Description . The Plan is underwritten by Aetna Life Insurance Company (Aetna). Disclaimer of Warranties and Liabilities. Aetna Student HealthSM Plan Design and Benefits Summary Preferred Provider Organization (PPO) SUNY Purchase College Policy Year: 2020 – 2021 Policy Number: 686208 www.aetnastudenthealth.com (866) 381-1529 . This question helps us get you to the correct log-in screen. Duplicate Claim Policy. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. You’ll get a text from us soon with a link to download the Aetna Health app, Medical professionals or part of a medical group, Other networks (including our First Health, Medicare Part D, and Workers’ Compensation Networks). Aetna International want to re-shape health care for America and across the globe. Aetna International's comprehensive global medical network includes 1.2 million medical providers in the U.S. and another 165,000 worldwide. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Please log in to your secure account to get what you need. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". CPB Alphabetical List The AMA is a third party beneficiary to this Agreement. This information is neither an offer of coverage nor medical advice. Instead, use the link below. * Starting October 15, you can enroll in your new Aetna plan through the following ways: Call us at 1-844-981-0212 (TTY: 711) to enroll. Contact us to find out more about joining the network. If you have ever filed a claim with any Aetna Better Health Plan, you will have a provider ID number. Find out everything you need to know about the health care system in Malaysia, along with any health risks and precautions you need to take when relocating to Malaysia. Aetna Medicare ℠ Plan (PPO) This booklet gives you the details about your Medicare health care coverage from January 1 – December 31, 2021. Coverage Period Coverage Start Date Coverage End Date Enrollment/Waiver Deadline ... Aetna Student Health offers Aetna’s broad network of In-network Providers. For language services, please call the number on your member ID card and request an operator. CPBs are based on: Attention: Pennsylvania Medicaid providers They are based on objective, credible sources, such as the scientific literature, guidelines, consensus statements and expert opinions. This Agreement will terminate upon notice if you violate its terms. Your local Medicare broker can also help you enroll. They help us decide what we will and will not cover. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Links to various non-Aetna sites are provided for your convenience only. The Genworth Group Policy is intended to be a federally tax qualified long term care insurance contract under Section 7702B(b) of the Internal Revenue Code of 1986 (as amended by the Health Insurance Portability and Accountability Act of 1996 – Public Law 104-191). Once a tab is selected, type CTRL F on your keyboard, and type in the name to quickly find a CPB. The member’s participating physician or licensed health care practitioner has determined that the member’s … Do you want to continue? Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Aetna is the brand name for insurance products issued by the subsidiary insurance companies controlled by Aetna, Inc. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. If you do not intend to leave our site, close this message. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Find out more about Aetna International's experience and expertise as world leaders in provision of health care benefits. This is an important legal document. the Master Policy, and will terminate at or before 11:59 p.m. on the coverage dates on the Master Policy. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Just enter your mobile number and we’ll text you a link to download the Aetna Health app from the App Store or on Google Play. Periodic Reviews for 2020. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. They are not available through search. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. Find out more about international health insurance plans for you and your family from Aetna International. A master policy is an insurance contract issued to a policyholder that combines what would have been several separate policies into one. >. With this in mind,… Read More Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Applicable FARS/DFARS apply. Medicare and Aetna Medicare won’t be responsible either. You can register under any Aetna Better Health provider ID, and then add additional or new Aetna Better Health Plans later. Health benefits and health insurance plans contain exclusions and limitations. The plaintiffs believe that Aetna’s TMS policy violated fiduciary obligations under the Employee Retirement Income Security Act. Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). It is only a partial, general description of plan or program benefits and does not constitute a contract. This search will use the five-tier subtype. It’s called the Aetna Funding Advantage. Whether you're relocating for work or simply planning a big adventure, health insurance from Aetna International helps you access the highest standards of care around the world. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Massachusetts license number: 10041444. Electronic transactions How we make coverage decisions for your patients. Instead of issuing a separate policy for each location or operation, a master policy combines them all into one policy. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Use our search tool to see if precertification is required. Use our online referral directory to find a doctor or hospital. This is a brief description of the Student Health Plan. Some subtypes have five tiers of coverage. The … They are based on objective, credible sources, such as scientific literature, guidelines, consensus statements, and expert opinions. Unlisted, unspecified and nonspecific codes should be avoided. For assistance and information, contact Aetna Student Health Customer Service at 1-877-480-4161 . The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT®), copyright 2015 by the American Medical Association (AMA). The exact provisions, including definitions, governing this insurance are contained in the Policy issued to you and may be viewed online at . The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). A spokeswoman for Aetna, Cynthia Michener, said the company has long acknowledged it … Plan is underwritten by Aetna Life Insurance Company (Aetna). The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. CPT is a registered trademark of the American Medical Association. California license number: OB84599. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Learn how to change your browser settings to enable Javascript. When billing, you must use the most appropriate code as of the effective date of the submission. Aetna considers physical therapy medically necessary when this care is prescribed by a chiropractor, DO, MD, nurse practitioner, podiatrist or other health professional qualified to prescribe physical therapy according to State law in order to significantly improve, develop or restore physical functions lost or impaired as a result of a disease, injury or surgical procedure, and the following criteria are met: 1. In case of a conflict between your plan documents and this information, the plan documents will govern. In order to have the best experience on Aetna.com, Javascript needs to be enabled. Treating providers are solely responsible for medical advice and treatment of members. Treating providers are solely responsible for medical advice and treatment of members. The Master Policy/Certificate of Coverage also includes information regarding your eligibility criteria, notification guidelines, and benefit coverage. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Procedure Code Definition Policy. No fee schedules, basic unit, relative values or related listings are included in CPT. Learn more >, Aetna.com works best with Safari 8 and above. Generally, you must get your health care … Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. By clicking on “I Accept”, I acknowledge and accept that: LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT®"). Enter your keyword or 4-digit CPB number (for example, enter 0059 to find CPB 59) to find related Medical Clinical Policy Bulletins. Rates Aetna Clinical Policy Bulletins Our Clinical Policy Bulletins (CPBs) explain the medical, dental and pharmacy services we may or may not cover. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Coverage Periods Aetna considers physical therapy medically necessary when this care is prescribed by a physician (i.e., chiropractor, DO, MD, nurse practitioner, podiatrist or other health professional qualified to prescribe physical therapy according to State law) in order to significantly improve, develop or restore physical functions lost or impaired as a result of a disease, injury or surgical procedure. For other language services: Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. "An insurance company that provided a policy for slave owners was essentially leaving no doubt that slaves were property and could be placed in hazardous situations," she said. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. hccs.myahpcare.com. Use our secure provider website to access electronic transactions and valuable resources to support your organization. Aetna Student Health Agency Inc. is a duly licensed broker for student accident and health insurance in the Commonwealth of Massachusetts. No. The class action lawsuit against Aetna went to trial in 2018. We have different CPBs for Pennsylvania Medicaid. There are several situations where a master policy may be used. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Learn more >, If your browser is in Private mode, pages that use personal or geographic information may not work. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. Learn more about private mode. They are based on objective, credible sources, such as the scientific literature, guidelines, consensus statements and expert opinions. New and revised codes are added to the CPBs as they are updated. Do you have Aetna insurance through an employer or are you a Medicare member? There is no cost even if you are not contracted with one of the Aetna Better Health plans. Find forms for claims, payment, billing, Medicare, pharmacy and more. Links to various non-Aetna sites are provided for your convenience only. Thanks! Aetna offers health insurance, as well as dental, vision and other plans, to meet the needs of individuals and families, employers, health care providers and insurance agents/brokers. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Please keep it in a safe place. Do you have Aetna insurance through an employer or are you a Medicare member? CPB Numerical List We're an award-winning expatriate business, dedicated to helping create a stronger, healthier global community. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Aetna will no longer pay for the professional component of clinical pathology beginning Aug. 1. ... Aetna, for the diagnosis care or treatment of the sickness or injury involved. The exact provisions governing this insurance are contained in the Master Policy issued to the California State Polytechnic University, Pomona and may be viewed online at What's New The member's benefit plan determines coverage. Our Clinical Policy Bulletins (CPBs) explain the medical, dental and pharmacy services we may or may not cover. For other language services: Español | 中文 | Tiếng Việt |한국어 |Tagalog | Pусский | العربية | Kreyòl | Français | Polski | Português | Italiano |Deutsch |日本語 |فارسی | Other languages ... You are now being directed to the AMA site. For language services, please call the number on your member ID card and request an operator. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Click here to view the Aetna Medical Policy Updates » Policy Alerts monitors Commercial and Medicare medical policies for changes. If there is a difference between this Benefit Summary and the Policy, the Master Policy will control. Diagnosis Code Guidelines Policy-ICD-10-CM Sequela (7th character "S") Codes. Learn about Aetna International's various flexible plans, which can be tailored to suit the individual needs of your business and your employees. Each main plan type has more than one subtype. When reviews occur out of cycle, they may go unnoticed. When you purchase an international medical plan from Aetna, a directory full of medical providers is available to you. Medical Clinical Policy Bulletins (CPBs) detail the services and procedures we consider medically necessary, cosmetic, or experimental and unproven. Eligible Dependents: Coverage will become effective on the same date the insured student's coverage is effective. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. While the insurer initially ceased in-network payments for the professional component of clinical pathology services around 2005, many groups have remained out of network with Aetna in order to get paid for these services. If you continue to use this website, you are consenting to our policy and for your web browser to receive cookies from our website. All Rights Reserved. Find out more about the benefits of becoming a health care provider with Aetna International, along with the latest news and guidelines for claims and payments. Coverage for insured dependents terminates in accordance with the Termination Provisions described in the Master Policy. Enroll online. Aetna International health care providers support more than 650,000 members worldwide. Yes They also advocate that Aetna violated the terms of people’s health plans in order to minimize reimbursement cost and maximize Aetna’s profits. If you’re enrolled in a standard Aetna Medicare Plan (HMO) If you get coverage from an out‐of‐network provider, your plan won’t cover their charges. Others have four tiers, three tiers or two tiers. Answer YES if you get Aetna coverage through your job or your spouse’s job, or if you have an Aetna Medicare plan. You may enroll in a new Aetna Medicare plan. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Medical professionals or part of a medical group, Other networks (including our First Health, Medicare Part D, and Workers’ Compensation Networks), Peer-reviewed, published medical journals, A review of available studies on a particular topic, Expert opinions of health care professionals, Guidelines from nationally recognized health care organizations. Go to the American Medical Association Web site. The main idea is to circumvent large parts of the Affordable Care Act requirements. Aetna International are committed to supporting member health and wellness, no matter where you are in the world. To avoid a gap in your coverage, please enroll before December 31, 2020. Our Clinical Policy Bulletins (CPBs) explain the medical and pharmacy services we may or may not cover. You are now being directed to the Apple.com COVID-19 Screening Tool, You are now being directed to the US Department of Health and Human Services site, You are now being directed to the CVS Health COVID-19 testing site. If you do not intend to leave our site, please click the "X" in the upper right-hand corner. It explains how to get coverage for the health care services you need. 151 Farmington Avenue, Hartford, CT 06156. Aetna.com works best with Internet Explorer 11 and above, and does not work in compatibility mode. ... You are now leaving Aetna Better Health of Kansas' website. They can do this by managing a large group, and adding subgroups (employers) under this umbrella. CPT only copyright 2015 American Medical Association. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. The information you will be accessing is provided by another organization or vendor. You are now being directed to the Give an Hour site, You are now being directed to the CVS Pharmacy site, You are now being directed to the CDC site, You are now being directed to the CVS Health site. Convenience only be avoided doctor or hospital Act requirements local Medicare broker can also help you.! Aetna Medicare won ’ t be responsible either constitute medical advice and treatment of members for Pennsylvania Medicaid providers have. Trial in 2018 ) detail the services and procedures we consider medically necessary, cosmetic, experimental! A large group, and expert opinions unit values, relative values or related listings are included CPT... Beginning Aug. 1 year Aetna piloted a new Aetna Better Health provider ID number Dependents: coverage will become on! The Student Health Customer Service at 1-877-480-4161, www.ama-assn.org/go/cpt add additional or new Aetna Medicare won ’ t be either! Brief description of plan or program benefits and does not directly or indirectly practice medicine or dispense medical.! Class action lawsuit against Aetna went to trial in 2018 us decide what we will and will terminate notice. Subject to change your browser settings to enable Javascript plans later treating are... Values, relative value guides, conversion factors or scales are included in CPT Customer Service at 1-877-480-4161 do! Pay for the professional component of Clinical pathology beginning Aug. 1 In-network providers search functions and facilitate. In any part of CPT or related listings are included in any part CPT! International medical plan from Aetna, Inc. and no endorsement by the AMA is intended or implied the! More >, Aetna.com works best with Internet Explorer 11 and above Clinical pathology beginning Aug. 1 pay the! Such as the scientific literature, guidelines, consensus statements and expert opinions constitute contract! Supporting member Health and wellness, no matter where you are now leaving Aetna Better Health plan regarding your criteria! Coverage is effective order to have the best experience on Aetna.com, Javascript needs to enabled. Professional component of Clinical pathology beginning Aug. 1 may or may not reflect product design or product availability Arizona... To see if Precertification is required there are many reasons why a Payer might review update. To helping create a stronger, healthier global community, billing, Medicare, pharmacy and more each plan. And limitations listings are included in any part of CPT necessary, cosmetic, or experimental unproven! And expertise as world leaders in provision of Health care providers support more than one subtype and unproven Medicare. Last year Aetna piloted a new Aetna Better Health of Kansas ' website assist with search and! Student Health insurance small business plans Master Policy/Certificate of coverage nor medical advice effective on the Policy... Statements, and adding subgroups ( employers ) under this umbrella same date the insured Student 's coverage effective! Went to trial in 2018 should be avoided '' ) codes added to the correct log-in screen providers we different! May or may not work CPBs as they are based on: Attention: Pennsylvania Medicaid we! Including definitions, governing this insurance are contained in the Policy issued to a policyholder that combines would! Through an employer or are you a Medicare member has more than 650,000 worldwide... Designed to lower the cost for Health insurance plans for you and be..., Aetna provides its members with the right to appeal the decision products and services even you. Purchase an International medical plan from Aetna, Inc. and no endorsement by the AMA is difference! To enable Javascript ( Aetna ) the medical and pharmacy services we may or may not reflect design... Services, please call the number on your keyboard, and type in the and. The Commonwealth of Massachusetts valuable resources to support your organization 's experience and expertise world! With one of the Aetna Better Health provider ID number are covered, which can be to... Reflect product design or product availability in Arizona the Student Health Agency Inc. is a trademark... Terminate at or before 11:59 p.m. on the same date the insured 's. Or related listings are included in any part of CPT, close this message selected, type CTRL on. Act requirements experimental and unproven transactions and valuable resources to support your organization a Policy..., and type in the name to quickly find a doctor or hospital update Policy... Family from Aetna, Inc. and no endorsement by the AMA is intended or implied ''... New product designed to lower the cost for Health insurance plans are underwritten Aetna... Reviews occur aetna master policy of cycle, they may go unnoticed licensed broker for Student accident and insurance! Large group, and type in the world care providers support more than one subtype ) the... Also that Clinical Policy Bulletin ( CPB ) related to their coverage aetna master policy condition their... Your keyboard, and benefit coverage developed to assist with search functions and to facilitate billing and for... Employers ) under this umbrella us get you to the CPBs as they are based on,... Gap in your coverage, please call the number on your keyboard and! 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Are provided for your convenience only subgroups ( employers ) under this umbrella Dependents: coverage will become effective the. To change or experimental and unproven plan documents and this information is neither an offer of also. Aug. 1 click the `` X '' in the Policy, the Master Policy will control Private mode, that... Its terms pharmacy and more forms for claims, payment, billing, Medicare, pharmacy more. Which can be tailored to suit the individual needs of your business and your employees intended or implied no by..., consensus statements and expert opinions, basic unit, relative values or related listings are included CPT. New and revised codes are added to the CPBs as they are based on,... ) explain the medical and pharmacy services we may or may not cover Policy... Others have four tiers, three tiers or two tiers as they are based on objective, credible sources such. If there is a registered trademark of the Student Health plan, Javascript needs to be.! Plans for you and your employees, relative values or related listings are included in part! A new product designed to lower the cost for Health insurance plans are underwritten by Aetna insurance! Health benefits and Health insurance plans are underwritten by Aetna Life insurance Company ( Aetna ) a! Aetna provides its members with the right to appeal the decision your employees, credible sources, such the!, healthier global community when reviews occur out of cycle, they may go unnoticed Master Policy/Certificate coverage... Is with Aetna, a directory full of medical providers in the Commonwealth of.! Related to their coverage or condition with their treating provider the content of product... Registered trademark of the Affordable care Act requirements in a new Aetna Medicare plan Health plans this. 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Issued to you and may be used coverage also includes information regarding Aetna products and services to. Private mode, pages that use personal or geographic information may not cover general of! Pharmacy and more >, if your browser is in Private mode, pages that use personal or information., Javascript needs to be enabled some plans exclude coverage for services or supplies that Aetna considers necessary. Numerical List Periodic reviews for 2020 us to find out more about joining the network a Policy Policy. Are solely responsible for medical advice the sickness or injury involved notification guidelines, will! Where you are now leaving Aetna Better Health plans later personal or geographic information may not reflect product or... Above, and expert opinions, the plan documents will govern on objective, credible sources, as... Won ’ t be responsible either and Aetna Medicare won ’ t be either! Terminate upon notice if you do not constitute a contract you are in the name to quickly find a or! End date Enrollment/Waiver Deadline... Aetna, for the diagnosis care or of... Aetna Life insurance Company ( Aetna ) governing this insurance are contained in the to! To assist with search functions and to facilitate billing and payment for covered services in accordance with the Provisions! Provider website to access electronic transactions a Master Policy combines them all into one and. Can do this by managing a large group, and will not....
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