Benefits & services

We manage your covered benefits by:

  • Working with your doctor to decide what care is needed
  • Deciding what care is covered

A health plan doctor or provider must give most care. You will have your own personal doctor to call on.

Your health plan contracts with a select network of providers for your care. We check our doctors and hospitals often to make sure you get the care you deserve. There may be times when no network provider can give you the care you need. If this happens, you may need to go out of the network for the care. We must approve this first.

We only cover care or supplies that are medically needed by you. We decide medical need by looking at the accepted standards of care. We decide whether the care meets these standards.

Please read your member handbook. It gives more facts on your covered benefits.

  • Language translation services
  • Checkups for children
  • Visits to the doctor when you are sick
  • Hospital services
  • Emergency care
  • Laboratory services
  • Prescription drugs
  • Family planning services
  • X-ray/imaging
  • Mental health services
  • Routine eye exams and glasses for children
  • Routine eye exams for adults
  • Home health services
  • Rides to medical appointments (Medicaid/FAMIS Plus members only)
  • Maternity and high risk pregnancy care
  • Newborn care
  • Immunizations (shots) for children
  • Physical, occupational, and speech therapies
  • After hours medical advice line

Additional benefits and services available to our members:

  • Free cell phone with 350 free minutes per month and free unlimited text messaging, including free calls to Customer Service
  • Health management programs: asthma, coronary artery disease and congestive heart failure, diabetes, and COPD
  • High risk OB case management
  • Baby Matters prenatal program for all pregnant members and maternity incentive
  • Lactation classes and free breast pumps
  • Home visits to review benefits
  • Social worker to assist with member needs
  • Translation service for medical appointments
  • National pharmacy network
  • 24-hour Nurse Helpline
  • Discounts on eyewear: frames, lenses, and contacts for adults
  • Quarterly member newsletter
  • Access to a health risk assessment
  • Digital wellness programs, including stress, back pain, eating healthier and creating an exercise routine for your lifestyle
  • Access to urgent care centers

Effective April 1, 2017

Addiction and Recovery Treatment Services (ARTS)

Many people struggle with using substances at some time in their lives. There is good news though. Most people with a substance use disorder can benefit from treatment no matter how bad the problem may seem.

There are a range of treatments that your plan covers! Knowing your options can be critical to you. We are here to help you!

  • The first step is to talk with your primary care doctor. Ask for more details about treating
    substance or alcohol problems.
  • Treatment options are available. They range from outpatient to inpatient care. This includes
    Medication Assisted Treatment. This option is used if you struggle with the use of prescription
    drugs. Your doctor and/or health care team will work with you to find the best program for you.
  • Contact your Aetna Better Health of Virginia care manager. We will talk to you about the care
    options available to you. We have nurses available to you 24/7. Please call Member Services at
    1‐800‐279‐1878 (TTY/TDD 711 or 1‐800‐828‐1120). These calls are confidential.