), What your Aetna plan will pay -Negotiated /recognized amount, What your Aetna plan will pay -Percent your plan pays, What your Aetna plan will pay -Aetnas negotiated rate/recognized amount covered under plan, What you owe -Your coinsurance responsibility (In-network 30%, Out-of-network 50%), What you owe -Amount that can be balance billed to you. Map: View. www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision. Review the AD&D Insurance web page for details on the plan. Note: Certain drugs to treat Gender dysphoria are considered specialty drugs. Your health plan must comply with the NSA protections that hold you harmless from unexpected bills. You should contact the carrier to make sure your preferred doctors, clinics, and hospitals will be in network. Extended care benefit: All necessary services during confinement in a skilled nursing facility with a 60-day limit per calendar year when full-time nursing care is necessary and the confinement is medically appropriate as determined by a Plan doctor and approved by the Plan. 60 visits per person, per calendar year for physical or occupational therapy, or a combination of both for the services of each of the following: Note: We only cover therapy when a physician: Note: Occupational therapy is limited to services that assist the member to achieve and maintain self-care and improved functioning in other activities of daily living. When information is wrong -Do you think theres something wrong or missing in your personal information? FastMed. Map: View, Dayspring of OK, Stillwater,Oklahoma Stillwater Oklahoma Stillwater,OK Stillwater OK StillwaterOK OK, Dayspring, 14426 S. Outer 40 Town and Country, Missouri 63017, Phone: 636-224-1300 In such case, the hospitalized family members benefits under the new plan begin on the effective date of enrollment. Newborns of covered children are insured only for routine nursery care during the covered portion of the mother's maternity stay. OPM requires that FEHB plans be accredited to validate that plan operations and/or care management meet nationally recognized standards. Map: View, Employment Services, Poplar Bluff,Missouri Poplar Bluff Missouri Poplar Bluff,MO Poplar Bluff MO Poplar BluffMO MO, Chafee Transitional Living, Phone: 217-224-6300 If you want more information about us, call 888-238-6240, or write to Aetna, Federal Plans, PO Box 550, Blue Bell, PA 19422-0550. See www.opm.gov/healthcare-insurance for enrollment information as well as: Also, your employing or retirement office can answer your questions, and give you brochures for other plans and other materials you need to make an informed decision about your FEHB coverage. Generic injectable contraceptive drugs, such as Depo-Provera. Map: View, Residential Adolescent, Jefferson City,Missouri Jefferson City Missouri Jefferson City,MO Jefferson City MO Jefferson CityMO MO, jeff city, jc Residential Detox Adolescent, 5620 W. Wildwood Ranch Parkway Joplin, Missouri 64804, Phone: 417-623-1990 This can help you get the care you need at a lower price. When you are enrolled in Original Medicare along with this Plan, you still need to follow the rules in this brochure for us to cover your care. When you use our network providers, you will receive covered services at reduced costs. Fax: 314-830-2565 Ask questions and make sure you understand the answers. In-network: Nothing at a network provider (no deductible). The formulary is a list of drugs that your health plan covers. 5) Are a reemployed annuitant with the Federal government and your position is not excluded from the FEHB (your employing office will know if this is the case) and 6) Are a Federal judge who retired under title 28, U.S.C., or a Tax Court judge who retired under Section 7447 of title 26, U.S.C. Fax: 573-442-5200 Fax: 620-221-6253 How much we pay and you pay depends on whether you use a network or non-network provider or facility. We reserve the right to apply our reimbursement policies to all out-of-network services including involuntary services. The Original Medicare Plan (Original Medicare) is available everywhere in the United States. For a complete list of screenings go to the U.S. Preventive Services Task Force (USPSTF) website at, Individual counseling on prevention and reducing health risks, Well woman care such as Pap smears, gonorrhea prophylactic medication to protect newborns, annual counseling for sexually transmitted infections, contraceptive methods, and screening for interpersonal and domestic violence. These policies consider: Our reimbursement policies are based on our review of: We use commercial software to administer some of these policies. Aetna is solely responsible for the selection of network providers in your area. The remaining balance of the Self Plus One or Self and Family deductible can be satisfied by one or more family members. Although some of these complications may not be avoidable, patients do suffer from injuries or illnesses that could have been prevented if doctors or the hospital had taken proper precautions. ABA and our members fully support consumers ability to access and share their financial data in a secure, transparent manner that gives them control. Now D.C. has moved into cryptos territory, with regulatory crackdowns, tax proposals, and demands for compliance. You agree that you will be enrolled in our Aetna Medicare Advantage Plan. Fax: 573-346-3957 Call 800.248.1955. Note: If you change options in this Plan during the year, we will credit the amount of covered expenses already accumulated toward the catastrophic out-of-pocket limit of yourprioroption to the catastrophic protection limit of your new option. In-network: Nothing at a network provider. You are responsible for ensuring that we are asked to precertify your care. 2. Community Services, Rolla,Missouri Rolla Missouri Rolla,MO Rolla MO RollaMO MO, 2626 W College Rd Springfield, Missouri 65802, Phone: 417-869-8086 Gail Schellberg was born on August 18, 1942 to Leslie and Frances (Suckow) Bahl in Chippewa County, Montevideo, Minnesota. We will only pay for any covered medical supplies and services that are otherwise payable on an outpatient basis. However, you may be eligible for your own FEHB coverage under either the spouse equity law or Temporary Continuation of Coverage (TCC). A comprehensive range of services, such as: Note: Generally, we pay for internal prostheses (devices) according to where the procedure is done. Map: View, Employment Services, Rolla,Missouri Rolla Missouri Rolla,MO Rolla MO RollaMO MO, Chafee Transitional Living, 1212 E St. Route 72, Suite 8 Rolla, Missouri 65401, Phone: 573-308-3400 Join us for 2023 and get free membership for the rest of 2022. A carrier's pursuit of a recovery from any party that may be liable, any applicable insurance policy, or a worker's compensation program or insurance policy, as successor to the rights of a covered individual who suffered an illness or injury and has obtained benefits from that carrier's health benefits plan. Email: Send Email They are not benefits under your health plan. Each prescription is limited to a maximum 90-day supply. Email: Send Email You must tell us if you or a covered family member has coverage under any other health plan or has automobile insurance that pays health care expenses without regard to fault. If we determine that the stay was medically necessary, we will pay the inpatient charges, less the $500 penalty. Save on gym memberships, health coaching, fitness gear and nutrition products that support a healthy lifestyle. Email: Send Email Your child age 26 or over (unlessthey aredisabled and incapable of self-support prior to age 26). . We will make our decision on the claim within 48 hours (1) of the time we received the additional information or (2) theend of the time frame, whichever is earlier. When you use our network providers, you will receive covered services at reduced costs. Network facilities are hospitals and other facilities in our service area that we contract with to provide covered services to our members. Email: Send Email Educational services for treatment of behavioral disorders. Map: View, , Eldon,Missouri Eldon Missouri Eldon,MO Eldon MO EldonMO Adolescent, 6910 N Holmes St, Suite 231 Gladstone, Missouri 64118, Phone: 816-353-2750 If you are divorced from a Federal employee, or annuitant, you may not continue to get benefits under your former spouses enrollment. Certain health care services, such as hospitalization or outpatient surgery, require precertification with Aetna to ensure coverage for those services. Postal Service zip codes. Map: View, 801 Westchester Ave. Harrisonville, Missouri 64701, Phone: 816-884-3008 The remaining balance of the Self Plus One or Self and Family deductible can be satisfied by one or more family members. You must satisfy the deductible before your Traditional medical coverage may begin. Psychiatrists 20 visits per condition per member per calendar year for pulmonary rehabilitation to treat functional pulmonary disability. Email: Send Email If you change options in this Plan during the year, we will credit the amount of covered expenses already applied toward the deductible of yourprioroption to the deductible of your new option. If you need assistance, please contact your employing agency, Tribal Benefits Officer, personnel/payroll office, or retirement office. Your employing or retirement office will not notify you when a family member is no longer eligible to receive benefits, nor will we. Uniform Dental Insurance: Premium for employee only coverage will increase slightly. Section 5, which describes the Aetna Advantage benefits, is divided into subsections. Be sure to read Section 4, Your costs for covered services, for valuable information about how cost- sharing works, with special sections for members who are age 65 or over. Services, drugs, or supplies you receive from a provider or facility barred from the FEHB Program. Contact member services at 888-238-6240 for more information. Changes made during ABE to your AD&D coverage will be effective January 1, 2023. Email: Send Email Covered benefits required in order to prevent serious deterioration of your health that results from an unforeseen illness or injury if you are temporarily absent from our service area and receipt of the health care service cannot be delayed until your return to our service area. This means that we provide benefits to cover at least 60% of the total allowed costs of essential health benefits. Infertility is a disease defined by the failure to conceive a pregnancy after 12 months or more of timed intercourse or egg-sperm contact for women under age 35 (six (6) months for women age 35 or older). Email: Send Email e)Include your email address, if you would like to receiveour decision via email. Please note that by providing us your email address, you may receiveour decision more quickly. Map: View, Bridgeway, St. Charles,Missouri St. Charles Missouri St. Charles,MO St. Charles MO St. CharlesMO MO, Bridgeway, BBH, St Charles Residential Outpatient Day care Detox Day Treatment WomenAdult, 118 N. Second St. St. Charles, Missouri 63301, Phone: 636-224-1210 However, we will cover the cost of treatment that exceeds the amount of the payment you received. 317 S Madison Ave Aurora, Missouri 65605, Phone: 417-678-0123 In-network and out-of-network deductibles do not cross apply and will need to be met separately for traditional benefits to begin. Oregon, Most of Oregon- Baker, Benton, Clackamas,Clatsop, Columbia, Coos, Crook, Curry, Deschutes, Douglas, Gilliam, Harney, Hood River, Jackson, Jefferson, Josephine,Lane, Lincoln, Linn, Malheur, Marion, Multnomah, Polk,Tillamook, Umatilla, Union, Wasco, Washington and Yamhill counties. The example below is based on the following Aetna health benefits and insurance plan features and assumes youve already met your deductible: What your plan pays (plan coinsurance): 70% in-network/50% out-of-network, What you pay (coinsurance): 30% in-network/50% out-of-network, Your out-of-pocket maximum: $7,500/$15,000 in-network; $10,000/$20,000 out-of-network***, Example: A five-day hospital stay- comparison of member costs in network versusout-of-network (see additional examples on our website: www.aetnafeds.com), Hospital Bill - Amount BilledIn-network:$25,000Out-of-network:$25,000, Amount Aetna uses to calculate payment -in-network rate (Doctors, hospitals and other health care providers in Aetnas network accept Aetnas payment rate and agree that you owe only your deductible and coinsurance)In-network:$8,750Out-of-network:N/A, Amount Aetna uses to calculate payment -Recognized amount out-of-network (When you go out of network, Aetna determines a recognized amount. Boston Medical Center. And finally, you can save on teeth whitening, electronic toothbrushes, Z Sonic toothbrushes, replacement brush heads and various oral health care kits. Comuncate con el proveedor para obtener ms informacin. Fax: 417-623-9931 A program that ensures youmake it to and from your doctor or hospital appointments without always having to rely on family or friends. You can see participating or nonparticipating providers without a referral. If you leave Federal service, Tribal employment, or if you lose coverage because you no longer qualify as a family member, you may be eligible for Temporary Continuation of Coverage (TCC). Discount offers are not guaranteed and may be ended at any time. The most current information on our Network facilities is also on our website at www.aetnafeds.com. Email: Send Email Locate the Demo.ocxprogram and run it. An approved clinical trial includes a phase I, phase II, phase III or phase IV clinical trial that is conducted in relation to the prevention, detection, or treatment of cancer or other life-threatening disease or condition and is either Federally funded; conducted under an investigational new drug application reviewed by the Food and Drug Administration; or is a drug trial that is exempt from the requirement of an investigational new drug application. We may need more information to enroll you in this plan prior to your effective date. Nevada , Las Vegas Carson City, Churchill, Clark, Douglas, Elko, Humboldt,Lander, Lyon, Mineral,Nye, Pershing, Storey, Washoe and White Pinecounties. Read also about the Dental Foundations attempt to recruit more volunteers to screen young people with disabilities. Map: View, SPIRIT, Edina,Missouri Edina Missouri Edina,MO Edina MO EdinaMO MO, Spirit, Knox, R-1 School, SPIRIT Adolescent, 1402 South Highway 32 El Dorado Springs, Missouri 64744, Phone: 417-876-5500 A physician or other health care professional licensed, accredited, or certified to perform specified health services consistent with state law. Our service areas are: Alabama, Most of Alabama Autauga, Baldwin, Bibb, Blount, Bullock, Calhoun, Chambers, Cherokee, Chilton, Choctaw, Clarke, Clay, Cleburne, Coffee, Colbert, Coosa, Covington, Crenshaw, Cullman, Dale, Dallas, De Kalb, Elmore, Escambia, Etowah, Fayette, Franklin, Geneva,Greene, Hale, Henry, Houston, Jackson, Jefferson, Lamar, Lauderdale, Lawrence, Lee, Limestone, Lowndes, Macon, Madison, Marengo, Marion, Marshall, Mobile, Monroe, Montgomery, Morgan, Perry, Pickens, Pike, Randolph, Russell, St. Clair, Shelby, Sumter, Talladega, Tallapoosa, Tuscaloosa, Walker, Washington, Wilcox and Winston counties. This Plan enhances your FEHB coverage by lowering/eliminating cost-sharing for services and/or adding benefits at no additional cost. Note: We cover growth hormone injectables under the prescription drug benefit. Observation care can be billed as Emergency Room, Outpatient, or Inpatient depending on where services are rendered, benefited accordingly and how it is billed to us within the scope of the facilities contract. Map: View, Clarity Healthcare FQHC, Columbia,Missouri Columbia Missouri Columbia,MO Columbia MO ColumbiaMO MO, FQHC, Clarity, Community Health Center, Dentist, 1805 E Walnut St Columbia, Missouri 63201, Phone: 573-476-0030 Accidental death & dismemberment coverage, Identity Theft coverage from Generali Global Assistance. Our reconsideration will take into account all comments, documents, records, and other information submitted by you relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination. Map: View, Bridgeway, Union,Missouri Union Missouri Union,MO Union MO UnionMO MO, Bridgeway, BBH Outpatient TOC ARTC SATOP Adult & Adolescent, 605 E. Booneslick Rd Warrenton, Missouri 63383, Phone: 636-224-1500 Email: Send Email SeeSection 1. Contact us, or, if we drop out of the Program, contact your new plan. All inpatient services extending beyond the initial certification period will require concurrent review. You must get prior approval for certain services. Federal law prevents the pharmacy from accepting unused medications. You should review your automobile insurance policy to ensure that uncoordinated medical benefits have been chosen so that the automobile insurance policy is the primary payer. If you are currently enrolled in a plan with a name change, you will remain enrolled in the renamed plan. Mail Order or CVSPharmacy, for a 31-day up to a 90-day supply per prescription or refill: $20 per preferred generic (PG) formulary drug; and, 50% plus the difference between our Plan allowance and the billed amount. These conditions and errors are sometimes called Never Events or Serious Reportable Events.. ocessationPrograms, including individual group/phone counseling, and for over the counter (OTC) and prescription drugs approved by the FDA totreatnicotine dependence. If you see a non-participating physician you must obtain approval. For a complete list of immunizations go to the Centers for Disease Control (CDC) website at, You can also find a complete list of preventive care services recommended under the U.S. Preventive Services Task Force (USPSTF) online at, Well-child care charges for routine examinations, immunizations and care (up to age 22), Seven (7) routine exams from birth to age 12 months, Three (3) routine exams from age 12 months to 24 months, Three (3) routine exams from age 24 months to 36 months, One (1) routine exam per year thereafter to age 22, Hearing loss screening of newborns provided by a participating hospital before discharge, One (1) routine eye exam every 12 months through age 17 to determine the need for vision correction, One (1) routine hearing exam every 24 months through age 17 to determine the need for hearing correction. The process whereby an alcohol or drug intoxicated or alcohol or drug dependent person is assisted, in a facility licensed by the appropriate regulatory authority, through the period of time necessary to eliminate, by metabolic or other means, the intoxicating alcohol or drug, alcohol or drug dependent factors or alcohol in combination with drugs as determined by a licensed Physician, while keeping the physiological risk to the patient at a minimum. FMOLHS. Email: Send Email Any costs associated with the professional charge (i.e., physicians, etc.) Map: View, PFH/Bridgeway, Troy,Missouri Troy Missouri Troy,MO Troy MO TroyMO MO, Bridgeway, BBH Outpatient TOC Day Treatment SATOP shared address Adult, PFH/Bridgeway, Troy,Missouri Troy Missouri Troy,MO Troy MO TroyMO MO, Bridgeway, BBH Outpatient TOC shared address Adolescent, 6440 S. Lewis Ave, Suite 2200 Tulsa, Oklahoma 74136, Phone: 918-712-0859 Where such use is appropriate, our utilization review/patient management staff uses nationally recognized guidelines and resources, such as Milliman Care Guidelines and InterQual ISD criteria, to guide the precertification, concurrent review and retrospective review processes. You can ask us to change it. Email: Send Email Map: View, Employment Services, Cape Girardeau,Missouri Cape Girardeau Missouri Cape Girardeau,MO Cape Girardeau MO Cape GirardeauMO MO, Chafee Transitional Living shared address, Phone: 573-334-4477 However, you may want to contact your carrier to make sure your preferred doctors, clinics, and hospitals will remain in network. Email: Send Email The review will not be conducted by the same person, or theirsubordinate, who made the initial decision. In the event the confinement starts on a Friday or Saturday, the 48 hour requirement will be extended to 72 hours. Fax: 417-683-6608 Map: View, Employment Services, Nevada,Missouri Nevada Missouri Nevada,MO Nevada MO NevadaMO MO, Chafee Transitional Living shared address, Phone: 417-667-4638 For specific information on surprise billing, the rights and protections you have, and your responsibilities go to www.aetnafeds.com or contact the health plan at 888-238-6240. Note:If your physician prescribes or you request a covered brand name prescription drug when a generic prescription drug equivalent is available, you will pay the difference in cost between the brand name prescription drug and the generic prescription drug equivalent, plus the applicable copayment/coinsurance unless your physician submits a preauthorization request providing clinical necessity and a medical exception is obtained. Heal pain or stress points with acupunctureorchiropractic care. When you use network providers, your annual maximum for out-of-pocket expenses, deductibles, coinsurance, and copayments) for covered services is limited to the following: Out-of-network: Your annual out-of-pocket maximum is$10,000. If you have met (or pay cost-sharing that results in your meeting) the out-of-pocket maximum under the prior plan or option, you will not pay cost-sharing for services covered between January 1 and the effective date of coverage under your new plan or option. Fax: If you have a pre-service claim and you do not agree with our decision regarding precertification of an inpatient admission or prior approval of other services, you may request a review in accord with the procedures detailed below. Map: View, Clarity Healthcare FQHC, Bowling Green,Missouri Bowling Green Missouri Bowling Green,MO Bowling Green MO Bowling GreenMO MO, FQHC, Clarity, Community Health Center, Dentist, #1 Center Drive, Suite 3 Brookfield, Missouri 64628, Phone: 660-258-4188