Member Benefits
Understand your benefits
Coverage from head to toe
Looking to live a healthier life? Our benefits and programs are designed to help you do just that.
This coverage includes preventive services like doctor’s visits, lab testing, X-rays and more. Plus, we can help with serious health concerns. These may be chronic diseases or mental health issues. We also can connect you with resources in your community for extra help.
Look at this section closely so that you can better understand your plan. You’ll know what is covered, what is not, and how you can find the right care when you need it.
Summary of Benefits
Your Summary of Benefits and Coverage helps you understand how your health plan works. It provides details about the kind of care you can access, what services are covered and much more.
View your 2016 Summary of Benefits - English
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Dental
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Care for your teeth
As an adult, you only get one set of teeth. It’s important to take care of your teeth and gums. That means brushing and flossing daily and seeing a dentist two times a year. Preventive care can help make sure small problems don’t become big ones.
For a complete list of what’s included in your dental coverage, view your 2016 Summary of Benefits - English
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Behavioral health
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Your mental health is important
We believe in total health. And your mental health is as important as your physical health. If you suffer from mental illness, mood disorder, or alcohol or drug problems, you may need therapy or medicine. Behavioral health benefits cover these services.
Your plan covers many kinds of services for mental health. Below is a partial list of what is covered. For a more complete list, view your 2016 Summary of Benefits - English.
Medicine for mental health- Mental health assessments
- Counseling
- Group therapy
- 24-hour access to help for a crisis
- Partial hospitalization
- Alcohol and drug detoxification
- Community support
- Lab services for urine screens
- Methadone administration
If you are in crisis, we can help. Call Member Services at 1-866-600-2139 (toll-free), 24 hours a day, 7 days a week. TTY Relay Illinois 7-1-1.
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Vision
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See better with vision coverage
As you get older, you may notice changes in your eyes. Some of these changes are normal. Others are not. Preventive care is important at every age. Your vision coverage helps make sure that you get this care and that any problems are treated right away.
For a complete list of what’s included in your vision coverage, view your 2016 Summary of Benefits - English
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Non-emergency transportation
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No car? No bus line? No problem
Don’t let a lack of transportation keep you from getting the care you need. If you don’t have a way to get to your doctor, we may be able to help. Aetna Better Health Premier Plan can connect you with free transportation services. We can arrange a ride for you and one other person, such as a caregiver.
For more information, call Member Services at 1-866-600-2139 (toll-free), 24 hours a day, 7 days a week. TTY Relay Illinois 711.
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National Coverage Determination
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The Centers for Medicare & Medicaid Services (CMS) sometimes change the coverage rules that apply to an item or service covered under Medicare and through your health plan that provides Medicare benefits. When these rules are changed, CMS issues a National Coverage Determination (NCD) and we are required to notify you of this information.
NCDs tell us:
- What rule is changing
- If Medicare will pay for an item or service
- What item or service is covered