AETNA BETTER HEALTHSM PREMIER PLAN
2018 Summary of Benefits
Aetna Better HealthSM Premier Plan (Medicare-Medicaid Plan) is a health plan that contracts
with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees.
www.aetnabetterhealth.com/illinois
92.06.300
How your health insurance works
Important information about you and your membership in Aetna Better Health of Illinois (Aetna Better Health).
As a member of Aetna Better Health, you should know your rights, how to appeal a decision and other information
that is essential to being an active partner
Practitioner Application Screening Form
PLEASE COMPLETE ONE FORM PER PRACTITIONER IN PRACTICE
Mail completed form to:
Aetna Better Health, 333 West Wacke
Integrated Care Program
Hospital Name County Address City State Zip Code Phone
ADVENTIST BOLINGBROOK HOSPITAL Will 500 Remington Boulevard Bolingbrook IL 60440 (630) 312-5000
ADVENTIST GLENOAKS HOSPITAL Cook 701 Winthrop Avenue Glendale Heights IL 60139 (630) 545-8000
ADVENTIST HINSDALE HOSPIT
Aetna Better Health®
Pharmacy Prior Authorization
Erythropoiesis – Stimulating Agents Clinical Guideline
Last update: 10/2015 Page | 1
Aranesp® (darbepoetin alfa) Epogen® (epoetin alfa)
Procrit® (epoetin alfa)
Authorization Guidelines:
For patients who meet all of the following:
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