Services covered by Aetna Better Health are listed below. Some limitations and prior authorization requirements may apply. All services must be medically necessary.* If you have questions about covered services, call Member Services at 1-866-212-2851.
Type of Care |
Covered Services |
Coverage and Benefit Limitations |
Abortions |
|
Covered benefit when necessary to preserve the woman's life or health or when the pregnancy is the result of rape or incest. |
Ambulatory Surgery |
- > Preoperative examinations
- > Operating and recovery room services
- > All required drugs and medicines
|
Covered benefit |
Behavioral Health |
Mental health services including but not limited to:
- > Mental health assessment and/or psychological evaluation
- > Medication management
- > Community treatment and support including peer specialists or family peer specialist support services
- > Therapy/counseling
Subacute alcohol and substance abuse treatment, including but not limited to:
- > Outpatient treatment
- > Residential treatment
- > Detoxification
- > Psychiatric evaluation services
- > Day treatment
|
Covered benefit |
Chiropractic |
Services are limited to the treatment of the spine by manual manipulation. |
Covered benefit |
Dental |
- > Exams (1 per year for members under age 21; limited to first visit per dentist for members over age 21)
- > Cleanings (2 per year for members under age 21)
- > X-rays
- > Fluoride treatments (1 per year for members under age 21)
- > Sealants
- > Fillings
- > Crowns (caps)
- > Root canals
- > Dentures
- > Extractions (pulling)
- > "Practice" visits for members to become more comfortable with the dentist's office
- > Mobile dental services for members in intermediate care facilities and nursing homes
|
Covered benefit.
Call DentaQuest toll free at
1-800-416-9185 or see dental page for more information. |
Dialysis — Outpatient |
|
Covered benefit |
Medical Equipment and Supplies |
Nondurable medical supplies, including, but not limited to:
- > Asthma medical supplies such as peak flow meter (not including medicine)
- Diabetes testing supplies such as glucometer (not including medicine)
Durable medical supplies (DME) including but not limited to:
- > Wheelchairs
- > Oxygen supplies
- > Apnea monitors
|
Covered benefit
Provider must get authorization for these services.
The member must use a medical supply company or pharmacy that is in our network. |
Emergency Room |
|
Covered benefit |
Emergency Transportation |
|
Covered benefit |
Eye Care |
- > Routine eye exam (1 per year)
- > Glasses (1 pair per year)
- > Medically necessary contacts
- > Replacement glasses for members ages 19 and 20 as needed. This includes lenses and frames
- > Replacement lenses for members ages 21 and older, when medically necessary
- > One replacement pair of glasses each year if the first pair of glasses is lost or broken beyond repair, for members ages 21 and older
|
Covered benefit.
Call March Vision Care toll free at 1-888-493-4070 or see vision page for more information.
Limitations on exams and glasses:
|
Family Planning |
Including but not limited to:
- > Provider visit
- > Birth control and family planning education and counseling
- > Contraceptives (birth control)
- > Testing for sexually transmitted diseases and HIV
- > Sterilization
|
Covered benefit.
Limitations on sterilization include:
- > Age 21 or older
- > Completed consent form
|
Hearing Care |
Includes:
- > Audiologist services
- > Hearing screening
- > Cochlear implants
- > Hearing aids and repairs
|
Covered benefit. |
Home Health Care |
|
Covered benefit |
Hospice Services |
|
Covered benefit |
Hospital - Inpatient |
|
Covered benefit |
Immunizations (Shots) |
|
Covered benefit |
Laboratory Services/X-rays |
|
Covered benefit |
Nurse Midwife Services |
|
Covered benefit |
Maternity Care |
- > Prenatal care (before birth)
- > Labor and delivery
- > Postpartum (after the baby is born)
|
Covered benefit |
Nursing Care |
Members under the age of 21 can get medically necessary in-home shift nursing and personal care services provided by a registered nurse (RN), licensed practical nurse (LPN) or Certified Nurses Aide under the direction of a qualified home health agency. |
Covered benefit for members ages 19- 20 who are not in the Medically Fragile Technology Dependent (MFTD) waiver.
Home health agency providing the nursing services must be in our network. |
Organ Transplant |
|
Covered benefit |
Orthotics/Prosthetics |
|
Covered benefit |
PCP visit |
|
Covered benefit |
Podiatric Services |
|
Covered benefit |
Provider Office Visits/Preventive Care |
Includes:
- > Periodic well adolescent visits (members 19-20)
- > Well woman visits
- > Well man visits
|
Covered benefit |
Rehabilitative Services |
Including but not limited to:
- > Occupational therapy
- > Physical therapy
- > Speech and language therapy
|
Covered benefit |
Radiology |
|
Covered benefit |
Aetna Better Health considers a service, supply or medicine to be medically necessary when it meets the descriptions below.
The following services are not covered.