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What’s
covered?
This is [State Medicaid program name] coverage. As a member, you’ll enjoy benefits and services that can help you reach your health goals. To learn more, check our list of covered services:
The Aetna Better Health® difference
You deserve to be as healthy as you can be. That’s why we offer the support and tools you need to be your healthiest, bringing together what matters most to your health. It’s care you can trust. And experience you can count on — with extra benefits that go beyond your standard health coverage.
Pregnancy care
Are you planning to start a family or expecting a child? We’ll help you stay healthy during your pregnancy. Our programs can help you get the care and services you need. [And you can earn rewards for making healthy choices.]
Rewards
Did you know that you can get rewards for taking care of your health? Complete some healthy steps to claim your rewards. We’ll show you how it works.
[$25] for over-the-counter (OTC) products
You should have everything you need to help you feel your best. That’s why we’re working with CVS Health® to give you [$25] of OTC health supplies and products. And we'll send them to you every month at no extra cost.
Ted E. Bear, M.D.® kids club
[Kids can get $50/year toward an after-school program like Boys and Girls Clubs, 4-H, Boy Scouts, Girl Scouts or Big Buddy. They can also get $50/year toward swim lessons at participating YMCA™ locations.]
Questions? You can call us at [member services phone].
Telehealth
Through secure video on your computer, you can meet with a doctor for treatment of common health conditions. Cold or flu? Great reasons to use telehealth. You can also get help with allergies, sinus problems and more.
Help stopping nicotine use
[Get coaching and medications to help you quit.]
[Want to learn more about stopping nicotine use? Call us at [member services phone].
Even more benefits
- [Dental care: $500 per year toward dental care]
- [Vision care: One eye exam and $100 toward glasses (frames and lenses) or contact lenses every year]
- [Rewards you can earn: Gift cards for completing certain healthy steps]
Benefits in your plan
Learn about all your plan benefits, from [vision and dental care to telehealth, maternity care and help stopping nicotine use]. You can learn more about all these topics in your:
Medicaid coverage
Medicaid covers some services that we don’t cover. [For these services, you don’t have to use a provider in our network.]
Copays
Members don’t have any copays for the services we cover. You only have copays for medicines. If a provider bills you, don’t pay the bill. Just call us at [member services phone].
Approval for services
Some services need approval or prior authorization (PA), before you get them. We base all our decisions on whether the service is:
- Needed for your health
- Likely to help you
- Covered
We take care of the whole you. That means you’re covered if you need to see a specialist, have an emergency or plan to start a family. [You have unlimited visits, so you can see your primary care physician (PCP) as many times as you need to — at no cost.]
You can also get a wide range of preventive care and vaccines. Start by finding a provider today.
A healthy smile goes a long way. Dental care is part of your overall health. That’s why you should see your dentist every six months.
Check your member ID card from your dental plan. Then, call your plan for answers to questions about care and coverage.
Routine eye exams are an easy way to keep your eyes healthy. You don’t need a referral to see a provider in the network. Just be sure to show your member ID card at every visit.
We make it easy to get the medicines you need to feel better. You may have a copay for those on [our formulary/the state’s preferred drug list (PDL)]. This is a list of medicines we cover. Don’t see yours on the list? Ask your provider to find a similar medicine. And you can fill your prescription at any pharmacy in our network.
You deserve to be healthy in body and mind. Your plan covers health for you as a whole person. That includes help with your mental health or substance use. You or your child can go to any behavioral health provider in our network.
Help in a crisis
No matter what time of day, you’re not alone. We have resources in place to help you in a crisis or mental health emergency. This includes thoughts of harming yourself or others. Here are some options for help:
Call or text the 988 Suicide & Crisis Lifeline at 988. Trained counselors can help you 24 hours a day, 7 days a week. Chat online with a counselor through their Lifeline Chat service.
Call [Member Services number or designated behavioral health hotline] at [phone number].(TTY: 711). [Then, choose the crisis option.] We’re here for you [hours of operation].
Call 911 or go to the nearest hospital.
Find other local resources and services in your own community.
You can use any hospital for emergency care, even if it isn’t in our network. Just show your member ID card.
You can also call us at [Member Services phone]. We’re here for you [member services hours].
We can help you and your baby be as healthy as possible. When you take part in [Maternity Matters/our program], here are some benefits you’ll enjoy:
- [A new mom welcome kit and baby bundle with diapers, diaper bag and other items
- Info about healthy pregnancies and baby care
- Help from a care manager
- Text4baby™, a text service that sends health tips and reminders
- Local community programs and resources
- Info about family planning
- Coverage of long-acting birth control
- Coverage of circumcision for newborn boys]
We’ll help you get birth control counseling and supplies. You can see any in-network or out-of-network provider. Any family planning care that you get is private. You can call us at [member services phone] to choose a family planning provider. Or you can read more about family planning.
Stopping nicotine use is hard, whether you smoke, chew, vape or use another method. Most people need help to quit, and we’re here for you. [Insert specific plan benefits for what we offer.]
Do you need help getting care? Our care management team is here for you. Care managers are nurses and social workers who understand your health conditions and help connect you to the right care. A care manager can help you learn more about your health, find a ride to your health care visits and more.
Chronic disease management
Some health issues need more care. Our care managers can help you manage chronic conditions like [asthma, diabetes, chronic obstructive pulmonary disease (COPD)] and more.
If it’s late at night or you can’t reach your PCP, you’re not alone. You can speak with a nurse about your health care questions 24 hours a day, 7 days a week. Not sure if you should find urgent care or go to the emergency room? The Nurse Line can help. It doesn’t take the place of your PCP, so be sure to follow up later.
Just call us at [member services phone]. Then, choose the option for Nurse Line.
Get a phone plan with a variety of services at no cost to you. This allows you to stay in touch with your health care team with health tips and reminders by text.
If you have no way to get to the hospital during an emergency, call 911. We cover ambulance rides on the ground in a medical emergency for all members.
If you don’t have a ride to your appointment, we’ll help you get one. These rides are for the medical services we cover, like:
- Doctor visits
- Dental care
- Behavioral health care
You can contact [One Call at 1-877-917-4150 (TTY: 1-866-288-3133) Monday through Friday, 8 AM to 5 PM. Be sure to schedule rides at least two business days before you need them.]
Health programs
These programs can help you live life as healthy as you can. We have special programs and services to help you get the care you need. And prevent health issues in the future.
Other language and format needs
Need language help? Just call us at [member services phone]. We’re here for you [member services hours]. You can get:
Interpreter services at no cost during any service or complaint process, including American Sign Language and real-time oral interpretation
Interpreter services for your health care visit (be sure to call 48 hours before your visit)
Info in another format, like audio, large print and braille
Materials in other languages if your primary language isn’t English
Legal notices
Aetna is part of the CVS Health® family of companies.
All trademarks are the property of their respective owners.