Program Provisions

Additional information about programs and products

Discount Program Disclaimers

Discount offers provide access to discounted services and are not part of an insured plan or policy. Discount offers are rate-access offers and may be in addition to any plan benefits. The member is responsible for the full cost of the discounted services. Aetna may receive a percentage of the fee paid to a discount vendor.

California

For California members, the discounts are only available under the member’s benefit plan contract after they enroll.
Members with covered benefits should exhaust those benefits prior to using these discounts.
These services and products are provided by organizations other than Aetna. The discounts are reductions from the vendor’s retail price for the products and services.
If you have questions about the discounts, please call 1-800-756-7039.
For HMO members, any complaints about these discount programs may be submitted using the process described in your Evidence of Coverage.
For more information on these programs, check with your employer or call the Member Services number on your ID card.

Texas

Discount programs are not insurance and program features are not guaranteed under the plan contract and may be discontinued at any time. Discount programs are in addition to any plan benefits and may require a separate charge to access such programs. Discounts offered hereunder are not insurance.

Simple Steps Disclaimer

Personal Health Record

The Personal Health Record is offered by Aetna Life Insurance Company and should not be used as the sole source of information about the member's medical history.

Informed Health Line Disclaimer

This information is not meant to be either a recommendation for medical treatment or a diagnosis of medical condition. Please consult your health care provider for the advice and care appropriate for your specific medical needs. The availability of a program may vary by geographic service area and by plan design. While only your doctor can diagnose, prescribe or give medical advice, the Informed Health nurses can provide information on more than 5,000 health topics. Contact your doctor first with any questions or concerns regarding your health care needs. While this material is believed to be accurate as of this date, it is subject to change. These programs are not insured benefits.

Vital Savings Disclaimer

The Vital Savings by Aetna® program (the "Program") is not insurance. The program does not meet the Minimum Creditable Coverage requirements in Massachusetts. It provides Members with access to discounts at certain health care providers for medical and dental services. These discounts are discounted fees according to schedules negotiated by Aetna Life Insurance Company for the Vital Savings by Aetna discount program. The range of discounts provided under the Program will vary depending on the type of provider and type of service received. The Program does not make payments directly to the participating providers of medical and dental services. Each Member is obligated to pay for all services or products but will receive a discount from those health care providers who have contracted with the Discount Medical Plan Organization to participate in the Program. Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, 1-877-698-4825 (Individual) or 1-866-368-4825 (Group), is the Discount Medical Plan Organization
www.vitalsavings.com (Individual) or www.vitalsavingsbyaetna.com (Group).

Pharmacy Disclaimers

Aetna Pharmacy Management may at times collaborate with, or delegate to, another entity to carry out a function that it would otherwise perform. The goal is to make any of these processes seamless to our members. Thus Aetna does not notify our members and providers when a service is delegated. We continuously review any delegated activities to ensure that the collaborator is properly performing the assigned functions and to meet the requirements of the accreditation agency URAC, the National Committee for Quality Assurance (NCQA), the Centers for Medicare & Medicaid services (CMS), as well as state regulations.

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. Aetna Rx Home Delivery and Aetna Specialty Pharmacy refer to Aetna Rx Home Delivery, LLC and Aetna Specialty Pharmacy, LLC, respectively. Aetna Rx Home Delivery and Aetna Specialty Pharmacy are licensed pharmacy subsidiaries of Aetna Inc. that operate through mail order. The charges that Aetna negotiates with Aetna Rx Home Delivery and Aetna Specialty Pharmacy may be higher than the cost they pay for the drugs and the cost of the mail order pharmacy services they provide. For these purposes, the pharmacies’ cost of purchasing drugs takes into account discounts, credits and other amounts that they may receive from wholesalers, manufacturers, suppliers and distributors.

Health Care Provider Network Disclaimer

Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services.

Health Information Program Disclaimer

Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional.

Oklahoma policy form numbers

For medical plans

Policy forms issued in OK include:
HMO – HMO OK COC-5 09/07, HMO/OK GA-3 11/01
QPOS/CHOICE POS – HMO OK POS RIDER 08/07
ALIC – GR-23 and/or GR-29/GR-29N

For dental plans

Policy forms issued in OK include:
GR-9/GR-9N, GR-23 and/or GR-29/GR-29N

For Life & Disability Plans

Policy froms issued in OK include:
GR-9/GR-9N and/or GR-29/GR-29N

For Individual Product Plans

Policy forms issued in OK include:
Comprehensive PPO-GR-11741 (5/04); Limited-GR-11741-LME (5/04) and Dental-11826 Ed 9/04

For Student Health Plans

Policy forms issued in OK include:
GR-96134

For Vital Savings and other Discount programs:

Policy forms issued in OK include:
GR-96402-02 04-09