Understanding your Aetna® member rights

We believe that you, as an Aetna member, are entitled to information and services that help you get the most out of your health plan coverage. Learn about your rights and responsibilities below.

What are my Aetna member rights?

Plan information

You have the right to know how your plan works. This includes:

• How to access your benefits and offerings
• Which doctors are in your network
• What services your plan covers (and doesn’t cover)
• Information about copayments and fees

Our Member Services team is always available to answer questions about your plan or coverage. You can reach them at the phone number on your member ID card.

You have the right to receive plan information in your preferred language and format. We provide interpreter services when needed.

Access to timely care

You have the right to see a doctor when you need care. You can choose (or change) doctors within your plan’s network.

Confidentiality

You have the right to privacy and dignity. We protect your personal data and health information.

Freedom to make your own choices

You always have a voice in your care decisions. You have the right to talk with your doctors about your options. You can refuse treatment or leave a medical facility, even if your doctors advise against it (as long as you accept responsibility and any financial consequences for the decision).

You can also choose someone you trust to make medical decisions and use these rights on your behalf. This can be done by completing Medical Power of Attorney and Health Insurance Portability and Accountability Act (HIPAA) authorization. These are distinct legal documents supporting health care decisions, but they can work together if you are looking to choose someone to make decisions about your care.

Input and feedback

You always have the right to share your thoughts about your plan's policies and service. Your feedback is critical to our continuous improvement.

Disputes and appeals

You or your doctor may disagree with a coverage decision. You have the right to an appeal process. You also have the right to:

• Know the reasoning behind a denial, such as through an Explanation of Benefits or other similar communication
• Be told how to file an appeal or complaint
• Know that you or your doctor won’t be punished for filing an appeal or complaint

We address disputes according to your health plan, as well as state and federal guidelines and standards. Learn more about our dispute process.

Plan-specific Aetna member rights

In addition to the list above, you may also have specific rights based on your plan type or geography.

• For Medicare Advantage: You can find your rights in the Medicare Advantage Evidence of Coverage document for your plan. You can also reference rights regarding coverage decisions, appeals and grievances for Medicare Advantage.
• For Medicaid: Please reference your state-specific webpage: Find your local health plan.
• For Employer-Sponsored Plans: For group Commercial HMO and PPO plans: HMO and PPO member rights and responsibilities

In addition to these rights and responsibilities, we work closely with you to help you live your healthiest life.

Learn more about our member commitment to you

What are my responsibilities as an Aetna member?

As Aetna members, you play an important role in your care and health. This comes with certain responsibilities:

1. Exercise your rights: Know your rights and use them when needed.
2. Follow instructions: Following the treatment plans, directions and advice you and your doctor decide together can lead to health improvement. Additional responsibilities include:
   • Paying required premiums and copayments
   • Being honest in all health insurance matters
3. Communicate: If something isn’t clear, tell your doctor you don’t understand. You can also ask your doctor to explain something in a different way. Tell them right away if you’re experiencing new or worsening symptoms. Additional responsibilities include:
   • Letting us know about other medical coverage you may have
   • Contacting our Member Services team (at the number on the back of your card) if you need support understanding your benefits or how to access them

What are my resources?

We're committed to bringing together our resources to support every step of your health journey. We’re available over the phone or at your fingertips, on our app and online.

• Member Services: If you have any questions about your Aetna member rights and responsibilities, contact our Member Services team at the phone number on your member ID card. To access your member handbook, reference your plan-specific webpage or contact our Member Services team at the phone number on your member ID card for help.
• Secure member website: Secure member websites are plan specific and allow you to manage your benefits, find care, get help with your health and more. Register for and log onto your plan-specific website or contact our Member Services team at the phone number on your member ID card for help.