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The Aetna Better Health® difference
You deserve to be as healthy as you can be. That’s why we offer unique benefits that take care of the whole you. We have experience you can count on — with a range of services to help you on your health journey. We’ve added some benefits that go beyond your standard health coverage.
Rides to see a specialist or dentist
Do you need to see a specialist or dentist but can’t find one nearby? We’ll cover a ride for you and a relative to see one if:
The provider is between 40 and 70 miles from your home
No similar providers are located closer to your home
You get prior authorization
You limit your rides to 4 round trips per year
Healthy behaviors and rewards
Did you know that you can get rewards for taking care of your health? Take part in one or more of our healthy behaviors programs, and you can earn gift cards and more. We’ll show you how it works.
Benefits in your plan
Benefits in your plan
Learn about all your plan benefits, from well-child visits and vaccines to behavioral health care and prescription medications. You can learn more about all these topics in your member handbook English (PDF) | Spanish (PDF).
To manage your covered benefits, we:
Work with your doctor to decide what care you need
Decide what care is covered
We contract with a select network of providers. We check these doctors and hospitals often to make sure you get the care you need. There may be times when no network provider can give you the care you need. In this case, you can see an out-of-network provider if we approve it first.
A copay is a set amount you pay for a certain service. But many of our services, including preventive care, don’t have a copay. These are services like well-child visits and routine vision and hearing exams. There also is no copay for behavioral health or substance use disorder treatment. You may have a small copay for other services. For example, you’ll have a $5 copay if you see a doctor for a minor accident or illness.
Your yearly copays won’t total more than 5% of your family’s gross yearly income. For some members, this total may also include your monthly premium payments. You can check your member handbook for details.
Approval for services
Some services need approval, or prior authorization (PA), before you get them. We base all our decisions on whether the service is:
- Needed for your health
- Likely to help you
You can learn more about PA. Just visit our PA page.
We take care of the whole you. That means you’re covered if you need to see a specialist or have an emergency. Preventive care and vaccines are covered. Unlimited visits to doctors in our network are also covered.
A healthy smile goes a long way. Dental care is part of your overall health. That’s why you should see your dentist every six months.
Your dental services are covered by a separate dental company, not by Aetna Better Health. For more info on what’s covered, you can call Florida Healthy Kids at 1-888-540-KIDS (5437), Monday through Friday, 7:30 AM to 7:30 PM ET.
Routine eye exams are an easy way to keep your eyes healthy. You should get an eye exam at least once a year.
Vision services are handled by iCare Health Solutions. If you fail a vision test done by your primary care provider (PCP), you’re covered to see an optometrist in the network. They can decide if you need glasses or contact lenses.
To find a vision provider, you can call Member Services at 1-844-528-5815 (TTY: 711). Or you can find a vision provider with our provider search tool. Just search under "Find a specialty” for an optometrist or ophthalmologist.
We make it easy to get the medications you need to feel better. You may have a copay for those on the state’s preferred drug list (PDL). A PDL is a list of covered medications. If you don’t see your medication on the list, ask your provider to find one that’s similar. And you can fill your prescription at any pharmacy in our network.
You deserve to be healthy in body and mind. Your plan covers health for you as a whole person. That includes help with your mental health or substance use. You or your child can go to any behavioral health provider in our network.
Help in a crisis
Call 911 or go to the nearest hospital if:
- You have thoughts of harming yourself or someone else
- You have an emergency and need help right now
You can use any hospital for emergency care, even if it isn’t in our network. Just show your member ID card.
You can also call:
Us at 1-844-528-5815 (TTY: 711). Choose the crisis line option. We’re here for you 24 hours a day, 7 days a week.
We’ll help you get birth control counseling and supplies. You can see any in-network or out-of-network provider. And you don’t need prior authorization. Any family planning care that you get is private.
Covered services include:
- Birth control medication and supplies
- Classes and educational info
- Diagnostic procedures
Stopping nicotine use is hard, whether you smoke, chew, vape or use another way. Most people need help to quit, and we’re here for you. You can join our tobacco cessation healthy behaviors program. You can earn rewards as part of the program. For example, you can earn a $20 gift card for reaching certain goals.
Do you need help getting care? Our care management team is here for you. You’ll get a case manager as part of our care management program. Case managers are nurses and social workers who understand your health conditions and help connect you to the right care. A case manager can help you learn more about your health, find a ride to your appointments and more.
Some health issues need more care. Our care managers can help you manage complex conditions like asthma, diabetes, chronic obstructive pulmonary disease (COPD) and more.
If it’s late at night or you can’t reach your PCP, you’re not alone. You can speak with a nurse about your health care questions 24 hours a day, 7 days a week. Not sure if you should find urgent care or go to the emergency room? The Nurse Line can help. It doesn’t take the place of your PCP, so be sure to follow up later.
Just call Member Services at 1-844-528-5815 (TTY: 711). Then, choose the option for the Nurse Line.
Other language and format needs
Need language help? Just call us at 1-844-528-5815 (TTY: 711). We’re here for you Monday through Friday from 7:30 AM to 7:30 PM ET. You can get:
- Interpreter services at no cost during any service or complaint process, including American Sign Language and real-time oral interpretation
- Interpreter services for your medical visit (be sure to call 48 hours before your visit)
- Info in another format, like large print and braille
- Materials in other languages if your primary language isn’t English
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