Good news
—
your
health
benefits and insurance
plan
covers
the
services li
s
t
e
d
here
with
no
c
o
s
t
share
*
as
part
of
p
r
e
v
e
n
t
iv
e
care.
*
E
m
p
l
o
ye
r
s
with
grandfathered
plans may choose
not to
cover some
of
t
h
e
s
e
p
r
eve
n
t
i
ve
services,
or to
include
c
o
s
t
s
h
a
r
e
(
d
e
du
c
t
i
b
l
e
,
copay
or
coinsurance)
for
p
r
eve
n
t
i
ve
care services.
C
e
r
t
a
i
n
eligible
religious employers and
o
r
g
a
n
i
z
a
t
i
on
s
may choose
not
t
o
cover
c
on
t
r
a
c
e
p
t
i
ve
services as
part
of the
group health
c
o
ve
r
a
g
e
.
This includes routine
screenings and checkups.
I
t
a
l
s
o
includes counseling you
get
to
p
r
e
v
e
n
t
illness, disease
or
other health
p
r
o
b
l
em
s
.
Many
of
t
h
e
s
e
services are covered as
part
of
physical
e
x
a
m
s
.
These include regular checkups and
routine
gynecological
and
well-child
exams. You
won’t
have
to
pay
out of
pocket
f
o
r
t
he
s
e
preventive visits, when provided
in
ne
t
wor
k
.
But
t
h
e
s
e
services are generally
not
p
r
eve
n
t
i
ve
if
you get
them
as
part
of
a visit
to
diagnose,
monitor or treat
an illness
or
inj
u
r
y
.
Then copays, coinsurance and
de
d
uc
t
ibl
e
s
may
a
ppl
y
.
A
e
t
n
a
f
oll
ow
s
the
recommendations
of
national
medical
s
o
c
i
e
t
i
e
s
about how
often
children, men and women
need
t
h
e
s
e
services. Be sure
to
talk
with
your doctor about
which
services are
right for
your age, gender and
health
s
t
a
t
u
s
.
Covered preventive
services
for
a
du
l
t
s
generally
include:
Screenings
f
or
:
•
Abdominal aortic
aneurysm
(
one
-
t
i
me
screening
for men
of
specified
ages who have ever
s
m
o
k
e
d
)
•
Alcohol
m
i
su
s
e
•
Blood
p
r
e
ss
u
r
e
•
C
hol
e
s
t
e
r
ol
(
f
or
adults
of
certain
ages
or at
higher
r
i
s
k
)
•
C
olor
e
c
t
a
l
cancer
(
f
or
adults over age
50)
•
De
p
r
e
s
si
on
•
Type
2
d
i
a
b
e
t
e
s
(
f
o
r
a
du
l
t
s
with
high blood p
r
e
ss
u
r
e
)
•
Human immunodeficiency virus
(
H
I
V
)
• Obesity
•
Tobacco
u
s
e
•
Lung cancer
(
f
o
r
a
du
l
t
s
ages 55 and over
with
a
h
i
s
t
o
r
y
of
smoking),
effective on
renewal on
or
after
J
a
nu
a
r
y
1,
2015
•
S
y
ph
ili
s
(
f
or
all adults
at
higher
r
i
s
k
)
Medication and
s
upp
lem
e
nt
s
:
• Aspirin up to 81 mg for women up to the age of 45 at
risk for pre-eclampsia and up to 325 mg for men and
women age 45 and older with certain cardiovascular
risk factors
•
Vitamin D supplements
for
adults ages 65 and older
with
certain
c
ond
it
i
on
s
•
T
ob
ac
c
o
-
c
e
ss
at
i
on
medications approved by
the
U.S.
F
ood
and Drug
A
d
m
i
n
i
s
t
r
at
i
on
(FDA),
including o
ve
r
-
t
he
-
c
ou
nt
e
r
m
e
d
i
c
a
t
i
on
s
when prescribed by a
health
care provider
and
filled
at
a
participating ph
a
rm
acy
Counseling
f
o
r
:
•
Alcohol
m
i
su
s
e
•
D
i
e
t
(
f
o
r
a
du
l
t
s
with
hyperlipidemia and
other known
r
i
s
k
f
a
c
t
o
r
s
for
cardiovascular and
d
i
e
t
-
r
e
l
a
t
e
d
chronic d
i
s
ea
s
e
)
• Obesity
•
S
e
x
u
a
ll
y
t
r
a
n
s
m
it
t
e
d
infection
(STI)
prevention
(
f
or
adults
at
higher risk)
•
Tobacco use (including programs
to
help you
s
t
op
using
t
ob
ac
c
o
)
I
m
muni
z
a
t
ion
s
:
Doses,
recommended ages
and recommended populations
v
a
r
y
.
•
D
i
ph
t
h
e
r
i
a
,
p
e
r
t
u
ss
i
s
,
t
e
t
a
nu
s
(
D
P
T
)
•
He
p
a
t
i
t
i
s
A and
B
•
Herpes
z
o
s
t
e
r
•
Human papillomavirus
(H
P
V
)
•
I
n
f
l
u
enza
•
Measles, mumps, rubella
(
MM
R
)
•
Meningococcal
(
me
n
i
ng
it
i
s)
•
Pneumococcal
(
p
neu
mon
i
a
)
•
Varicella
(
c
h
ick
e
npo
x
)
Covered preventive
services
for women
Screenings and counseling
f
o
r
:
•
BRCA
(counseling and
genetic
t
e
s
t
i
ng
for
women at high
r
i
s
k
with
no personal
h
i
s
t
o
r
y
of
b
r
ea
s
t
a
nd
/
o
r
ovarian
c
a
n
c
e
r
)
•
B
r
ea
s
t
cancer chemoprevention
(
f
or
women
at
higher
r
i
s
k
)
•
B
r
ea
s
t
cancer (mammography every
1 to 2
years
for women
over
40
)
•
Cervical cancer
(
f
or
sexually ac
t
i
ve
women
)
•
Chlamydia
infection
(
f
or
younger women and
other
women
at
higher
r
i
s
k
)
•
Gonorrhea
(
f
or
all women
at
higher
r
i
s
k
)
•
Interpersonal
or
dome
s
t
i
c
violence
•
O
s
t
e
oporo
si
s
(
f
or
women over age 60 depending
on
risk
f
a
c
t
o
r
s)
Medication and
s
upp
lem
e
nt
s
:
•
Folic acid supplements
(
f
or
women
of
c
h
il
d
-
b
ea
r
i
ng
ag
e
s)
•
R
i
s
k
-
r
e
du
c
i
ng
medications such
as
tamoxifen
and
r
a
l
o
x
i
f
e
ne,
for
women ages 35 and older
at
increased risk
for
b
r
ea
s
t
cancer,
effective October 1,
2014
Contraceptive products and
s
e
r
v
i
ce
s**
:
•
Prescribed
F
D
A
-
a
ppro
ve
d
female
o
ve
r
-
t
h
e
-
c
oun
t
e
r
or
generic
cont
r
ace
p
t
i
ve
s
*
when filled at an i
n
-
ne
t
wor
k
pharmacy
•
Two visits a year
for
patient education and counseling
on
c
on
t
r
a
c
e
p
t
i
ve
s
are also covered under your A
e
t
n
a
medical
plan
Covered preventive
services
for
pregnant
women
•
R
ou
t
i
n
e
p
r
e
n
a
t
a
l
v
i
s
i
t
s
(you pay your normal
c
o
s
t
share
f
o
r
delivery,
po
s
t
p
a
r
t
u
m
care,
u
l
t
r
a
s
ound
s
or
other
maternity
procedures,
s
p
e
c
i
a
li
s
t
v
i
s
i
t
s
and
certain
lab
t
e
s
t
s)
•
Anemia
s
c
re
e
ni
ng
s
•
Diabetes
sc
r
ee
n
i
ng
s
•
B
a
c
t
e
r
i
u
r
i
a
urinary
tract or
other infection
s
c
r
ee
n
i
ng
s
•
Rh
incompatibility screening,
with
f
oll
ow
-
up
t
e
s
t
i
ng
f
or
women
at
higher
r
i
s
k
•
Hepatitis B counseling (at
the
f
i
r
s
t
prenatal
v
i
sit
)
•
E
x
p
a
nd
e
d
counseling on
t
ob
ac
c
o
u
s
e
•
B
r
ea
s
t
f
ee
d
i
ng
i
nt
e
r
ve
nt
i
on
s
to
support
and
promote
b
r
ea
s
t
f
ee
d
i
ng
after
delivery, including up
to
six
v
i
s
i
t
s
with
a
lactation
consultant
Covered preventive
supplies
for
pregnant
women
•
C
e
r
t
a
i
n
s
t
a
nd
a
r
d
e
l
e
c
t
r
i
c
b
r
ea
s
t
f
ee
d
i
ng
pumps
(
nonho
s
pit
a
l
grade)
anytime during
pregnancy
or
while you
are
b
r
ea
s
t
f
ee
d
i
ng
,
once every
three
yea
r
s
•
Manual
b
r
ea
s
t
pump anytime during
pregnancy
or after
delivery
for the
duration
of
b
r
ea
s
t
f
ee
d
i
ng
•
B
r
ea
s
t
pump supplies,
if
you get pregnant
again before
you
are eligible
for
a new
pump
For more i
n
f
or
m
at
i
on
,
go
to
www.aetna.com
and search
f
o
r
“
b
r
ea
s
t
pu
m
p
s
.
”
Or call Member Services
for
d
e
t
a
il
s
on how
t
o
use
t
h
i
s
b
e
n
e
f
i
t
.
Covered preventive
services
for children
Screenings and
a
ss
e
ss
m
en
t
s
f
o
r
:
•
Alcohol and drug use
(
f
or
ad
ol
e
s
c
e
nt
s)
•
A
u
t
i
s
m
(
f
o
r
children
at
18 and 24
m
on
t
h
s)
•
Behavioral i
ss
u
e
s
•
Cervical dysplasia
(
f
o
r
sexually a
c
t
i
ve
f
em
al
e
s)
•
Congenital
h
y
po
t
h
y
r
o
i
d
i
s
m
(
f
or
ne
wborn
s)
•
Developmental screening
(
f
or
children under age
3
,
and surveillance
throughout
c
h
il
dhood
)
•
Hearing
(
f
or
all ne
wborn
s)
•
H
ei
gh
t
,
weight
and body mass index
me
asu
r
e
me
nt
s
•
Lipid disorders (dyslipidemia screening
for
children
at
higher risk)
•
Hematocrit
or hemoglobin
•
Hemoglobinopathies
or
sickle cell
(
f
or
ne
wborn
s)
•
Human immunodeficiency virus
(HIV)
(
f
or
adolescents
at
higher
r
i
s
k
)
•
Lead
(
f
o
r
children
at
risk
for
e
x
po
s
u
r
e
)
•
Medical
history
• Obesity
•
Oral
health
(risk a
ss
e
ss
m
e
n
t
for
young
c
h
il
d
r
e
n
)
•
P
he
n
y
l
k
e
t
onu
r
i
a
(PKU) (
f
or
ne
wborn
s)
•
Tuberculin
t
e
s
t
i
ng
(
f
o
r
children
at
higher risk
of
t
ub
e
r
c
u
l
o
s
i
s)
• Vision
Medication and
s
upp
lem
e
nt
s
:
•
Gonorrhea preventive medication
for the
eyes
of all
ne
wborn
s
•
Iron
s
upp
l
e
m
e
n
t
s
(
f
o
r
children ages
6 to
12
m
on
t
h
s
at
r
i
s
k
for
a
n
e
m
i
a
)
•
Oral fluoride
for
children
6
m
on
t
h
s
through 11
years
of
age
(
p
r
e
s
c
r
i
p
t
i
on
supplements
for
children
without
fluoride
in
their
w
a
t
e
r
s
ou
r
c
e
)
• Topical application of fluoride varnish by primary care
providers
*
B
r
a
nd
-
n
a
m
e
c
on
t
r
a
c
e
p
t
i
ve
drugs,
m
e
t
hod
s
or
devices only covered
with
no member
c
o
s
t
sharing
under certain
limited
c
i
r
c
u
m
s
t
a
n
c
e
s, including
when required by your
doctor due
to
medical
n
e
c
e
ss
i
t
y
.
**
C
e
r
t
a
i
n
eligible
religious employers and
o
r
g
a
n
i
z
a
t
i
on
s
may choose
not
t
o
cover
c
on
t
r
a
c
e
p
t
i
ve
services as
part
of the
group health
c
o
ve
r
a
g
e.
Counseling
f
o
r
:
• Obesity
•
STI
prevention
(
f
or
adolescents
at
higher
r
i
s
k
)
I
m
muni
z
a
t
ion
s
:
From birth to
age 18
—
doses,
recommended ages
a
n
d
recommended populations
v
a
r
y
.
•
DP
T
•
Haemophilus influenzae
t
y
p
e
B
•
He
p
a
t
i
t
i
s
A and
B
•
H
P
V
•
I
n
a
ct
iv
a
t
ed
po
li
o
v
i
r
u
s
•
I
n
f
l
u
enza
• MMR
•
Meningococcal
(
me
n
i
ng
it
i
s)
•
Pneumococcal
(
p
neu
mon
i
a
)
•
R
o
t
a
vi
ru
s
•
Varicella
(
c
h
ick
e
npo
x
)
Exclusions and
limi
t
at
i
on
s
This plan does
not
cover all
health
care expenses and i
n
c
l
ud
e
s
exclusions and li
m
i
t
a
t
i
on
s
.
Members should refer
to
their
plan
do
c
u
m
e
n
t
s
to
determine which health
care services
are
covered and
to
what
e
x
t
e
n
t
.
The
following
is a
partial li
s
t
o
f
services and supplies
that
are generally
not
covered.
H
ow
eve
r
,
your plan
do
c
u
m
e
n
t
s
may
contain
exce
p
t
i
on
s
to
t
h
i
s
li
s
t
based on
the
plan design
or
rider(s)
pu
r
c
h
a
s
e
d
.
•
All medical and
ho
s
p
i
t
a
l
services
not
specifically covered i
n
,
or
which are
limited
or
excluded by, your plan
do
c
u
m
e
n
t
s
,
including
c
o
s
t
s
of
services
before coverage begins and
after
coverage
term
i
na
te
s
•
C
o
s
me
t
i
c
surgery
•
Cu
s
t
odi
a
l care
•
De
n
t
a
l
care and
dental
X
-
r
ay
s
•
Donor egg
retrieval
•
Durable medical
equipment
•
E
x
p
e
r
i
m
e
n
t
a
l
and i
n
ve
s
t
i
g
a
t
i
on
a
l
procedures
(
exce
p
t
f
o
r
coverage
for
medically necessary
routine patient
care c
o
s
t
s
for
members
participating
in
a cancer clinical
t
r
i
a
l
)
•
Hearing
ai
d
s
•
Home
bi
r
t
h
s
•
Immunizations
for
t
r
ave
l or work
•
I
m
pl
a
n
t
a
bl
e
drugs and
c
e
r
t
ain
inj
e
c
t
a
bl
e
drugs
including
inj
e
c
t
a
bl
e
infertility
d
r
ug
s
•
Infertility
services i
n
c
l
ud
i
ng
,
but not
limited
t
o
,
artificial
i
n
s
e
m
i
nat
i
on
and advanced
r
e
p
r
odu
c
t
i
ve
t
e
c
hnolog
i
e
s
such
as
in
vitro fertilization
(IVF), z
y
go
t
e
intrafallopian
t
r
a
n
s
f
e
r
(ZIFT),
g
a
m
e
t
e
intrafallopian
t
r
a
n
s
f
e
r
(
GI
F
T
)
,
i
nt
r
acy
t
op
l
a
s
m
i
c
sperm
injection
(ICSI), and
other
related
services unless
specifically li
s
t
e
d
as covered
in
your
plan
do
c
u
me
nt
s
•
Non-medically
necessary services
or
s
upp
li
e
s
•
O
r
t
ho
t
i
c
s
exce
p
t
d
i
a
b
e
t
i
c
o
r
t
ho
t
i
c
s
•
Outpatient p
r
e
s
c
r
i
p
t
i
on
drugs
(
exce
p
t
for
treatment
o
f
d
i
a
b
e
t
e
s)
,
unless covered by a
p
r
e
s
c
r
i
p
t
i
on
plan rider
and
o
ve
r
-
t
h
e
-
c
oun
t
e
r
m
e
d
i
c
a
t
i
on
s
(
exce
p
t
as provided
in a
hospital) and
su
pp
li
e
s
•
Radial
keratotomy
or
related
p
r
o
c
e
du
r
e
s
•
Reversal
of
s
t
e
r
ili
z
at
i
on
•
Services
for the
treatment
of
sexual
d
y
s
f
u
nc
t
i
on
or
inadequacies, including
t
h
e
r
a
p
y
,
supplies
or
c
oun
s
e
l
in
g
•
S
p
e
c
i
a
l-
du
t
y
nu
r
s
i
ng
•
Therapy
or
rehabilitation other than what
is li
s
t
e
d
a
s
covered
in the
plan
do
c
u
m
e
n
t
s
•
W
e
ight
-
c
on
t
r
o
l
services including surgical
p
r
o
c
e
d
ur
e
s
,
medical
t
r
e
at
me
nt
s
,
w
ei
gh
t
-
c
ont
r
ol
/
l
o
ss
programs,
dietary
regimens and supplements,
appetite
suppressants
and
other
m
e
d
i
c
a
t
i
on
s
,
food or food
s
upp
l
e
m
e
n
t
s
,
e
xe
r
c
i
s
e
programs, exercise
or
other
e
qu
i
p
m
e
n
t
,
and
other
s
e
r
v
i
c
e
s
and supplies
that
are primarily intended
to
control weight
or
treat
obesity, including morbid obesity,
or for the
purpose
of
weight
r
e
du
c
t
i
on
,
regardless
of the
e
x
i
s
t
e
nc
e
of comorbid
c
ond
it
i
on
s.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary
companies, including Aetna Life Insurance Company and its affiliates (Aetna).
This information is subject to change as regulations are issued and interpretation evolves. This information should not be
considered legal guidance regarding the ACA or its potential impact. Consult your legal or regulatory adviser for guidance.
The content described in this communication is not intended to be legal or tax advice and should not be construed as
such. The intent is to provide information only. We encourage you to consult with your legal counsel and tax experts for
legal and tax advice. This material is for information only and is not an offer or invitation to contract. An application must
be completed to obtain coverage. Rates and benefits may vary by location. Health benefits plans contain exclusions and
limitations. Health information programs provide general health information and are not a substitute for diagnosis or
treatment by a physician or other health care professional. Plan features and availability may vary by location and group
size. Providers are independent contractors and not agents of Aetna. Provider participation may change without notice.
Aetna does not provide care or guarantee access to health services. Not all health services are covered. Se
e plan
documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features are
subject to change. Aetna receives rebates from drug manufacturers that may be taken into account in determining Aetna’s
Preferred Drug List. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions.
Information is believed to be accurate as of the production date; however, it is subject to change. For more informatio
n
about Aetna plans, refer to www.aetna.com.
www
.
ae
t
na
.
c
om
©2015
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