Disclosure Information

Select a Disclosure Information category.

Medical    

How Aetna Pays Out-of-Network Benefits  (PDF, 631 KB)

HMO and Aetna Value Network plans*  
HMO and AVN General English HMO and AVN General Spanish Arizona HMO and QPOS Disclosure California English California HMO Spanish California Aetna Value Network Spanish Aetna HealthFund HMO - California Aetna HealthFund HMO - California Spanish Connecticut English Connecticut Spanish Delaware English Delaware Spanish Massachusetts English Massachusetts Spanish Maryland English Maryland Spanish Missouri Missouri Spanish Nevada Small Group Standard Nevada Small Group Basic Nevada Individual Standard Nevada Individual Basic New Jersey New Jersey Spanish New York HMO English New York HMO Spanish Pennsylvania English Pennsylvania Spanish Texas HMO English Texas Large Group Spanish Virginia English Virginia Spanish   

QPOS* and Managed Choice POS** plans
POS General English POS Spanish Arizona QPOS English Arizona Managed Choice English Arizona Managed Choice Spanish Arizona QPOS Appeals Packet English Arizona Managed Choice Appeals Packet English California QPOS English California QPOS Spanish Connecticut English Connecticut QPOS Spanish Delaware English Delaware Spanish Massachusetts English Massachusetts Spanish Massachusetts Managed Choice Spanish Maryland English Maryland QPOS Spanish Missouri English Missouri QPOS Spanish Missouri Managed Choice Spanish New Jersey English New Jersey QPOS Spanish New York QPOS English New York Managed Choice English Pennsylvania English Pennsylvania QPOS Spanish Texas QPOS Large Group Texas QPOS Large Group Spanish Virginia English Virginia QPOS Spanish Washington Managed Choice English Washington Managed Choice Spanish   

Open Access HMO*, Health Network Option*, Health Network Only*, Aetna Choice POS*, Open Choice PPO**, Open Access Managed Choice** and Student** plans
Open Access English Open Access Spanish Arizona HMO, HNO, AC POS English Arizona OC, OA MC and Student English Arizona OC, OA MC and Student Spanish Arizona HMO, HNO, AC POS Appeals Packet English Arizona OC, OA MC and Student Appeals Packet English Connecticut English Connecticut Spanish Delaware English Delaware Spanish Massachusetts English Massachusets Spanish Massachusetts OC, OA MC and Student Spanish Maryland English Maryland Spanish Missouri English Missouri Spanish New Jersey English New Jersey Spanish New York Open Access HMO and Health Network Only - English New York Open Access HMO and Health Network Only Spanish New York Open Choice, Open Access Managed Choice and Student Plans - English New York Open Choice, Open Access Managed Choice and Student Plans Spanish New York Health Network Option and Aetna Choice POS plans - English New York Aetna Health Network Option, and Aetna Choice POS Spanish Pennsylvania English Pennsylvania Spanish Texas Open Access Texas Open Access Spanish Virginia English Virginia Spanish Washington OC, OA MC and Student English Washington OC, OA MC and Student Spanish   

Elect Choice, Open Access Elect Choice, Aetna Select, Open Access Aetna Select and Aetna Choice POS II plans*
ASC English ASC Spanish New York Fully Insured Elect Choice and Open Access Elect Choice plans - English   

Traditional Choice Indemnity Plan
Indemnity English Indemnity Spanish Washington Traditional Choice Plan   

Addendums – If you have a plan in one of the states listed, include this extra disclosure with your main disclosure above.
GA Disclosure Addendum Iowa Medical Disclosure Addendum LA Disclosure Addendum MA Disclosure Addendum – Complaints, Appeals and External Review NH Disclosure Addendum – Patients' Bill of Rights NH Disclosure Addendum - Continuing Health Care Benefits NY Addendum CO Disclosure Addendum RI Disclosure Addendum TX Disclosure Addendum   

Health Savings Accounts (HSA)
HSA Disclosure/Custodial Agreement - English HSA Disclosure/Custodial Agreement -Spanish   

Aetna Advantage Plans for Individuals, Families and the Self-Employed Disclosures
Generic Disclosure Arizona Disclosure New York HMO Disclosure New York PPO Disclosure New York QPOS Disclosure Pennsylvania HMO Disclosure Pennsylvania PPO Disclosure Texas Disclosure   

Aetna Voluntary Plans
Affordable HealthChoices Affordable Healthchoices Spanish Indemnity Indemnity Spanish New York Affordable HealthChoices PPO Dental PPO Dental Spanish   

Accountable Care Organizations (ACOs)
Aetna Whole Health Plan - Individual Aetna Whole Health Plan - Group   


Dental   

How Aetna Pays Out-of-Network Benefits  (PDF, 631 KB)

Aetna Dental Access/Vital Savings by Aetna
Aetna Dental Access/Vital Savings by Aetna Aetna Dental Access/Vital Savings by Aetna Spanish   

Generic Dental Disclosures
DMO DMO Spanish Exclusive Provider Plan (EPP) Indemnity Indemnity Spanish Preferred Provider Benefit Plans (PPO) Preferred Provider Benefit Plans (PPO) Spanish   

State Specific Dental Plans
Arizona DMO Arizona DMO Spanish Arizona Managed Dental Arizona Managed Dental - Spanish Arizona Preferred Provider Benefit Plans (PPO) Arizona Preferred Provider Benefit Plans (PPO) Spanish California DMO California DMO - Spanish California Managed Dental California Managed Dental - Spanish California PPO California PPO Spanish California Indemnity California Indemnity - Spanish Maine Dental PPO Maine Dental PPO - Spanish NC Disclosure Addendum - Authorization for in-network level of benefits North Carolina Dental PPO Plan Amendment Texas DMO Texas DMO Spanish Texas Managed Dental Texas Managed Dental Spanish Virginia DMO   

Vision   

Disclosure
Aetna Vision Preferred - Massachusetts   

Medicare   

Disclosure

• Medicare Advantage  (PDF, 302 KB)
• Medicare Prescription Drug Plan  (PDF, 278 KB)

New Jersey   

Financial arrangements between Aetna and its providers  (PDF, 1 MB)

Rhode Island Consumer Disclosures 

In accordance with Rhode Island Rules and Regulations for Certifying Health Plans, to follow are documents with valuable consumer information about your health plan.  The following documents are provided to prospective and current enrollees via the Aetna.com website or a paper copy can be requested by calling Aetna Member Services at 1-888-982-3862.

The Consumer Rights Disclosure Document contains information about your specific health plan.

Aetna's DocFind web-based Provider Directory provides a comprehensive list of providers available at  http://www.aetna.com/docfind/home.do. A paper copy of the directory can be requested by calling 1-888-87-AETNA (1-888-872-3862.)

Aetna Student Health Version Medical PPO with Pharmacy #155 Dental Gatekeeper (DMO/RI) #153 Standalone Vision #196 Dental PPO #154 Indemnity Major Medical with Pharmacy #156