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Submitted URL: https://mail-connect.aetna.com/dc/t028gjDXHouCrcjQrWfbcXwH73CeuEKA62PtKSGhZ0ChSiahM-AzYvCDxzRTHnAY2dlD8vC8rm0z6M7bTo-vH7znJx9od...
Effective URL: https://www.aetna.com/individuals-families/member-rights-resources/rights/disclosure-information.html?cid=eml-AFA-SG-O...
Submission: On October 28 via api from US — Scanned from DE
Effective URL: https://www.aetna.com/individuals-families/member-rights-resources/rights/disclosure-information.html?cid=eml-AFA-SG-O...
Submission: On October 28 via api from US — Scanned from DE
Form analysis 6 forms found in the DOM
/search-results.html
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<span tabindex="-1" class="errorMsg"><strong>Error or missing data. Please check your entries for an error message.</strong></span>
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<option value="Aetna Student Health | Machine readable files">Aetna Student Health | Machine readable files</option>
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<option value="Individual ACA plans | Machine readable files">Individual ACA plans | Machine readable files</option>
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<span tabindex="-1" class="errorMsg"><strong>Error or missing data. Please check your entries for an error message.</strong></span>
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<input type="submit" value="Send me a text" class="btn btn--primary">
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</form>Text Content
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Fed No Surprises Act
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Read about your rights and protections against surprise medical bills.
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EXPLORE PLANS
* Medicare
* Health coverage
* Dental, vision and supplemental
* Pharmacy
* Medicaid
*
MEMBER SUPPORT
* Account management
* The health guide
* Additional resources
*
* EXPLORE AETNA SITES
* Individuals & Families
* Affordable Care Act
* Medicare
* Medicaid
* Providers
* Employers
* Agents & Brokers
* Partners
* Careers
* About Us
MEDICARE
* Browse Aetna Medicare plans
* Find a doctor
* Check our drug list
* Understand Medicare
* Find a plan to meet your needs
* Enroll in Medicare
HEALTH COVERAGE
* ACA individual and family health plans
* Health plans through an employer
* Options without employer coverage
* Student plans
* International plans
DENTAL, VISION AND SUPPLEMENTAL
* Dental plans
* Find a dentist
* Vision plans
* Find an eye doctor
* Supplemental plans
PHARMACY
* Get pharmacy plan information
* Find a pharmacy
MEDICAID
* Medicaid plans
* Find a doctor
ACCOUNT MANAGEMENT
* Log in to your member website
* Find a form
* Get your ID card opens in secure site
* Check a claim opens in secure site
* View coverage opens in secure site
THE HEALTH GUIDE
* All health resources
* Living healthy
* Understanding health care
* Managing health
ADDITIONAL RESOURCES
* Women's health
* Health insurance rights and resources
* Contact us
* Frequently asked questions
* Prior authorization guidelines
IMPORTANT DISCLOSURE INFORMATION
This information can help you understand what your plan covers, the costs of and
rules for using your plan, how to file a grievance and more.
WE MEET QUALITY STANDARDS
WE MEET QUALITY STANDARDS
We follow health plan accreditation standards of the National Committee for
Quality Assurance (NCQA) to offer you quality health plans. Learn how we meet
those standards — plus how you can get plan details online or by phone, find
out about your rights and responsibilities, understand plan costs and more.
Read More Read Less
* Meeting NCQA standards Aetna Vision℠ Preferred plan - English (PDF)
* Meeting NCQA standards – Spanish (PDF)
CONSUMER DISCLOSURES FOR HEALTH, DENTAL AND VISION PLANS
INDIVIDUAL PLANS
In certain states we offer health plans for you and your family. Just select a
state to find documents that describe these plans, along with state-specific
disclosure requirements to help you determine the right coverage.
Dental — a stand-alone plan for individuals
Individual dental disclosure (PDF)
Health plans
Error or missing data. Please check your entries for an error message.
LOADING, PLEASE WAIT
State Select CaliforniaDelawareFloridaGeorgiaIllinoisMissouriNevadaNew
JerseyNorth CarolinaTexasVirginia
GROUP PLANS
We also offer group health, dental and vision plans (available through an
employer). Just select a state to find documents that describe these plans,
along with state-specific disclosure requirements to help you determine the
right coverage.
Error or missing data. Please check your entries for an error message.
LOADING, PLEASE WAIT
State Select
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of
ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew
HampshireNew JerseyNew YorkNorth CarolinaNorth
DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth
DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Product Select
Beginning January 1, 2022, covered dental services provided to Texas members
through Teledentistry by a licensed health professional, will be covered the
same as if the services were performed in an in-person setting.
Affordable Care Act Individual Health Insurance Broker Compensation Information
For Policies Sold in Florida, Georgia, Missouri, North Carolina, Nevada, Texas,
and Virginia for the 2022 Calendar Year Aetna Health Inc.
TRANSPARENCY IN COVERAGE
Error or missing data. Please check your entries for an error message.
LOADING, PLEASE WAIT
Disclosures Select Aetna Student Health | Machine readable filesFully Insured
plans | Machine readable filesIndividual ACA plans | Machine readable filesSmall
Group AFA | Machine readable files
DIRECT BROKER COMMISSIONS SCHEDULE
State
Amount per enrolled member per month*
Florida
$28
Georgia
$22
Missouri
$20
North Carolina
$25
Nevada
$18
Texas
$25
Virginia
$20
State
Florida
Amount per enrolled member per month*
$28
State
Georgia
Amount per enrolled member per month*
$22
State
Missouri
Amount per enrolled member per month*
$20
State
North Carolina
Amount per enrolled member per month*
$25
State
Nevada
Amount per enrolled member per month*
$18
State
Texas
Amount per enrolled member per month*
$25
State
Virginia
Amount per enrolled member per month*
$20
*Commissions are payable to a maximum of five members per policy.
In addition to direct commissions, your broker may also be eligible for a bonus
program:
A one-time bonus for new members enrolled on January 1, 2022 and February 1,
2022 according to the following schedule:
Amount of members
Amount of payment per enrolled member
10-24 members
$25
25-49 members
$50
50+ members
$75
Amount of members
10-24 members
Amount of payment per enrolled member
$25
Amount of members
25-49 members
Amount of payment per enrolled member
$50
Amount of members
50+ members
Amount of payment per enrolled member
$75
The broker bonus program applies only to policies sold in these states for the
2022 calendar year. Certain other conditions apply.
WOMEN’S HEALTH AND CANCER RIGHTS ACT (WHCRA)
WOMEN’S HEALTH AND CANCER RIGHTS ACT (WHCRA)
If you have had or are going to have a mastectomy, you may be entitled to
certain benefits under the WHCRA of 1998. We’ll determine what your coverage
will be based on our consultations with you and the attending physician
regarding:
* All stages of reconstruction of the breast on which the mastectomy was
performed
* Surgery and reconstruction of the other breast to produce a symmetrical
appearance
* Prosthesis
* Treatment of physical complications of the mastectomy, including lymphedema
You’ll also receive benefits if you’ve had a mastectomy as a result of breast
cancer while covered under a different health plan. Your coverage is provided in
accordance with your plan design and is subject to plan limitations, copays,
deductibles, coinsurance and referral requirements, if any, as noted in your
plan documents.
For more information, contact Member Services at the number on your ID card. You
can also find resources from the Centers for Medicare & Medicaid Services and
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ASAM TERMS AND CONDITIONS
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Licensee's use and interpretation of the American Society of Addiction
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Conditions does not imply that the American Society of Addiction Medicine has
either participated in or concurs with the disposition of a claim for benefits.
This excerpt is provided for use in connection with the review of a claim for
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Copyright 2015 by the American Society of Addiction Medicine. Reprinted with
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* The term precertification here means the utilization review process to
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medical device meets the company's clinical criteria for coverage. 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
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* Applies to: Aetna Choice® POS, Aetna Choice POS II, Aetna Medicare℠ Plan
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* The five character codes included in the Aetna Precertification Code Search
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listing of descriptive terms and five character identifying codes and
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contains the complete and most current listing of CPT codes and descriptive
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* This product includes CPT which is commercial technical data and/or computer
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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
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* Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in
administering plan benefits and do not constitute dental advice. Treating
providers are solely responsible for dental advice and treatment of members.
Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to
their coverage or condition with their treating provider.
* While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in
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benefits. 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. Each
benefit plan defines which services are covered, which are excluded, and
which are subject to dollar caps or other limits. Members and their providers
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exclusions or other benefit limitations applicable to this service or supply.
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coverage may be mandated by applicable legal requirements of a State or the
Federal government.
* Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly
updated and are therefore subject to change.
* 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.
* Under certain plans, if more than one service can be used to treat a covered
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Members should discuss any Clinical Policy Bulletin (CPB) related to their
coverage or condition with their treating provider.
* While the Clinical Policy Bulletins (CPBs) are developed to assist in
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benefits. The Clinical Policy Bulletins (CPBs) express Aetna's determination
of whether certain services or supplies are medically necessary, experimental
and investigational, or cosmetic. 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
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national health professional organizations, views of physicians practicing in
relevant clinical areas, and other relevant factors).
* Aetna makes no representations and accepts no liability with respect to the
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defame. Aetna expressly reserves the right to revise these conclusions as
clinical information changes, and welcomes further relevant information
including correction of any factual error.
* CPBs include references to standard HIPAA compliant code sets to assist with
search functions and to facilitate billing and payment for covered services.
New and revised codes are added to the CPBs as they are updated. When
billing, you must use the most appropriate code as of the effective date of
the submission. Unlisted, unspecified and nonspecific codes should be
avoided.
* Each benefit plan defines which services are covered, which are excluded, and
which are subject to dollar caps or other limits. 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.
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. The
member's benefit plan determines coverage. Some plans exclude coverage for
services or supplies that Aetna considers medically necessary. If there is a
discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of
benefits, the benefits plan will govern.
* In addition, coverage may be mandated by applicable legal requirements of a
State, the Federal government or CMS for Medicare and Medicaid members.
See CMS's Medicare Coverage Center
* Please note also that Clinical Policy Bulletins (CPBs) are regularly updated
and are therefore subject to change.
* Since Clinical Policy Bulletins (CPBs) 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.
* 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. In the event that a member disagrees with a
coverage determination, Aetna provides its members with the right to appeal
the decision. 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. 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.
See Aetna's External Review Program
* 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). 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.
* 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.
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). No fee schedules, basic
unit values, relative value guides, conversion factors or scales are included
in any part of CPT. 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. Applicable FARS/DFARS apply.
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT®")
CPT only copyright 2015 American Medical Association. All Rights Reserved. CPT
is a registered trademark of the American Medical Association.
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.
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.
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.
Go to the American Medical Association Web site
U.S. Government Rights
This product includes CPT which is commercial technical data and/or computer
data bases and/or commercial computer software and/or commercial computer
software documentation, as applicable which were developed exclusively at
private expense by the American Medical Association, 515 North State Street,
Chicago, Illinois, 60610. 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.
Disclaimer of Warranties and Liabilities.
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. No fee schedules, basic unit, relative
values or related listings are included in CPT. The American Medical Association
(AMA) does not directly or indirectly practice medicine or dispense medical
services. The responsibility for the content of this product is with Aetna, Inc.
and no endorsement by the AMA is intended or implied. 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.
This Agreement will terminate upon notice if you violate its terms. The AMA is a
third party beneficiary to this Agreement.
Should the foregoing terms and conditions be acceptable to you, please indicate
your agreement and acceptance by selecting the button labeled "I Accept".
The information contained on this website and the products outlined here may not
reflect product design or product availability in Arizona. Therefore, Arizona
residents, members, employers and brokers must contact Aetna directly or their
employers for information regarding Aetna products and services.
This information is neither an offer of coverage nor medical advice. It is only
a partial, general description of plan or program benefits and does not
constitute a contract. In case of a conflict between your plan documents and
this information, the plan documents will govern.
I accept
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