The member's benefit plan determines coverage. This program doesnt replace your relationship with your personal doctor. Another program available at no cost to you is an annual Healthy Home Visit (HHV). Talk to a licensed Aetna representative by calling ${dynamicPhone} ${tty} ${hours}. Find Aetna Medicare network doctors, pharmacies, dentists, and hospitals in your area. Health care coverage from a school employer is different than coverage available for retirees. It also lists any changes to your plans drug list, or formulary, that may affect you. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Health benefits and health insurance plans contain exclusions and limitations. This information helps us provide information tailored to your Medicare eligibility, which is based on age. TDD: 800-759-1089, Toll-Free: 888-236-2377 Choose the option that works best for you. This search will use the five-tier subtype. Here are a few important things that will help you get started. You pay a co-pay at the time of service ($20 for primary care office visits and $45 for specialist office visits). We're here to help you get the most from your plan. You must enroll in dental/vision coverage to enroll your spouse and/or children. Take the picture in a well-lit area or turn on your flash. Lets get started! To qualify for a premium subsidy, you must have at least 20 years of qualified service credit, or be receiving a disability benefit. ID cards can be saved and printed. CPT is a registered trademark of the American Medical Association. Make your receipt as flat and wrinkle-free as possible. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Call the phone number or visit the website shown in the information mailed to you. TDD: 877-486-2048, www.ssa.gov/medicare Aetna handles premium payments through Payer Express, a trusted payment service. That reduces the chance that an unauthorized party is able to view your personal information. This site has its own log in. When your request is complete, details can be viewed on your. This program allows a licensed Nurse Practitioner or board-certified physician to visit you in your own home. Schedule a call to answer your questions. This information is neither an offer of coverage nor medical advice. Make sure the file name doesn't contain any spaces and includes only letters, numbers, hyphens (-) and underscores (_). Includes PPO, HMO, HMO-POS medical plans with or without drugs. WebReady to Retire Forms and Publications Your Health Care Coverage in Retirement Currently SERS offers health care coverage, which includes medical and prescription drug Toll-Free: 800-877-7195 Our HRA combines an Aetna health insurance or benefits plan with a fund paid for by your employer. Doctors, hospitals and other health care providers in our network have a contract to provide reduced rates to our members. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. SilverScript is a Prescription Drug Plan with a Medicare contract marketed through Aetna Medicare. Thanks! Having the support of Aetna and not having to worry about bills or paperwork or is this covered, I didnt have any of that. If you still have Medicare questions, please give us a call or visit AetnaMedicare.com to learn more. This type of plan has an open access feature that allows you to see a specialist without getting a referral. SERS helps you enroll in a federal Health Insurance Marketplace plan with an individualized premium based on household size and income. If you dont have access to a printer, call Customer Care at the number on your member ID card. This site has its own log in. Si tu intencin no era salir del sitio web, cierra este mensaje. 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. Toll-Free: 866-685-2791 Reimbursement form. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. **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. 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. I am a retired New Jersey high school principal and middle school principal. 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. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. SERS helps reduce health care premiums by providing a subsidy to those who qualify when enrolling in SERS traditional group plans. Does Aetna Medicare Cover Hearing Aids 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. Links to various non-Aetna sites are provided for your convenience only. Health Care Resources | SERS Provide your email address to receive status updates about your form submission. Be sure to check your email for periodic updates. So Aetna has helped me stay on track. Now I never would have caught something that could be potentially very dangerous had that nurse not come to my home. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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. WebYou pay the provider for their services and submit a receipt to your plan for reimbursement up to the allowance amount. For 2021, the Choice PPO has a $400 individual/$800 family deductible and the Basic PPO has a $1,500 Lets get started! Aetna Custom HMO Central PA. Geisinger Custom HMO Northeastern PA. To learn more, contact Aetna Member Services. All services deemed "never effective" are excluded from coverage. WebAetna Medicare SM Plan (PPO)Premier ESA PPO PlanRx $2/$10/$40/$75/$75 Benefits and Premiums are effective January 1, 2021 through December 31, 2021 SUMMARY OF BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY * Fees displayed are based on contracted amounts negotiated for specified treatments. Date and Time Location July 12 9:00 a.m. to 3:00 p.m. DAYTON/BEAVERCREEK Hilton As of the end of the fourth quarter of 2021, the Federal Reserve calculated that U.S. public pensions held $5.85 trillion in assets. This fund helps you pay eligible out-of-pocket health care costs. Want to see options for a different location? Toll-Free: 866-258-5819 You may see any licensed provider who accepts Medicare patients in the U.S., and you must provide the name of the individual practitioner who performed the service. Do you want to continue? You are eligible for this plan regardless of where you live in the U.S. and the U.S. territories. To the extent that resources permit, SERS intends to continue offering access to health care coverage. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Convenient tools and guidelines to help you get paid faster. Your Payer Express log in may be different from your Aetna secure member site log in. Keep the camera still until the picture is fully processed (this can take a few seconds, depending on your phone or camera). Visit the secure website, available through www.aetna.com, for more information. The discussion is confidential. Si tu intencin no era salir del sitio web, cierra este mensaje. The member's benefit plan determines coverage. An Aetna HealthFund Health Reimbursement Arrangement (HRA)* gives you access to quality care. 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. Eligible health care expenses are automatically paid from the fund. 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. Most printed directories come with both English and Spanish text included. Confirm that the file is not password protected. Your InstaMed log in may be different from your Caremark.com secure member site log in. Network & Out-of-Network Care - Aetna | Benefits, Coverage 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. Do you want to continue? Contracted physicians can access fee schedules online on our secure provider website. 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. Does Aetna Medicare cover vision Well send you a copy by mail. Any person who knowingly and with intent to injure, defraud or deceive any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. 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. In case of a conflict between your plan documents and this information, the plan documents will govern. When billing, you must use the most appropriate code as of the effective date of the submission. Why choose ${company} Medicare Solutions? Aetna Signature Administrators (ASA) enables us to extend our services to additional plan sponsors with PPO plans, Some of our plans pay for services from doctors who are not in our network. With the backing of SERS Board of Trustees, H.B. 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. If you do not intend to leave our site, close this message. Please note that following this link will take you to a public Aetna site and not all links on this public page will apply to your Medicare Advantage plan. Fill out this form if you paid a provider for covered medical, dental, vision, hearing or vaccination services and want to request For benefit questions or learn more about the Aetna Medicare Advantage plan for SERS Retirees call Aetna Member Services at ${groupPhoneNumber} ${tty}, ${memberhours}. Within 31 days of the involuntary termination of health care coverage under another plan. Legitimate calls are often made on behalf of SERS Health Care Services. Im turning 65 or just starting to explore Medicare. Attach an itemized receipt showing your provider's name. WebFor over 30 years, weve been providing employees with the security of cash benefits for out-of-pocket expenses that medical plans dont cover. Go to the American Medical Association Web site. 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. If youre not healthy, youre not going anywhere. Medicare regulations also require that specific calls go out during the year. WebAetna Medicare Plan (PPO) SERS PPO Plan SKILLED NURSING SERVICES* This is what you pay for network providers. 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. Applicable FARS/DFARS apply. This is a true member story and is not a paid endorsement. New and revised codes are added to the CPBs as they are updated. The Marketplace offers a variety of plans in every state, including Ohio. Examples include but are not limited to: dental cleanings, dental fillings, eye exams, or eyeglasses. Select a state below to update coverage details. Choose the option that works best for you. We will only contact you for updates about your reimbursement request. Aetna representatives will also speak directly with your providers to help explain the Plan and to find out if the Mayo Clinics or Johns Hopkins will be willing to bill Aetna directly for your treatment. Web The PPO provides care through a network of participating medical providers. If you do not intend to leave our site, close this message. Members should discuss any matters related to their coverage or condition with their treating provider. I live with my husband here in Westfield, New Jersey and Ive been married to Bill, itll be 38 years this summer. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Some services are subject to an in-network deductible. Toll-Free: 800-826-6259 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. Available online provider directories (PDF): Call a licensed agent at ${dynamicPhone} ${tty},${hours}. While SERS is happy to assist you with your retirement or health care needs, sometimes it is necessary to contact the plan administrator directly. 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. The information you will be accessing is provided by another organization or vendor. Enrollment in our plans depends on contract renewal. These visits can include discussions about your health, a non-invasive physical exam, medication review and discussions about health resources. If you do not intend to leave Aetna Medicare, close this message. Disclaimer of Warranties and Liabilities. Your employer sets up and pays into the fund. Some subtypes have five tiers of coverage. CITY OF HOUSTON Proof of involuntary termination is required. 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). So Im comfortable in my own environment, I dont have to leave the house. Marketplace premiums can be as low as $0. 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. Use this fund to cover health care costs that are eligible under your health plan. If you do not enroll when you retire or begin receiving a disability benefit, you can only enroll: You cannot cancel dental/vision coverage before the next Dental and Vision Open Enrollment unless you are also canceling SERS medical and prescription coverage. 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. 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. Yes, I'm a memberNo, I'm looking for a plan. This can be paid for by your HRA as long as theres a balance in the fund. Explore claims options Tools that save you time and 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. Estimate how much your patients will owe for an office visit. Actual costs may differ from the estimate if, for example, claims for other services are processed after you get your estimate but before the claim for this service is submitted. When it came time for me to enroll in Medicare, I wanted the one with the least amount of hassles and I had been told what a great health plan Aetna has. The member's benefit plan determines coverage. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Submitting a claim is not a guarantee of payment, or payment in the full amount. A network is a group of health care providers. Hi, my name is Nancy Baton. Links to various non-Aetna sites are provided for your convenience only. Members can log in to their secure account to use the tool. Aetna Medicare is a HMO, PPO plan with a Medicare contract. Tips and resources on staying healthy and connected during the pandemic. Health Insurance Forms for Individuals & Families - Aetna PA Department of Aging. It includes doctors, specialists, dentists, hospitals, surgical centers and other facilities. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Aetna Medicare Plan (PPO) And, if necessary, these visits can give you and your doctor the opportunity to set up long-term treatment plans. With your consent, the Know Your Rx pharmacist will contact the prescriber to discuss a possible change. There is no obligation to enroll. Thats why I chose Aetna and Im very happy I did. 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. WebAetna Medicare Advantage will reimburse you. Your statements remain safely stored on MDS.Memberdoc.comeven if you are experiencing computer issues. Web Health Insurance Through Work Considering Aetna Insurance Discounts Ready to enroll? SERS Aetna Stay in network. A National Provider Identifier (NPI) is a unique 10-digit number that identifies your doctor though the health care industry. Treating providers are solely responsible for dental advice and treatment of members. Whether we notify you about an overpayment or your office identifies it, we provide simple steps to refunding. Includes PPO, HMO, HMO-POS medical plans with or without drugs. Members can log in to view their accounts. You are now being directed to the CVS Health site. Contact HealthSCOPE Benefits toll-free at 1-888-236-2377. See page 8 of the Member Health Care Guide for more information. And find information you need to help you get healthier and stay healthier, today, tomorrow and all your tomorrows. Get answers to your health questions from a registered nurse anytime. Yes, I'm a memberNo, I'm looking for a plan. There are 492 Medicare Advantage Plans in the state that are an alternative to Original Medicare. 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. Providing the procedure code is not required, but can help us process your request more efficiently. When billing, you must use the most appropriate code as of the effective date of the submission. Counselors will help you evaluate the costs and benefits of the SERS plan alternatives. By clicking on I accept, I acknowledge and accept that: Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". And it enables us to direct you to the health programs and services you need. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Our HRA combines an ***Qualified expenses determined by the employer according to IRS guidelines can be reimbursed by an RRA. Get reminders aboutimportant Medicare enrollment dates and information. Reimbursement Forms: Dental & Medical | Aetna Medicare
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