Have an account?
Manage your plan, find care, get help with your health and more.
Not registered? Create my account.
We offer group health, dental and vision plans. These plans are available through your employer. You can find information to help you choose the right coverage. To get state-specific disclosures, follow these steps:
If we offer a plan where you live, you can find state information to help you choose the right plan.
Search individual & family plan disclosures by state
Get details on our standalone dental and vision plans, which are available without a medical plan
For Texas members: Beginning January 1, 2022, covered teledentistry services will be covered the same as services received in person.
Dental PPO plan disclosure (PDF)
If you’ve had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act. This federal law protects patients who choose breast reconstruction after a mastectomy.
We’ll consult with you and your attending doctor to determine your coverage for:
All stages of reconstruction of the breast on which the mastectomy was performed
Surgery and reconstruction of the other breast to create a symmetrical appearance
Prosthesis or breast implant
Treatment of physical complications of the mastectomy, including lymphedema
You’ll also receive benefits if you’ve had a mastectomy to treat or prevent breast cancer while you were covered under a different health plan. Your coverage is based on your plan design. You may have limits, copays, deductibles, coinsurance and referrals. Check your plan documents for details.
Call Member Services at the number on your ID card. You can also find resources from the Centers for Medicare & Medicaid Services and the National Institutes of Health.
Find information to make the right decisions about your care. These resources can help you learn about your benefits and your rights as a health care consumer.
Find health plan policies and guidelines for your state.
Learn about IRS rules for different flexible spending accounts (FSAs).
Get guidance for changing your health plan as your life changes.
Understand your rights and protections against surprise medical bills.
For employer-funded plans: Self-funded plans governed by the Employee Retirement Income Security Act (ERISA) do not have state mandates. Not sure if your plan is self-funded and/or governed by ERISA? Speak with your benefits office. Your plan documents take the place of the general information on this page.
Managed plans offered by HMO entities are Aetna Health Network Only™, Aetna Primary Care℠ Plan HMO, Aetna Health Network Option℠, Aetna Open Access® HMO, Aetna Choice® POS and QPOS®.
Managed plans offered by Aetna Life Insurance Company are Managed Choice® POS, Aetna Choice® Plan POS, Aetna Open Access® Managed Choice, Open Choice® PPO, Aetna Choice® Plans PPO, Aetna Open Access® Elect Choice, Aetna Choice® POS, Aetna Select℠ and Open Access Aetna Select℠.
Dental plans are offered, underwritten or administered by Aetna Health Inc., Aetna Health of California Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company, Aetna Life Insurance Company (Aetna), Aetna Dental Inc. and/or Aetna Dental of California Inc.
Policy forms issued in OK include: GR-/GR-9N, GR-29/GR-29N-29N.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its affiliated 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.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its affiliated 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.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its affiliated 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.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its affiliated 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.
You are now being directed to the CVS Health site.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its affiliated 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.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its affiliated 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.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its affiliated 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.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its affiliated 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.
The information you will be accessing is provided by another organization or vendor. If you do not intend to leave our site, close this message.
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.
Message and data rates may apply*
Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers. This search will use the five-tier subtype. 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. Do you want to continue?
By clicking on “I Accept”, I acknowledge and accept that:
The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical Necessity Guide does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.
Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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.
The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.
Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change.
Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law.
You are now being directed to CVS Caremark® site.
By clicking on “I accept”, I acknowledge and accept that:
Licensee's use and interpretation of the American Society of Addiction Medicine’s ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits.
This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose.
Copyright 2015 by the American Society of Addiction Medicine. Reprinted with permission. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM.
By clicking on “I accept”, I acknowledge and accept that:
Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept".
By clicking on “I accept”, I acknowledge and accept that:
By clicking on “I accept”, I acknowledge and accept that:
Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept".
See CMS's Medicare Coverage Center
See Aetna's External Review Program
CPT only copyright 2015 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association.
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.
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. 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt.
Go to the American Medical Association Web site
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. 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.
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. No fee schedules, basic unit, relative values or related listings are included in CPT. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. 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.
This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.
Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept".
The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services.
This information is neither an offer of coverage nor medical advice. It is only a partial, general description of plan or program benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.
We're working with 3Won to process your request for participation. Please select "Continue to ProVault to begin the contracting and credentialing process.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its affiliates are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its affiliated 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.
Proceed to Healthcare.gov site
By choosing “I accept,” I understand that:
Our glossary lists general terms we use on our site. To get specific info about your plan’s definition of a term, or for coverage details, check your plan documents.