Important info about your Aetna Better Health® of Maryland plan

Jump to:

View your current member newsletter

Where to find important info about your plan

Your rights and responsibilities

Your pharmacy benefits

How we make decisions about your health care (utilization management)

Population health programs

Clinical practice guidelines

Quality matters

How to file a complaint, grievance or appeal

How to report fraud, waste and abuse

Your privacy rights

Language assistance

Where to find important info 

Your Aetna Better Health member handbook covers everything you need to know about your health plan. You can find info on: 

• What your plan covers, and what it does not
• How to get your medicine and use your pharmacy benefits
• Copays and other costs you may need to pay
• What’s covered outside the Aetna Better Health network
• How to get language help at no cost
• How to ask for auxiliary aids and services at no cost
• How to submit a claim
• How to get info about providers in the Aetna Better Health network
• How to get primary care services
• How to get specialty care. This includes:
  • Behavioral health care
  • Hospital services
  • Care for specific conditions
  • How to get a referral
• How to get care after normal office hours
• How and when to use emergency room care
• How to get care outside of your service area
• How to file a complaint or grievance
• How to appeal a decision that affects your coverage, benefits or relationship with your plan
• How we decide which new services or tools we cover
• How we make decisions about your care (called utilization management)
• Your member rights and responsibilities
• Notice of privacy practices

We update the handbook every year. If we make major changes, we will send you a letter at least 30 days before they start. 

You can view your handbook online at AetnaBetterHealth.com/maryland/member-materials-forms.html.

Prefer a hard copy? Call us at 1-866-827-2710 (TTY: 711) to have your member handbook or any other information mailed to you at no cost. Let us know if you need it in another language, a larger font or other formats.

Your rights and responsibilities

As an Aetna Better Health member, you have certain rights and responsibilities. 

Your rights include:

• A right to get info about:
  • The organization and its services
  • The organization’s practitioners and providers
  • Your member rights and responsibilities
• A right to be treated with respect and dignity
• A right to privacy
• A right to work with your providers to make decisions about your health care
• A right to talk openly about treatment options, regardless of cost or benefit coverage
• A right to voice complaints or submit appeals about the organization or the care it provides
• A right to give feedback on the organization’s member rights and responsibilities policy

Your responsibilities include:

• A responsibility to give info that the organization and its providers need to provide you with care
• A responsibility to follow plans for care that you have agreed to with your providers
• A responsibility to understand your health problems and join in developing treatment goals

Go to AetnaBetterHealth.com/maryland/medicaid-rights-responsibilities.html for a complete list of your rights and responsibilities.

Your pharmacy benefits 

Learn more about your pharmacy benefits at AetnaBetterHealth.com/maryland/pharmacy-prescription-drug-benefits.html. You can find info such as:

• Preferred drug list (PDL) or formulary
• Medications that require prior authorization and coverage criteria
• A list and explanation of medications that have limits or quotas
• Copayment and coinsurance requirements and the medications or classes to which they apply
• Steps for getting clinical or PDL prior authorization, generic substitution or preferred brand interchange
• Info on pharmaceutical management procedures
• Criteria used to add new medicines to the formulary
• How to ask for a coverage exception

How we make decisions about your health care 

Our utilization management (UM) program ensures you get the right care in the right setting when you need it. UM staff can help you and your providers make decisions about your health care. 

When we make decisions, it’s important for you to remember the following: 

• We make UM decisions by looking at your benefits and clinical guidelines for the most appropriate care and service. We consider:
  • Your needs
  • Evidenced-based practice
  • Availability of care
  • You also must have active coverage.
• We don’t reward providers or other people for denying coverage or care.
• Our employees do not get any incentives to reduce the services you get. 

If you have questions about UM, call Member Services. They can also help if you need language translation or support.

Get extra support for your health care needs 

Every Aetna Better Health member is on their own health care journey. We can help guide you in managing and improving your health. Our population health management programs can help with things like:

• Managing a health condition
• Pregnancy care
• When to use urgent care
• What to do after a hospital stay
• Staying healthy and preventing health problems

You can learn more about our programs at AetnaBetterHealth.com/maryland/population-health-programs.html or in your member handbook.

For most programs, we will automatically enroll you if you are eligible. You can choose to join or leave a program at any time by calling Member Services.

You can also get a referral to a management program. Referrals can come from:

• Your provider
• A medical management program
• Hospital discharge planner
• A caregiver
• Yourself

Call us at 1-866-827-2710 (TTY: 711) or go to our website for a member referral into case management.

Our Care Managers are here for you!

Care Managers are nurses and social workers who understand your health conditions and help connect you to the right care. A Care Manager can teach you more about your health, get you services and care that you need.

If you have questions or if you would like to speak to a care manager, call us at 1-866-827-2710 (TTY: 711). You can also email us at AetnaBetterHealthMDCM@Aetna.com. Members may disenroll from the program at any time.

Care you can trust

Our network providers follow proven care guidelines. These guidelines:

• Are based on strong medical evidence or agreement among experts in the field
• Take members’ needs into account
• Are created with input from the providers we work with
• Are checked and updated at least every two years

You or your provider can call us for a copy of these guidelines. Find out more at AetnaBetterHealth.com/maryland/providers/clinical-guidelines-policy-bulletins.html. 

Quality matters

You deserve the best care. And we work with your provider to make sure that happens. 

Our Quality Improvement (QI) program helps us make our services better. We share info about our QI program with members every year. You can find this info at AetnaBetterHealth.com/maryland/quality-improvement-program.html.

How to file a complaint, grievance or appeal

If you are dissatisfied with a provider or Aetna Better Health of Maryland, this is called a complaint. If your complaint is about a service or care your provider feels you need but we will not cover, you can ask us to review your request again. This is called an appeal. You must file an appeal within 60 days from the date on the denial letter you received. You can file an appeal by phone at 1-866-827-2710 (TTY: 711).

A complaint that is not related to a denial of some type of service or care is called a grievance. Examples of grievances include quality of care issues, not being treated fairly by someone who works here or at your doctor’s office, or trouble getting an appointment. A grievance can be filed at any time by calling customer service at 1-866-827-2710 (TTY: 711).

Our customer service representative can assist you with filling a complaint, grievance, or appeal. You can find more information about appeals and grievances in your Member Handbook.

How to report fraud, waste or abuse

Members and providers are required to report Medicaid fraud, waste and abuse. 

• Fraud happens when someone lies to get money or services.
• Waste happens when someone uses benefits or services they don’t need.
• Abuse happens when someone takes money for services when they aren’t legally entitled to payment. 

If you suspect or know that fraud, waste or abuse is occurring, report it immediately. There are three options: 

• Call Aetna Better Health Member Services: 1-866‑827‑2710 (TTY: 711)
• Notify the Maryland Department of Health, Office of the Inspector General: 1-866-770-7175 or DHMH.Maryland.gov/OIG/Pages/Report_Fraud.aspx
• Contact the U.S. Department of Health and Human Services, Office of the Inspector General: 1-800-447-8477 or OIG.HHS.gov/Fraud/Report-Fraud/Index.asp.

Reporting fraud, waste or abuse will not affect how you will be treated by Aetna Better Health of Maryland, and you can remain anonymous. Combating fraud, waste and abuse is everyone’s responsibility. Failure to comply with these laws could result in civil and criminal penalties.

We care about your privacy

We protect your personal health information (PHI). That includes your:

• Race
• Ethnicity
• Language
• Sexual orientation
• Social needs info

 We only share your info when needed and as allowed by law. 

You have rights over your health data. That includes how it’s used and who can access it. Go to AetnaBetterHealth.com/health-optimization-disclaimer.html to learn more about your privacy rights and how we safeguard your data.

Language assistance

Aetna follows applicable Federal civil rights laws. Aetna does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Don't speak English or need auxiliary aids and services? Aetna provides interpreter services at no cost, including sign language interpreters. Call the number on the back of your ID card for help. You can also ask for written info in another language or format, including:

• Large print
• Audio
• Accessible electronic formats

Go to AetnaBetterHealth.com/maryland/notice-of-non-discrimination.html for more info.

ENGLISH: If you speak a language other than English, free language assistance services are available. Visit our website or call the phone number listed in this document.

SPANISH: Si habla un idioma que no sea inglés, se encuentran disponibles servicios gratuitos de asistencia de idiomas. Visite nuestro sitio web o llame al número de teléfono que figura en este documento.

TRADITIONAL CHINESE: 如果您使用英文以外的語言，我們將提供免費的語言協助服務。請瀏覽我們的網站或撥打本文件中所列的電話號碼。

TAGALOG: Kung hindi Ingles ang wikang inyong sinasalita, may maaari kayong kuning mga libreng serbisyo ng tulong sa wika. Bisitahin ang aming website o tawagan ang numero ng telepono na nakalista sa dokumentong ito.

FRENCH: Si vous parlez une autre langue que l'anglais, des services d'assistance linguistique gratuits vous sont proposés. Visitez notre site Internet ou appelez le numéro indiqué dans ce document.

VIETNAMESE: Nếu quý vị nói một ngôn ngữ khác với Tiếng Anh, chúng tôi có dịch vụ hỗ trợ ngôn ngữ miễn phí. Xin vào trang mạng của chúng tôi hoặc gọi số điện thoại ghi trong tài liệu này.

GERMAN: Wenn Sie eine andere Sprache als Englisch sprechen, stehen Ihnen kostenlose Sprachdienste zur Verfügung. Besuchen Sie unsere Website oder rufen Sie die Telefonnummer in diesem Dokument an.

KOREAN: 영어가 아닌 언어를 쓰시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 저희 웹사이트를 방문하시거나 본 문서에 기재된 전화번호로 연락해 주십시오.

RUSSIAN: Если вы не владеете английским и говорите на другом языке, вам могут предоставить бесплатную языковую помощь. Посетите наш веб-сайт или позвоните по номеру, указанному в данном документе.

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.

HINDI: अगर आप अंग्रेजी के अलावा कोई अन्य भाषा बोलते हैं, तो मुफ्त भाषा सहायता सेवाएं उपलब्ध हैं। हमारी वेबसाइट परजाएं या इस दस्तावेज़ में दिए गए फोन नंबर पर कॉल करें।

ITALIAN: Nel caso Lei parlasse una lingua diversa dall'inglese, sono disponibili servizi di assistenza linguistica gratuiti. Visiti il nostro sito web oppure chiami il numero di telefono elencato in questo documento.

PORTUGUESE: Caso você seja falante de um idioma diferente do inglês, serviços gratuitos de assistência a idiomas estão disponíveis. Acesse nosso site ou ligue para o número de telefone presente neste documento.

HAITIAN CREOLE: Si ou pale yon lòt lang ki pa Anglè, wap jwenn sèvis asistans pou lang gratis ki disponib. Vizite sitwèb nou an oswa rele nan nimewo telefòn ki make nan dokiman sa a.

POLISH: Jeżeli nie posługują się Państwo językiem angielskim, dostępne są bezpłatne usługi wsparcia językowego. Proszę odwiedzić naszą witrynę lub zadzwonić pod numer podany w niniejszym dokumencie.

JAPANESE: 英語をお話しにならない方は、無料の言語支援サービスを受けることができます。弊社のウェブサイトにアクセスするか、または本書に記載の電話番号にお問い合わせください。

ALBANIAN: Nëse nuk flisni gjuhën angleze, shërbime ndihmëse gjuhësore pa pagesë janë në dispozicionin tuaj. Vizitoni faqen tonë në internet ose merrni në telefon numrin e telefonit në këtë dokument.

AMHARIC: ከእንግሊዝኛ ሌላ ቋንቋ የሚናገሩ ከሆነ ነጻ የቋንቋ ድጋፍ አገልግሎቶችን ማግኘት ይቻላል። የእኛን ድረ-ገጽ ይጎብኙ ወይም በዚህ ሰነድ ላይ የተዘረዘረውን ስልክ ቁጥር በመጠቀም ይደውሉ።

ARMENIAN: Եթե խոսում եք անգլերենից բացի մեկ այլ լեզվով, ապա Ձեզ համար հասանելի են լեզվական աջակցման անվճար ծառայություններ։ Այցելեք մեր վեբ կայքը կամ զանգահարեք այս փաստաթղթում նշված հեռախոսահամարով։

BENGALI: যদি আপনি ইংরেজী ব্যতীত অন্য কোনো ভাষায় কথা বলেনতাহলে বিনামূল্যের দোভাষীর পরিষেবা উপলব্ধ আছে।আমাদের ওয়েবসাইট দেখুন এবং এই নথিতে তালিকাভুক্ত ফোন নম্বরে ফোন করুন।

KHMER: បើលោកអ្នកនិយាយភាសាផ្សេងក្រៅពីភាសាអង់គ្លេស សេវាកម្មជំនួយផ្នែកភាសាមានផ្ដល់ជូនដោយឥតគិតថ្លៃ។ សូមចូលមើលគេហទំព័ររបស់យើងខ្ញុំ ឬហៅទៅកាន់លេខទូរស័ព្ទដែលមានរាយនៅក្នុងឯកសារនេះ។

SERBO-CROATIAN: Ako govorite neki jezik koji nije engleski, dostupne su besplatne jezičke usluge. Posetite našu internet stranicu ili nazovite broj telefona navedenog u ovom dokumentu.

DINKA: Na ye jam thuɔŋdɛ̈t tënë thoŋ ë Dïŋlïth, ke kuɔɔny luilooi ë thok ë path aa tɔ̈ thïn. Nem ɣöt tɛ̈n internet tɛ̈dë ke yï cɔl akuën cɔ̈tmec cï gat thin në athör du yic.

DUTCH: Als u een andere taal spreekt dan Engels, is er gratis taalondersteuning beschikbaar. Bezoek onze website of bel naar het telefoonnummer in dit document.

GREEK: Εάν ομιλείτε άλλη γλώσσα εκτός της Αγγλικής, υπάρχουν δωρεάν υπηρεσίες στη γλώσσα σας. Επισκεφθείτε την ιστοσελίδα μας ή καλέστε τον αριθμό τηλεφώνου που αναγράφεται στο παρόν έγγραφο.

GUJARATI: જો તમે અંગ્રેજી સિવાયની ભાષા બોલતા હો તો મફત ભાષાકીય સહાયતા સેવાઓ ઉપલબ્ધ છે. અમારી વેબસાઇટની મુલાકાત લો અથવા દસ્તાવેજમાં સૂચીબદ્ધ કરવામાં આવેલ ફોન નંબર પર કૉલ કરો.

HMONG: Yog hais tias koj hais ib hom lus uas tsis yog lus Askiv, muaj cov kev pab cuam txhais lus dawb pub rau koj. Mus saib peb lub website los yog hu rau tus xov tooj sau teev tseg nyob rau hauv daim ntawv no.

LAO: ຖ້າທ່ານເວົ້າພາສານອກເໜືອຈາກອັງກິດ, ການບໍຣິການ ຊ່ວຍເຫຼືອດ້ານພາສາໂດຍບໍ່ເສັຽຄ່າແມ່ນມີໃຫ້ທ່ານ. ໄປທີ່ເວັບໄຊທ໌ຂອງພວກເຮົາ ຫຼື ໂທຕາມເບີໂທລະສັບທີ່ລະບຸໃນເອກະສານນີ້.

NAVAJO: Bilagáana bizaad doo bee yáníłti’da dóó saad nááná ła’ bee yáníłti’go, ata’ hane’ t’áá jíík’e bee áká i’doolwołígíí hólǫ́. Béésh nitsékeesí bee na’ídíkid bá haz’ánígi ąą’ádíílííł éí doodago béésh bee hane’í bee nihich’į’ hodíílnih díí naaltsoos bikáá’íjį’.

PENNSYLVANIA DUTCH: Wann du en Schprooch anners as Englisch schwetzscht, Schprooch Helfe mitaus Koscht iss meeglich. Bsuch unsere Website odder ruf die Nummer uff des Document uff.

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.

PUNJABI: ਜੇ ਤੁਸੀਂ ਅੰਗ੍ਰੇਜ਼ੀ ਤੋਂ ਇਲਾਵਾ ਕੋਈ ਹੋਰ ਭਾਸ਼ਾ ਬੋਲਦੇ ਹੋ, ਤਾਂ ਮੁਫ਼ਤ ਭਾਸ਼ਾ ਸਬੰਧੀ ਸਹਾਇਤਾ ਸੇਵਾਵਾਂ ਉਪਲਬਧ ਹਨ। ਸਾਡੀ ਵੈੱਬਸਾਈਟ 'ਤੇਜਾਓ ਜਾਂ ਿੲਸ ਦਸਤਾਵੇਜ਼ ਵਿਚ ਦਿੱਤੇ ਨੰਬਰ 'ਤੇ ਕਾਲ ਕਰੋ।

ROMANIAN: Dacă vorbiți o altă limbă decât engleza, aveți la dispoziție servicii gratuite de asistență lingvistică. Vizitați site-ul nostru sau sunați la numărul de telefon specificat în acest document.

SYRIAC: ܐܸܢ ܐܲܚܬܘܿܢ ܟܹܐ ܗܲܡܙܡܝܼܬܘܿܢ ܠܸܫܵܢܵܐ ܐَܚܪܹܢܵܐ ܠܸܠ ܠܸܫܵܢܵܐ ܐܸܢܓܠܝܼܙܵܝܵܐ ، ܐܝܼܬܼ ܦܘܼܠܚܵܢܵܐ ܕܡܗܲܝܪܵܢܵܐ ܬܸܫܡܸܬܵܝܵܐ ܕܠܸܫܵܢܵܐ. ܣܲܚܒܪܘܿܢ ܠܫܘܿܦܵܐ ܐܸܠܟܬܪܘܿܢܵܝܵܐ ، ܝܲܢ ܡܵܨܝܼܬܘܿܢ ܩܵܪܝܼܬܘܿܢ ܥܲܠ ܪܲܩܡܵܐ ܕܝܼܠܗ ܕܪܝܵܐ ܓܵܘ ܐܵܗܵܐ ܟܬܼܝܼܒܼܬܵܐ

THAI: หากคุณพูดภาษาอื่นนอกเหนือจากภาษาอังกฤษ สามารถขอรับบริการช่วยเหลือด้านภาษาได้ฟรี เข้าไปที่เว็บไซต์ของเรา หรือโทรติดต่อหมายเลขโทรศัพท์ที่แสดงไว้ในเอกสารนี้

UKRAINIAN: Якщо ви не говорите англійською, до ваших послуг безкоштовна служба мовної підтримки. Відвідайте наш веб-сайт або зателефонуйте за номером телефону, що зазначений у цьому документі.

URDU: اگر آپ انگریزی کے علاوہ دوسری زبان بولتے ہیں تو، زبان سے متعلق مدد کی مفت خدمات دستیاب ہیں۔ ہماری ویب سائٹ ملاحظہ کریں یا اس دستاویز میں درج فون نمبر پر کال کریں۔

YIDDISH: אויב איר רעדט א שפראך אויסער ענגליש, זענען שפראך הילף סערוויסעס אוועילעבל. באזוכט אונזער וועבזייטל אדער רופט דעם טעלעפאן נומער וואס שטייט אויף דעם דאקומענט.