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Aetna Medicare Disclaimers

Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

Every year, Medicare evaluates plans based on a 5-star rating system.

For accommodations of persons with special needs at meetings, call 1-833-251-9949 (TTY: 711).

For the 2021 plan year, Aetna Medicare’s pharmacy network includes limited lower-cost, preferred pharmacies in Suburban Arizona, Suburban Illinois, Urban Kansas, Rural Michigan, Urban Michigan, Urban Missouri, Suburban West Virginia. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use.

For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-833-278-3928 (TTY: 711), or consult the online pharmacy directory.

For the 2022 plan year, Aetna Medicare’s pharmacy network includes limited lower-cost, preferred pharmacies in Suburban Arizona, Suburban Illinois, Urban Kansas, Rural Michigan, Urban Michigan, Urban Missouri, Suburban West Virginia. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use.

For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-833-278-3928 (TTY: 711), or consult the online pharmacy directory.

For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within 7 to 14 days. Please call the phone number listed on your member ID card if you do not receive your mail-order drugs within this timeframe. Members may have the option to sign-up for automated mail-order delivery.

For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Members who get “Extra Help” are not required to fill prescriptions at preferred network pharmacies in order to get Low Income Subsidy (LIS) copays.

Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change.

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

Out-of-network/non-contracted providers are under no obligation to treat Aetna members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

SilverScript is a Prescription Drug Plan with a Medicare contract marketed through Aetna Medicare. Enrollment in SilverScript depends on contract renewal.

For the 2021 plan year, SilverScript Smart Rx (PDP)’s pharmacy network includes limited lower-cost, preferred pharmacies in Rural Arkansas, Rural Kansas, Rural Oklahoma. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use.

The Formulary and/or Pharmacy network may change at any time. You will receive notice when necessary.

Aetna is part of the CVS Health® family of companies.

Aetna is the brand name for insurance products issued by the subsidiary insurance companies controlled by Aetna, Inc. The Medicare Supplement Insurance Plans are insured by Continental Life Insurance Company of Brentwood, Tennessee, an Aetna Company (Aetna), American Continental Insurance Company (Aetna), Aetna Health and Life Insurance Company (Aetna), Aetna Life Insurance Company (Aetna), or Aetna Health Insurance Company (Aetna).

Not connected with or endorsed by the U.S. Government or the Federal Medicare Program.

This is a solicitation of insurance. Contact may be made by a Licensed Insurance Agent or Insurance Company. The Medicare Supplement Insurance Plans are guaranteed renewable as long as the required premium is paid by the end of each grace period. The policies have exclusions, limitations, terms under which the policy may be continued in force or discontinued. Plans do not pay benefits for any service and supply of a type not covered by Medicare, including but not limited to dental care or treatment, eyeglasses and hearing aids. See Plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. AN OUTLINE OF COVERAGE IS AVAILABLE UPON REQUEST. In some states, Medicare Supplement Insurance Plans are available to under age 65 individuals that are eligible for Medicare due to disability or ESRD (end stage renal disease). Plans not available in all States.

Important notice: In Colorado: All Medicare Supplement standardized plans are offered to qualified individuals under 65.

Policy forms issued in OR include CLIMSP10A OR, CLIMSP10B OR, CLIMSP10F OR, CLIMSP10HF OR, CLIMSP10G OR, and CLIMSP10N OR. In ID, include AHLMSP17A ID, AHLMSP17B ID, AHLMSP17F ID, AHLMSP17HF ID, AHLMSP17G ID, and AHLMSP17N ID. In OK, include AHIMSP18A OK, AHIMSP18B OK, AHIMSP18F OK, AHIMSP18HF OK, AHIMSP18G OK, and AHIMSP18N OK. In TN, include CLIMSP19A TN, CLIMSP19B TN, CLIMSP19F TN, CLIMSP19G TN, CLIMSP19HG TN, and CLIMSP19N TN. In FL, include CLIMSP19A FL, CLIMSP19B FL, CLIMSP19F FL, CLIMSP19G FL, and CLIMSP19N FL. In OH, include CLIMSP19A OH, CLIMSP19B OH, CLIMSP19F OH, CLIMSP19G OH, CLIMSP19HG OH, and CLIMSP19N OH. In MO, AHLMSP18A MO, AHLMSP18B MO, AHLMSP18F MO, AHLMSP18G MO, AHLMSP18HF MO, and AHLMSP18N MO. In MD, AHIMSP19A MD, AHIMSP19B MD, AHIMSP19F MD, AHIMSP19G MD, AHIMSP19HG MD, and AHIMSP19N MD. IN NH, AHLMSP18A NH, AHLMSP18B NH, AHLMSP18F NH, AHLMSP18HF NH, AHLMSP18G NH, AHLMSP18N NH. In VA, CLIMSP19A VA, CLIMSP19B VA, CLIMSP19F VA, CLIMSP19G VA, CLIMSP19HG VA, and CLIMSP19N VA.

 

 

For California Dual Special Needs plans (D-SNP)

 

NONDISCRIMINATION NOTICE

 

Discrimination is against the law. Aetna Medicare Preferred Plan (HMO D-SNP) follows State and Federal civil rights laws. Aetna Medicare Preferred Plan (HMO D-SNP) does not unlawfully discriminate, exclude people, or treat them differently because of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, gender, gender identity, or sexual orientation.

 

Aetna Medicare Preferred Plan (HMO D-SNP) provides:

  • Free aids and services to people with disabilities to help them communicate better, such as:
  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats, other formats)

 

  • Free language services to people whose primary language is not English, such as:
  • Qualified interpreters
  • Information written in other languages

 

If you need these services, contact Aetna Medicare Preferred Plan (HMO D-SNP) between 8am-8pm 7 days a week by calling 1-866-409-1221. If you cannot hear or speak well, please call 711. Upon request, this document can be made available to you in braille, large print, audiocassette, or electronic form. To obtain a copy in one of these alternative formats, please call or write to:

 

Aetna Medicare Preferred Plan (HMO D-SNP)

Aetna Medicare PO Box 7405 London, KY 40742

1-866-409-1221

TTY/TDD 711

California Relay 711

 

 

 

HOW TO FILE A GRIEVANCE

 

If you believe that Aetna Medicare Preferred Plan (HMO D-SNP) has failed to provide these services or unlawfully discriminated in another way on the basis of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, gender, gender identity, or sexual orientation, you can file a grievance with Aetna Medicare Grievances. You can file a grievance by phone, in writing, in person, or electronically:

 

  • By phone: Contact Aetna Medicare Grievances between 8 AM to 8 PM, 7 days a week, by calling 1-866-409-1221. Or, if you cannot hear or speak well, please call TTY/TDD 711.
  • In writing: Fill out a complaint form or write a letter and send it to:

Aetna Medicare Grievances

PO Box 14834 Lexington, KY 40512

 

  • In person: Visit your doctor’s office or Aetna Medicare Preferred Plan (HMO D-SNP) and say you want to file a grievance.
  • Electronically: Visit Aetna Medicare Preferred Plan (HMO D-SNP) website at AetnaMedicare.com

 

 

 

OFFICE OF CIVIL RIGHTS – CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES

 

You can also file a civil rights complaint with the California Department of Health Care Services, Office of Civil Rights by phone, in writing, or electronically:

 

  • By phone: Call 916-440-7370. If you cannot speak or hear well, please call 711 (Telecommunications Relay Service).
  • In writing: Fill out a complaint form or send a letter to:

Deputy Director, Office of Civil Rights

Department of Health Care Services

Office of Civil Rights

P.O. Box 997413, MS 0009

Sacramento, CA 95899-7413

 

Complaint forms are available at http://www.dhcs.ca.gov/Pages/Language_Access.aspx.

 

 

 

 

OFFICE OF CIVIL RIGHTS – U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

If you believe you have been discriminated against on the basis of race, color, national origin, age, disability or sex, you can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights by phone, in writing, or electronically:

 

  • By phone: Call 1-800-368-1019. If you cannot speak or hear well, please call TTY/TDD 1-800-537-7697.
  • In writing: Fill out a complaint form or send a letter to:

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Room 509F, HHH Building

Washington, D.C. 20201

 

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

 

 

TTY: 711

 

English:

If you speak a language other than English, free language assistance services are available. Visit our website or call the phone number listed in this document.

 

Spanish:

Si habla un idioma que no sea inglés, se encuentran disponibles servicios gratuitos de asistencia de idiomas. Visite nuestro sitio web o llame al número de teléfono que figura en este documento.

 

Traditional Chinese:

如果您使用英文以外的語言,我們將提供免費的語言協助服務。請瀏覽我們的網站或撥打本文件中所列的電話號碼。

 

Vietnamese:
Nếu quý vị nói một ngôn ngữ khác với Tiếng Anh, chúng tôi có dịch vụ hỗ trợ ngôn ngữ miễn phí. Xin vào trang mạng của chúng tôi hoặc gọi số điện thoại ghi trong tài liệu này.

 

Tagalog:
Kung hindi Ingles ang wikang inyong sinasalita, may maaari kayong kuning mga libreng serbisyo ng tulong sa wika. Bisitahin ang aming website o tawagan ang numero ng telepono na nakalista sa dokumentong ito.

 

Korean:
영어가 아닌 언어를 쓰시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 저희 웹사이트를 방문하시거나 본 문서에 기재된 전화번호로 연락해 주십시오.

 

Armenian:
Եթե խոսում եք անգլերենից բացի մեկ այլ լեզվով, ապա Ձեզ համար հասանելի են լեզվական աջակցման անվճար ծառայություններ։ Այցելեք մեր վեբ կայքը կամ զանգահարեք այս փաստաթղթում նշված հեռախոսահամարով։

 

Farsi:

اگر به زبان دیگری بجز انگلیسی گفتگو می کنید، کمک زبانی رایگان فراهم می باشد. به وبسایت ما مراجعه نمایید و یا به شماره تلفن که در سند ذیل لست شده، تماس بگیرید.

 

Russian:
Если вы не владеете английским и говорите на другом языке, вам могут предоставить бесплатную языковую помощь. Посетите наш веб-сайт или позвоните по номеру, указанному в данном документе.

 

Japanese:
英語をお話しにならない方は、無料の言語支援サービスを受けることができます。弊社のウェブサイトにアクセスするか、または本書に記載の電話番号にお問い合わせください。

 

Arabic:

إذا كنت تتحدث لغة غير الإنجليزية، فإن خدمات المساعدة اللغوية المجانية متاحة. تفضل بزيارة موقعنا على الويب أو اتصل برقم الهاتف المدرج في هذا المستند.

Punjabi:
ਜੇ ਤੁਸੀਂ ਅੰਗ੍ਰੇਜ਼ੀ ਤੋਂ ਇਲਾਵਾ ਕੋਈ ਹੋਰ ਭਾਸ਼ਾ ਬੋਲਦੇ ਹੋ, ਤਾਂ ਮੁਫ਼ਤ ਭਾਸ਼ਾ ਸਬੰਧੀ ਸਹਾਇਤਾ ਸੇਵਾਵਾਂ ਉਪਲਬਧ ਹਨ। ਸਾਡੀ ਵੈੱਬਸਾਈਟ 'ਤੇਜਾਓ ਜਾਂ ਿੲਸ ਦਸਤਾਵੇਜ਼ ਵਿਚ ਦਿੱਤੇ ਨੰਬਰ 'ਤੇ ਕਾਲ ਕਰੋ।

 

Khmer:
បើលោកអ្នកនិយាយភាសាផ្សេងក្រៅពីភាសាអង់គ្លេស សេវាកម្មជំនួយផ្នែកភាសាមានផ្ដល់ជូនដោយឥតគិតថ្លៃ។ សូមចូលមើលគេហទំព័ររបស់យើងខ្ញុំ ឬហៅទៅកាន់លេខទូរស័ព្ទដែលមានរាយនៅក្នុងឯកសារនេះ។

 

Hmong:
Yog hais tias koj hais ib hom lus uas tsis yog lus Askiv, muaj cov kev pab cuam txhais lus dawb pub rau koj. Mus saib peb lub website los yog hu rau tus xov tooj sau teev tseg nyob rau hauv daim ntawv no.

 

Hindi:
अगर आप अंग्रेजी के अलावा कोई अन्य भाषा बोलते हैं, तो मुफ्त भाषा सहायता सेवाएं उपलब्ध हैं। हमारी वेबसाइट परजाएं या इस दस्तावेज़ में दिए गए फोन नंबर पर कॉल करें।

 

Thai:
หากคุณพูดภาษาอื่นนอกเหนือจากภาษาอังกฤษ สามารถขอรับบริการช่วยเหลือด้านภาษาได้ฟรี เข้าไปที่เว็บไซต์ของเรา หรือโทรติดต่อหมายเลขโทรศัพท์ที่แสดงไว้ในเอกสารนี้