directory. Aetna's 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). 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. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Or my wife has an extended hospital stay? If you do not intend to leave our site, close this message. Aetna Inc. and itsaffiliated 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. Were here and were glad that were here. Every September, benefit recipients enrolled in an SERS health care plan received an Open Enrollment packet in the mail. The information you will be accessing is provided by another organization or vendor. From arranging transportation to informing them about activities at local senior centers, our Resources For Living program ensures your retirees are connected to the resources they need in their daily lives. SUMMARY OF BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY Primary Care Physician (PCP): You have the option to choose a PCP. Premiums are based on: Years of qualified service credit Eligibility for a premium subsidy Health care plan selected If you enroll in dental and/or vision coverage, you will be charged additional premiums. You can get some diabetic supplies, including durable medical equipment (DME), with your Medicare Advantage (MA) and Medicare Advantage Prescription Drug plans (MAPD). If youre sick or injured, your bills can add up. The Aetna representatives they went pretty much from A to Z and we made the final decision that was it. There is no obligation to enroll. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. So they save. Dual Eligible Special Needs Plans (D-SNP). The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. Last year State Employees' Retirement System (SERS) had nearly 70,000 retirees and survivors receiving over $2.1 billion in retirement annuities - those are not small numbers. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. This site has its own log in. Being healthy, like you know I can go in my garden and work. Reemployment Forms and Publications Premiums The premium you pay for SERS' health care coverage includes medical and prescription drug coverage. Links to various non-Aetna sites are provided for your convenience only. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Members just select a network PCP to guide their care. All SBCs must follow a standard format. 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. Your doctor is in charge of sending us prior authorization requests for medical care. This Aetna Dental Preferred Provider Organization (PPO) benefits summary is provided by Aetna Life Insurance Company for some of the more frequently performed dental procedures. I worked for General Motors for forty six years. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). For benefit questions or learn more about the Aetna Medicare Advantage plan for SERS Retirees call Aetna Member Services at 1-866-282-0631 (TTY: 711), Monday to Friday, 8 AM to 9 PM ET. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Were leading the way as a health solutions company with the aim of helping our members achieve their best health no matter where they are in their health journey and no matter how they define health. But when I got there, all the doctors every one of the doctors was on there. Exclusive benefits just for members Your Aetna plan offers extras to help you save money and feel your best. All Rights Reserved. Links to various non-Aetna sites are provided for your convenience only. Back to FAQ home page What if my drug is not on the formulary? Review the plan benefit information you received from them. Si tu intencin no era salir del sitio web, cierra este mensaje. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Well versed in the treatment of Parkinson's disease " See all nearby highly-recommended providers Find and compare top local doctors Read verified reviews from patients and see real-time availability for every doctor Check that you're covered If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. This information is neither an offer of coverage nor medical advice. **FOR EXTRA BENEFITS CARD: Check your Summary of Benefits to see if your Extra Benefits Card can be used for other things such as OTC items, transportation and utilities. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. Speak with a licensed insurance agent by calling 1-877-890-1409 1-877-890-1409 TTY Users: 711 24 hours a day, 7 days a . Want to see options for a different location? Thanks! Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. With the AetnaOpen Choice POS II plan, members can visit any doctor, hospital or facility, in or out of network, with no referrals. Broad networks. Disclaimer of Warranties and Liabilities. We want to make sure you can access your benefits even during urgent situations - like a public health emergency or state of disaster. Thats cash for medical and non-medical expenses. Or you can use the cash to cover mortgage payments, groceries, utility bills and day care. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. For some services, your PCP is required to obtain prior authorization from Aetna Medicare. You are now being directed to the CVS Health site. Please call us or see your Evidence of Coverage for more information, including the cost share for outofnetwork services. Many plans include dental coverage, vision benefits and hearing allowances. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. You can learn more about these benefits, find reimbursement forms and more online. Disclaimer of Warranties and Liabilities. Mifflin County. This lessens your administrative burden as well as creates a more streamlined approach for your retirees who will benefit from: Your retirees will have access to over 67,000 pharmacies nationwide. Did you know me? The benefits you receive will vary depending on the plan you choose. The average cost of an Aetna health insurance plan on the ACA marketplace for a 30-year-old is $421 monthly, a 40-year-old pays $474 on average and a 50-year-old spends $662 on average. This search will use the five-tier subtype. When billing, you must use the most appropriate code as of the effective date of the submission. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 3 plan options to prepare for the unexpected, Please be sure to add a 1 before your mobile number, ex: 19876543210. With the Aetna Open Choice PPO plan, members can visit any provider, in network or out, without a referral. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. If you get coverage from an outofnetwork provider, your plan wont cover their charges. That can help you balance your choices with your budget. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Add whole health to your benefits plan with our range of dental, vision and other ancillary benefits. Please log in to your secure account to get what you need. It is only a partial, general description of plan or program benefits and does not constitute a contract. You get fixed payments for your covered hospital stay. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Medicare coverage for the whole you body, mind and spirit, Discover coverage that takes a total approach to health, See how we help you get the right resources and care, Take full advantage of everything your plan offers you. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). View Coverage & Benefits Find your plan information You can find your Evidence of Coverage (EOC), Summary of Benefits, Star Ratings, Formulary - Prescription Drug Coverage, Over the counter (OTC) benefit catalog, and more. For language services, please call the number on your member ID card and request an operator. When it rains, I have my umbrella. Today, more than 21 million people count on Medicare Advantage plans. Group Medicare Individual Medicare Health Maintenance Organization (HMO) plans Indemnity plans Stop loss plans Options for whole health Add whole health to your benefits plan with our range of dental, vision and other ancillary benefits. Lots of flexibility, with a little guidance, Please be sure to add a 1 before your mobile number, ex: 19876543210, Health Maintenance Organization (HMO) plans, Great for fully insured and self-funded customers. All services deemed "never effective" are excluded from coverage. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Links to various non-Aetna sites are provided for your convenience only. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. 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. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. The Primary Care Office Visit co-pay changes from $20 to $10; Outpatient Rehab Therapies from $20 to $15; and Cardiac and Pulmonary Rehab Services from $20 to . New and revised codes are added to the CPBs as they are updated. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Aetna Inc. and itsaffiliated 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. It is only a partial, general description of plan or program benefits and does not constitute a contract. Call Member Services at the number on your ID card. Medicare Advantage PPO Plans With Aetna Medicare Advantage PPO plans, you can visit providers in or out of our provider network who accept Medicare and our plan terms. While others in Illinois may . Just check your plans Evidence of Coverage (EOC) for details and limitations. CPT is a registered trademark of the American Medical Association. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If you do not intend to leave our site, close this message. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. All Rights Reserved. Larry:I'm not worried. 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. November 1 - 30, 2022. It may be different from your Aetna secure member site log in. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. Health insurance plans Health Insurance Through Work Extra Member Benefits Live fully with these extras No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. But depending on their plan, choosing a primary care physician (PCP) and staying in network could cost less. You must use network providers, except for: If you get routine care from outofnetwork providers, Medicare and Aetna Medicare wont be responsible for the costs. Y0001_32266_2023_C Updated 07/01/2023 23016B2NG1b. Your benefits plan determines coverage. When you enroll, you may cover your spouse, and children up to age 26. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater.