Please be sure to add a 1 before your mobile number, ex: 19876543210, Ongoing, one-on-one phone calls with a nurse who serves as a trusted resource for you and your family, Digital support that provides a variety of resources to help you better manage your health, Customized health action plans based on your needs and preferences, Finish treatment with a doctor who is not part of the network*, Transition your remaining orthodontia treatment to your new dental plan, Switch existing prescriptions to your new plan. Sign in to your EmblemHealth member portal. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Learn About the SEHBP Healthy Rewards Program. Some subtypes have five tiers of coverage. You are now being directed to CVS Caremark site. 524 0 obj <> endobj First Name (required) Last Name (required) Birthday (required) (mm/dd/yyyy) Next. Soit really does pay to check on your health. 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. 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. I understand that my information will be used in accordance with my plan notice of privacy practices. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. New and revised codes are added to the CPBs as they are updated. No fee schedules, basic unit, relative values or related listings are included in CPT. Our main goal is to help you live your healthiest life possible, body and mind. A $25 gift card: Complete a follow-up visit with your behavioral health provider within seven days of your first visit. It is only a partial, general description of plan or program benefits and does not constitute a contract. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. It is only a partial, general description of plan or program benefits and does not constitute a contract. For special needs plans, or SNPs, monthly premiums range from $8.50 to $41.00. Each carrier's Rewards Program operates differently. 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. FAQ on New CMS Regulations for Rewards & Incentives in Medicare Advantage. You can earn rewards for completing preventive care. The information you will be accessing is provided by another organization or vendor. Gym & fitness benefits ** Register now, so you'll be all set when you receive eligible care. Customer Motivators is facilitating the gift card fulfillment on behalf of Aetna. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. 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. 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. 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. Providers are independent contractors and are not agents of Aetna. *Aetna maternity program may not be available through your plan. NJWELL has partnered with Aetna to offer a voluntary wellness program designed just for SEHBP Aetna Medicare Advantage plan members. For language services, please call the number on your member ID card and request an operator. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Enter the first six characters of your Claim Code in the first box and the second twelve characters in the second box then click submit. Find the Aetna Medicare forms you need to help you get started with claims reimbursements, Aetna Rx Home Delivery, filing an appeal and more. Members should discuss any matters related to their coverage or condition with their treating provider. You can start earning anytime. It's easy as: . Step 2: Members can earn rewards by completing some or all program activities. Another group or vendor provides the info on the next page. Treating providers are solely responsible for medical advice and treatment of members. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Beginning January 1, 2020, get rewarded for completing healthy activities NJ Well is partnering with Aetna to offer a new, voluntary wellness program designed just for SEHBP Medicare Advantage plan members. Please note: 551 0 obj <>/Filter/FlateDecode/ID[<7C23BF6F2139455B81BEE5D9C35589FF><104C746439B7AD4CA72BC94D467C689F>]/Index[524 50]/Info 523 0 R/Length 128/Prev 179942/Root 525 0 R/Size 574/Type/XRef/W[1 3 1]>>stream Go to the American Medical Association Web site. 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). Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. CPT is a registered trademark of the American Medical Association. By James H. Haskins IV. These options are located below the login area. Step 1: Enter the first six characters of your Claim Code in the first box and the second twelve characters in the second box then click submit. 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. You can speak with a licensed insurance agent to find out what Aetna Medicare Advantage plans are offered in your area. If you dont want to leave our site, choose the X in the upper right corner to close this message. Non-discrimination notice and language assistance. 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. 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. No fee schedules, basic unit, relative values or related listings are included in CPT. This is the best way to keep you and your family healthy. Services administered in a home or residence for Aetna Medicare Advantage members in Georgia, Virginia, and/or Oklahoma will need pre-approval from myNEXUS before they can commence. 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. 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. Qualifying products and requirements are a combination of any of these products: Medicare Supplement =one-for-one on production Final Expense =two-for-one on production Contact Us. 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. 0 This information is neither an offer of coverage nor medical advice. Aetna is committed to making health insurance simpler and more convenient. Aetnaprovides infoabout COVID-19on the next page. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Y0001_26003_2022. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Stay healthy and earn up to $200 in gift cards by completing eligible health activities by December 31, 2022. It utilizes an Apple Watch to track activity and provides users with proactive health tips and personalized goals. 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. All Rights Reserved. The program helps members improve their health and well-being. $50 worth of baby supplies (diapers, wipes and other items): Complete first three prenatal visits. The AMA is a third party beneficiary to this Agreement. Reprinted with permission. Please log in to your secure account to get what you need. This search will use the five-tier subtype. Having trouble? endstream endobj 525 0 obj <>/Metadata 29 0 R/Names 553 0 R/OpenAction 526 0 R/Outlines 45 0 R/Pages 521 0 R/StructTreeRoot 54 0 R/Type/Catalog/ViewerPreferences<>>> endobj 526 0 obj <> endobj 527 0 obj <. 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. Links to various non-Aetna sites are provided for your convenience only. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). The Attain by Aetna mobile app goes beyond tness to provide reachable goals that can improve long-term health. Others have four tiers, three tiers or two tiers. 706-778-8035. A preterm labor program to support high-risk women Access to specially trained nurses for high-risk mothers-to-be One-on-one counseling to help pregnant women quit smoking We're here for you. Reprinted with permission. Coverage length varies by state law and by your condition. 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. 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. 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). Disclaimer of Warranties and Liabilities. Legal notices CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. Applicable FARS/DFARS apply. A $25 gift card: Complete your wellness checkup (age 12 months). The ABA Medical Necessity Guidedoes not constitute medical advice. You can earngift cards for each healthy step you complete. This fitness reimbursement program is specifically designed for older adults and features classes led by trained instructors at more than 17,000 participating locations. 711) Monday-Friday, 8 AM-8 PM ET to opt-in to the Aetna Medicare Advantage for MHBP Standard Option. A $25 gift card: Complete your wellness checkup (age 15 months). Get Medicare coverage plus additional benefits. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Qualifying products and requirements are a combination of any of these products: Medicare Supplement = one-for-one on production Final Expense = two-for-one on production Aetna Medicare will continue to support members in 2021 by committing to $0 COVID-19 testing even if the public health emergency ends. Attain by Aetna SM. Login for MA/MAPD Register my MA/MAPD Combine Gift Certificates. Quality health care is more than just going to the doctor once or twice a year. Applicable FARS/DFARS apply. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Go to browser and type https://www.aetnamedicare.com/en/login-register.html. 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. CPT only Copyright 2020 American Medical Association. Others have four tiers, three tiers or two tiers. Enrollment in our plans depends on contract renewal. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. If you do not intend to leave our site, close this message. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. You can start earning with healthy activities,like annual screenings, wellness checkups and more. 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. This Agreement will terminate upon notice if you violate its terms. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Treating providers are solely responsible for dental advice and treatment of members. Medicaid for children, newborns, pregnant women and some families, Medicaid for children and adults 20 or younger who have disabilities, A program for families and mother-to-be that dont qualify for Medicaid. CPT only copyright 2015 American Medical Association. A $25 gift card: Complete your wellness checkup (ages 320 years). The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Please contact them directly with any questions or concerns at 888-689-3420 or email Support@MyAetnaRewards.com Monday through Friday from 8:00 AM - 8:00 PM EST.Support@MyAetnaRewards.com Monday through Friday from 8:00 AM - 8:00 PM EST. Once youre a member, call us at 1-800-272-3531or log in to your member website at aetna.com. Disclaimer of Warranties and Liabilities. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". They can also help your provider find any health problems early, when theyre easier to treat. A $25 gift card: Complete your wellness checkup (age 9 months). 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. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. A $25 gift card and pregnancy handbook (current members):Enroll in care management within 30 days of finding out youre pregnant. This material is for information only. Reminder: Expanded Medicare Advantage program started August 1, 2021, Expanded Aetna Medicare Advantage program starting August 1, 2021, Please be sure to add a 1 before your mobile number, ex: 19876543210, Precertification lists and CPT code search, OfficeLink Updates Newsletters Medicare Updates, Members residing in the states of Georgia, Virginia and Oklahoma, Aetna Medicare DSNP members in Georgia and Texas only, Medicare members residing outside of the states of Georgia, Virginia and/or Oklahoma, Aetna and Coventry commercial fully insured HMO/POS/PPO plan, Aetna administrative services only (ASO) self-funded HMO/POS/PPO plan. After you read them, take action to report that you completed this activity and choose a $25 gift card . LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). This is the best way to keep you and your family healthy. There is no extra cost for preventive care. 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. 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. In early 2021, the Centers for Medicare & Medicaid Services (CMS) released the Contract Year 2022 Medicare Advantage (MA) and Part D Final Rule with sweeping changes to reward and incentive programs for MA plans that mostly flew under the radar . This information is not a complete description of benefits. Just contact us. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Your benefits plan determines coverage. Everyone needs regular checkups and health screenings. 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. **Aetna In Touch Careprogram may not be available through your plan. Go Shop. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. How can you participate? When billing, you must use the most appropriate code as of the effective date of the submission. If you were billed by a pharmacy for a covered prescription drug, mail us your completed form to request reimbursement.English . The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Medicare Member Rewards Program? Out-of-network/non-contracted providers are under no obligation to treat Aetna members, except in emergency situations. Welcome to the Aetna Healthy Actions SM Rewards Program Get your reward for healthy living! They can also help your provider find any health problems early, when they're easier to treat. ET. 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. Rewards are oered when goals are reached. The minimum production amount required to qualify for the payout or travel credits is $225,000 and for the Agent Rewards, the minimum production amount required is $190,000. You can even earn an Apple Watch if you don't . No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. to earn rewards you must complete and report eligible . They can give you peace of mind that youre as healthy as you feel. Health benefits and health insurance plans contain exclusions and limitations. Switching health insurance or plans can be overwhelming. Unlisted, unspecified and nonspecific codes should be avoided. They can give you peace of mind that you're as healthy as you feel. 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. 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. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. All services deemed "never effective" are excluded from coverage. All Rights Reserved. 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. New and revised codes are added to the CPBs as they are updated. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Individual activities can earn a member between $10 to $50. 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. 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. 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 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. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Receiving calls and/or text messages from Aetna Better Health of Texas that are informational and relate to my health and benefits. Aetna Healthy Rewards is coming your way! 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. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Or choose Go on to move forward to the provider website. A $50 gift card: Complete all wellness checkups (ages 2 weeks, 2 months, 4 months and 6 months). This change applies only to home health care services for: This change does not apply to any other plans or members, including, but not limited to: If you have questions, call myNEXUS Intake (Monday through Friday, 8 AM to 8 PM ET) at 1-833-585-6262. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Need help making an appointment? While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. or log in with your current Aetna member website username and password. 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. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". You are now being directed to the CVS Health site. Members should discuss any matters related to their coverage or condition with their treating provider. Starting January 1, 2020, you'll be . CPT is a registered trademark of the American Medical Association. 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. 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. Through our maternity program you'll get: Were here for you. 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. P.O. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Once youve completed each healthy step, youll want to contact us to claim your gift card. This search will use the five-tier subtype. Links to various non-Aetna sites are provided for your convenience only. Or finding a ride there? No, you dont need to sign up for rewards. If you have questions, call us at 1 . Do you want to continue? $50 worth of baby supplies (diapers, wipes and other items): Complete three more prenatal visits (six total) and one postpartum care visit after your babys birth.