+Do Aetna Health Plans offer dental coverage?

Dental coverage is part of most Aetna Health Plans for members up to age 19 (unless otherwise required in a state). This coverage is called Pediatric Dental.

+What is a formulary?

A formulary is a list of preferred medications put together by Aetna. The goal is to help you choose quality, cost-effective prescriptions. All of Aetna’s prescription drug plans use a formulary. Our Preferred Drug Guide gives information about medications covered under Aetna Health Plans.

+What does “generic drugs” mean?

Generic drugs have the same active ingredients in the same amounts as brand-name products. They usually cost less than brand-name drugs. And they may be a different color, shape or size. Generics have been approved by the Food and Drug Administration (FDA) as safe and effective. A generic drug can be substituted for a brand-name drug when rated as an equivalent by the FDA and where permitted by law and the prescriber.

+Are maternity benefits covered under Aetna Health Plans?

Yes. Maternity and newborn care are part of the “essential health benefits” covered by the Affordable Care Act (ACA).  So they’re automatically included in every Aetna Health Plan that meets the ACA requirements. A newborn is automatically covered under the policy for 31 days and can be added to the plan during this time. 

+What is a Primary Care Physician?

A Primary Care Physician (PCP) is trained to manage your health care. Your PCP plays many roles — primary caregiver, health care advisor and consultant, coordinator of specialty care and patient advocate.

 

PCPs can be:

 

  • Family/General Practitioners (doctors who treat patients of all ages)
  • Internists (doctors who treat adults; the doctor may have a subspecialty)
  • Pediatricians (doctors who treat children)
  • Obstetricians and Gynecologists (doctors who treat female reproduction and childbirth)

+Why is Aetna providing a Summary of Benefits and Coverage (SBC)? What does “SBC” mean?

The Summary of Benefits and Coverage, or “SBC,” is a uniform four-page, double-sided document that describes a health plan’s benefits and coverage. It also includes cost-sharing requirements and information about exceptions, reductions or limitations. Under the Affordable Care Act (ACA), active health plans must give you a concise SBC document detailing health plan benefits and coverage. It must be in plain language and a consistent format.

+What health care services are covered under Aetna Health Plans?

Once you see your available plans, you can review the benefits covered on each plan’s detail page and the available Summary of Benefits and Coverage (SBC) document. To see the full list of all covered benefits for your health plan, please reference your policy.