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Aetna Medicare Disclaimers

Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our DSNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

Every year, Medicare evaluates plans based on a 5-star rating system.

For accommodations of persons with special needs at meetings, call 1-833-251-9949 ${tty}.

For the 2024 plan year, the Aetna Medicare pharmacy network includes limited lower-cost, preferred pharmacies in Suburban Arizona, Rural California, Urban Kansas, Rural Michigan, Urban Michigan, Urban Missouri, Rural North Dakota, Suburban West Virginia. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use.

For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-833-278-3928 ${tty}, or consult the online pharmacy directory.

For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within 7 to 10 days. Please call the phone number listed on your member ID card if you do not receive your mail-order drugs within this timeframe. Members may have the option to sign-up for automated mail-order delivery.

For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Participating health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change.

The formulary and/or pharmacy network, may change at any time. You will receive notice when necessary.

Out-of-network/non-contracted providers are under no obligation to treat Aetna members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

SilverScript is a Prescription Drug Plan with a Medicare contract marketed through Aetna Medicare. Enrollment in SilverScript depends on contract renewal.

Aetna®, CVS Pharmacy® and MinuteClinic®, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health® family of companies.

To send a complaint to Aetna, call the Plan or the number on your member ID card. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

Members within the state of California are automatically enrolled with Manifest MedEx, which allows their doctor to view medical records to provide the best care. Members can opt out of being enrolled in this service through Manifest MedEx’s website at http://manifestmedex.org/opt-out/ or by calling Manifest MedEx at 1-800-490-7617.

Aetna is the brand name for insurance products issued by the subsidiary insurance companies controlled by Aetna, Inc. The Medicare Supplement Insurance Plans are insured by Continental Life Insurance Company of Brentwood, Tennessee, an Aetna Company (Aetna), American Continental Insurance Company (Aetna), Aetna Health and Life Insurance Company (Aetna), Aetna Life Insurance Company (Aetna), or Aetna Health Insurance Company (Aetna).

Not connected with or endorsed by the U.S. Government or the Federal Medicare Program.


This is a solicitation of insurance. Contact may be made by a Licensed Insurance Agent or Insurance Company. The Medicare Supplement Insurance Plans are guaranteed renewable as long as the required premium is paid by the end of each grace period. The policies have exclusions, limitations, terms under which the policy may be continued in force or discontinued. Plans do not pay benefits for any service and supply of a type not covered by Medicare, including but not limited to dental care or treatment, eyeglasses and hearing aids. See Plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. AN OUTLINE OF COVERAGE IS AVAILABLE UPON REQUEST. In some states, Medicare Supplement Insurance Plans are available to under age 65 individuals that are eligible for Medicare due to disability or ESRD (end stage renal disease). Plans not available in all States.

Important notice: In Colorado: All Medicare Supplement standardized plans are offered to qualified individuals under 65.


Policy forms issued in OR include CLIMSP10A OR, CLIMSP10B OR, CLIMSP10F OR, CLIMSP10HF OR, CLIMSP10G OR, and CLIMSP10N OR. In ID, include AHLMSP17A ID, AHLMSP17B ID, AHLMSP17F ID, AHLMSP17HF ID, AHLMSP17G ID, and AHLMSP17N ID. In OK, include AHIMSP18A OK, AHIMSP18B OK, AHIMSP18F OK, AHIMSP18HF OK, AHIMSP18G OK, and AHIMSP18N OK. In TN, include CLIMSP19A TN, CLIMSP19B TN, CLIMSP19F TN, CLIMSP19G TN, CLIMSP19HG TN, and CLIMSP19N TN. In FL, include CLIMSP19A FL, CLIMSP19B FL, CLIMSP19F FL, CLIMSP19G FL, and CLIMSP19N FL. In OH, include CLIMSP19A OH, CLIMSP19B OH, CLIMSP19F OH, CLIMSP19G OH, CLIMSP19HG OH, and CLIMSP19N OH. In MO, AHLMSP18A MO, AHLMSP18B MO, AHLMSP18F MO, AHLMSP18G MO, AHLMSP18HF MO, and AHLMSP18N MO. In MD, AHIMSP19A MD, AHIMSP19B MD, AHIMSP19F MD, AHIMSP19G MD, AHIMSP19HG MD, and AHIMSP19N MD. IN NH, AHLMSP18A NH, AHLMSP18B NH, AHLMSP18F NH, AHLMSP18HF NH, AHLMSP18G NH, AHLMSP18N NH. In VA, CLIMSP19A VA, CLIMSP19B VA, CLIMSP19F VA, CLIMSP19G VA, CLIMSP19HG VA, and CLIMSP19N VA.

 

 
 

 

For New Jersey Dual Eligible Special Needs plans (D-SNP)

 

We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex and does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. If you speak a language other than English, free language assistance services are available. Visit our website at AetnaBetterHealth.com/New-Jersey-hmosnp or call 1-844-362-0934 ${tty}, 8 a.m. to 8 p.m., 7 days a week.

 

In addition, your health plan provides auxiliary aids and services, free of charge, when necessary to ensure that people with disabilities have an equal opportunity to communicate effectively with us. Your health plan also provides language assistance services, free of charge, for people with limited English proficiency. If you need these services, call Member Services at 1-844-362-0934 ${tty}, 8 a.m. to 8 p.m., 7 days a week.

 

If you believe that we have failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with our Grievance Department by writing to Aetna Assure Premier Plus (HMO D-SNP) Appeals and Grievances, PO Box 818070, Cleveland, OH 44181. You can also file a grievance by phone by calling Member Services at 1-844-362-0934 ${tty}. If you need help filing a grievance, you can call Member Services at 1-844-362-0934, 8 a.m. to 8 p.m., 7 days a week.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights at https://ocrportal.hhs.gov/ocr/cp/complaint_frontpage.jsf.

 


ESPAÑOL (SPANISH): Si habla un idioma que no sea el inglés, los servicios gratuitos de asistencia en idiomas están disponibles. Visite nuestro sitio web en AetnaBetterHealth.com/New-Jersey-hmosnp o llame al 1-844-362-0934 ${tty}, de 8 a.m. a 8 p.m., los 7 días de la semana.

 

 

(CHINESE) 傳統漢語(中文)如果您講英語以外的語言,則提供免費語言援助服務。請造訪我們的網站 AetnaBetterHealth.com/New-Jersey-hmosnp 或致電, 1-844-362-0934 ${tty}, 上午8時至下午8時,每週7天

 

You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services at 1-844-362-0934 ${tty}, 8 AM to 8 PM, 7 days a week. The call is free.

 

 

For California Dual Eligible Special Needs plans (D-SNP)

 

NONDISCRIMINATION NOTICE

 

Discrimination is against the law. Aetna Medicare Preferred Plan (HMO D-SNP) follows State and Federal civil rights laws. Aetna Medicare Preferred Plan (HMO D-SNP) does not unlawfully discriminate, exclude people, or treat them differently because of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, gender, gender identity, or sexual orientation.

 

Aetna Medicare Preferred Plan (HMO D-SNP) provides:

  • Free aids and services to people with disabilities to help them communicate better, such as:
  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats, other formats)

 

  • Free language services to people whose primary language is not English, such as:
  • Qualified interpreters
  • Information written in other languages

 

If you need these services, contact Aetna Medicare Preferred Plan (HMO D-SNP) between 8am-8pm 7 days a week by calling 1-866-409-1221. If you cannot hear or speak well, please call 711. Upon request, this document can be made available to you in braille, large print, audiocassette, or electronic form. To obtain a copy in one of these alternative formats, please call or write to:

 

Aetna Medicare Preferred Plan (HMO D-SNP)

Aetna Medicare PO Box 7405 London, KY 40742

1-866-409-1221

TTY/TDD 711

California Relay 711

 

 

 

HOW TO FILE A GRIEVANCE

 

If you believe that Aetna Medicare Preferred Plan (HMO D-SNP) has failed to provide these services or unlawfully discriminated in another way on the basis of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, gender, gender identity, or sexual orientation, you can file a grievance with Aetna Medicare Grievances. You can file a grievance by phone, in writing, in person, or electronically:

 

  • By phone: Contact Aetna Medicare Grievances between 8 AM to 8 PM, 7 days a week, by calling 1-866-409-1221. Or, if you cannot hear or speak well, please call TTY/TDD 711.
  • In writing: Fill out a complaint form or write a letter and send it to:

    Aetna Medicare Grievances
    PO Box 14834 Lexington, KY 40512


  • In person: Visit your doctor’s office or Aetna Medicare Preferred Plan (HMO D-SNP) and say you want to file a grievance.
  • Electronically: Visit Aetna Medicare Preferred Plan (HMO D-SNP) website at AetnaMedicare.com

 

 

 

OFFICE OF CIVIL RIGHTS – CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES

 

You can also file a civil rights complaint with the California Department of Health Care Services, Office of Civil Rights by phone, in writing, or electronically:

 

  • By phone: Call 916-440-7370. If you cannot speak or hear well, please call 711 (Telecommunications Relay Service).
  • In writing: Fill out a complaint form or send a letter to:

    Deputy Director, Office of Civil Rights
    Department of Health Care Services
    Office of Civil Rights
    P.O. Box 997413, MS 0009
    Sacramento, CA 95899-7413

    Complaint forms are available at http://www.dhcs.ca.gov/Pages/Language_Access.aspx.
  • Electronically: Send an email to CivilRights@dhcs.ca.gov.

 

 

 

OFFICE OF CIVIL RIGHTS – U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

If you believe you have been discriminated against on the basis of race, color, national origin, age, disability or sex, you can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights by phone, in writing, or electronically:

 

 

 
 

English Tagline:

ATTENTION: If you need help in your language call 1-866-409-1221 (TTY/TDD 711). Aids and services for people with disabilities, like documents in braille and large print, are also available. Call 1-866-409-1221 (TTY/TDD 711). These services are free of charge.

 

Arabic:

إذا كنت تتحدث لغة غير الإنجليزية، فإن خدمات المساعدة اللغوية المجانية متاحة. تفضل بزيارة موقعنا على الويب أو اتصل برقم الهاتف المدرج في هذا المستند.

 

Հայկական տագլին (Armenian):

ՈՒՇԱԴՐՈՒԹՅՈՒՆ: Եթե ձեր լեզվով օգնության կարիք ունեք, զանգահարեք 1-866-409-1221 (TTY/TDD 711): Առկա են նաեւ հաշմանդամություն ունեցող անձանց համար նախատեսված օժանդակ միջոցներ եւ ծառայություններ, ինչպես բրեյլի եւ մեծ տպաքանակի փաստաթղթեր: Զանգահարեք 1-866-409-1221 (TTY/TDD 711): Այս ծառայությունները անվճար են:

 

ស្លាកសញ្ញាកម្ពុជា។ (Cambodian):

យកចិត្តទុកដាក់៖ ប្រសិនបើអ្នកត្រូវការជំនួយជាភាសារបស់អ្នក សូមទូរស័ព្ទទៅលេខ 1-866-409-1221 (TTY/TDD 711)។ ជំនួយ និងសេវាកម្មសម្រាប់ជនពិការ ដូចជាឯកសារជាអក្សរស្ទាប និងការបោះពុម្ពធំក៏មានផងដែរ។ ទូរស័ព្ទទៅ 1-866-409-1221 (TTY/TDD 711)។ សេវាកម្មទាំងនេះមិនគិតថ្លៃទេ។

 

简体中文标语 (Simplified Chinese):

请注意:如果您需要以您的母语提供帮助,请致电 1-866-409-1221 (TTY/TDD 711)。我们另外还提供针对残疾人士的帮助和服务,例如盲文和大字体阅读,提供您方便取用。请致电 1-866-409-1221 (TTY/TDD 711)。这些服务都是免费的。

 

Farsi:

اگر به زبان دیگری بجز انگلیسی گفتگو می کنید، کمک زبانی رایگان فراهم می باشد. به وبسایت ما مراجعه نمایید و یا به شماره تلفن که در سند ذیل لست شده، تماس بگیرید.

 

हिंदी टैगलाइन (Hindi):

ध्यान दें: यदि आपको अपनी भाषा में सहायता चाहिए तो 1-866-409-1221 (TTY/TDD 711) पर कॉल करें। विकलांग लोगों के लिए सहायता और सेवाएं, जैसे ब्रेल और बड़े प्रिंट में दस्तावेज़ भी उपलब्ध हैं। कॉल 1-866-409-1221 (TTY/TDD 711) । ये सेवाएं नि:शुल्क हैं।

 

Nqe Lus Hmoob Cob (Hmong) :

CEEB TOOM: Yog koj xav tau kev pab txhais koj hom lus hu rau 1-866-409-1221 (TTY/TDD 711). Muaj cov kev pab txhawb thiab kev pab cuam rau cov neeg xiam oob qhab, xws li puav leej muaj ua cov ntawv su thiab luam tawm ua tus ntawv loj. Hu rau 1-866-409-1221 (TTY/TDD 711). Cov kev pab cuam no yog pab dawb xwb.

 

日本語表記 (Japanese) :

注意日本語での対応が必要な場合は 1-866-409-1221 (TTY/TDD 711)へお電話く ださい。点字の資料や文字の拡大表示など、障がいをお持ちの方のためのサービスも 用意しています。 1-866-409-1221 (TTY/TDD 711)へお電話ください。これらのサービスは無料で提供しています。

 

한국어 태그라인 (Korean):

유의사항: 귀하의 언어로 도움을 받고 싶으시면 1-866-409-1221 (TTY/TDD 711)번으로 문의하십시오. 점자나 큰 활자로 된 문서와 같이 장애가 있는 분들을 위한 도움과 서비스도 이용 가능합니다. 1-866-409-1221 (TTY/TDD 711) 번으로 문의하십시오. 이러한 서비스는 무료로 제공됩니다.

 

ແທກໄລພາສາລາວ (Laotian):

ຂໍ້ຄວນລະວັງ: ຖ້າທ່ານຕ້ອງການຄວາມຊ່ວຍເຫຼືອໃນພາສາຂອງທ່ານ, ໃຫ້ໂທຫາ 1-866-409-1221 TTY/TDD 711. ການຊ່ວຍເຫຼືອ ແລະການບໍລິການຕ່າງໆສຳລັບຄົນພິການ, ເຊັ່ນເອກະສານທີ່ເປັນຕົວອັກສອນນູນ ແລະ ພິມໃຫຍ່, ຍັງມີຢູ່. ໂທຫາ 1-866-409-1221 TTY/TDD 711. ການບໍລິການເຫຼົ່ານີ້ແມ່ນບໍ່ເສຍຄ່າ.

 

Mien Tagline (Mien):

LONGC HNYOUV JANGX LONGX OC: Beiv taux meih qiemx longc mienh tengx faan benx meih nyei waac nor douc waac daaih lorx taux 1-866-409-1221 (TTY/TDD 711). Liouh lorx jauv-louc tengx aengx caux nzie gong bun taux ninh mbuo wuaaic fangx mienh, beiv taux longc benx nzangc-pokc bun hluo mbiutc aengx caux aamz mborqv benx domh sou se mbenc nzoih bun longc. Douc waac daaih lorx 1-866-409-1221 (TTY/TDD 711). Naaiv deix nzie weih gong-bou jauv-louc se benx wang-henh tengx mv zuqc cuotv nyaanh oc.

 

ਪੰਜਾਬੀ ਟੈਗਲਾਈਨ (Punjabi):

ਧਿਆਨ ਦਿਓ: ਜੇ ਤੁਹਾਨੂੰ ਆਪਣੀ ਭਾਸ਼ਾ ਵਿੱਚ ਮਦਦ ਚਾਹੀਦੀ ਹੈ ਤਾਂ 1-866-409-1221 (TTY/TDD 711) 'ਤੇ ਕਾਲ ਕਰੋ। ਅਪੰਗਤਾਵਾਂ ਵਾਲੇ ਲੋਕਾਂ ਵਾਸਤੇ ਸਹਾਇਤਾਵਾਂ ਅਤੇ ਸੇਵਾਵਾਂ, ਜਿਵੇਂ ਕਿ ਬਰੇਲ ਲਿਪੀ ਵਿਚਲੇ ਦਸਤਾਵੇਜ਼ ਅਤੇ ਵੱਡੇ ਛਾਪੇ ਵਾਲੇ ਦਸਤਾਵੇਜ਼, ਵੀ ਉਪਲਬਧ ਹਨ। 1-866-409-1221 'ਤੇ ਕਾਲ ਕਰੋ (TTY/TDD 711)। ਇਹ ਸੇਵਾਵਾਂ ਮੁਫ਼ਤ ਹਨ।

 

Русский слоган (Russian):

ВНИМАНИЕ! Если вам нужна помощь на вашем родном языке, звоните по номеру 1-866-409-1221 линия (TTY/TDD 711). Также предоставляются средства и услуги для людей с ограниченными возможностями, например документы крупным шрифтом или шрифтом Брайля. Звоните по номеру 1-866-409-1221 линия (TTY/TDD 711). Такие услуги предоставляются бесплатно.

 

Mensaje en español (Spanish):

ATENCIÓN: si necesita ayuda en su idioma, llame al 1-866-409-1221 (TTY/TDD 711). También ofrecemos asistencia y servicios para personas con discapacidades, como documentos en braille y con letras grandes. Llame al 1-866-409-1221 (TTY/TDD 711). Estos servicios son gratuitos.

 

Tagalog Tagline (Tagalog):

ATENSIYON: Kung kailangan mo ng tulong sa iyong wika, tumawag sa 1-866-409-1221 (TTY/TDD 711). Mayroon ding mga tulong at serbisyo para sa mga taong may kapansanan,tulad ng mga dokumento sa braille at malaking print. Tumawag sa 1-866-409-1221 (TTY/TDD 711). Libre ang mga serbisyong ito.

 

สโลแกน (Thai):

ความสนใจ: หากคุณต้องการความช่วยเหลือในภาษาของคุณ โทร 1-866-409-1221 (TTY/TDD 711) นอกจากนี้ยังมีบริการช่วยเหลือและบริการสำหรับคนพิการ เช่น เอกสารอักษรเบรลล์และตัวพิมพ์ขนาดใหญ่ โทร 1-866-409-1221 (TTY/TDD 711) บริการเหล่านี้ไม่เสียค่าใช้จ่าย

 

Примітка українською (Ukrainian) :

УВАГА! Якщо вам потрібна допомога вашою рідною мовою, телефонуйте на номер 1-866-409-1221 (TTY/TDD 711). Люди з обмеженими можливостями також можуть скористатися допоміжними засобами та послугами, наприклад, отримати документи, надруковані шрифтом Брайля та великим шрифтом. Телефонуйте на номер 1-866-409-1221 (TTY/TDD 711). Ці послуги безкоштовні.

 

Khẩu hiệu tiếng Việt (Vietnamese):

CHÚ Ý: Nếu quý vị cần trợ giúp bằng ngôn ngữ của mình, vui lòng gọi số 1-866-409-1221 (TTY/TDD 711). Chúng tôi cũng hỗ trợ và cung cấp các dịch vụ dành cho người khuyết tật, như tài liệu bằng chữ nổi Braille và chữ khổ lớn (chữ hoa). Vui lòng gọi số 1-866-409-1221 (TTY/TDD 711). Các dịch vụ này đều miễn phí.

 

 

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