Handbook

Your member handbook contains information to help you get the care and services you need. Questions? Just call Member Services at 1-800-279-1878 (TTY: 711) 24 hours a day, 7 days a week

 This handbook is to be used by Medallion 4.0 and FAMIS members.

New health insurance coverage for adults

Welcome to Aetna Better Health of Virginia. If you’re one of the many new Virginians enrolled in our health plan as part of Medicaid Expansion, we have some important information for you. Let’s get started.

What Makes You Eligible to be a Medicaid Expansion Member

You are eligible for Medicaid Expansion if you are 19 years of age to 64 years of age and you meet all of the following categories: 

  • You are not already eligible for Medicare coverage, 
  • You are not already eligible for Medicaid coverage through a mandatory coverage group (you are pregnant or disabled, for example) 
  • Your income does not exceed 138% of the Federal Poverty Level (FPL)

Medicaid eligibility is determined by your local Department of Social Services (DSS) or the Cover Virginia Central Processing Unit. Contact your local DSS eligibility worker or call Cover Virginia at 1-855-242-8282 (TDD: 1-888-221-1590) with any Medicaid eligibility questions. The call is free. For more information, you can visit Cover Virginia’s website at http://www.coverva.org.

Enrollment for a Medicaid Expansion Member

You can change your health plan during the first 90 days of your Medallion program enrollment for any reason. You can also change your health plan during your annual open enrollment period for any reason. You may contact the Managed Care Helpline at 1-800-643-2273 (TTY: 1-800-817-6608) or visit www.virginiamanagedcare.com to find out the open enrollment period for your region. You will get a letter from DMAS during the open enrollment period with more information.

Medicaid Expansion Benefits and Services

As a Medicaid Expansion member, you have a variety of health care benefits and services available to you. You will receive most of your services through Aetna Better Health.

If you are an eligible Medicaid Expansion member, in addition to the standard Medicaid services available to all Medicaid members, you will also receive the following four health benefits: 

  • Annual adult wellness exams 
  • Individual and group smoking cessation counseling 
  • Nutritional counseling if you are diagnosed with obesity or chronic medical diseases
  • Recommended adult vaccines or immunizations Aetna Better Health® of Virginia 9881 Mayland Drive Richmond, VA 23233

Aetna Better Health will also encourage you to take an active role in your health. This may mean taking part in disease management programs, getting a flu shot, quitting smoking or using tobacco/nicotine products, or accessing services that are not typically covered by traditional medical practices like gym memberships or vision services.

If you frequently visit the emergency room, we will reach out to you to help you address your needs. There may be opportunities to address your needs outside of the emergency room, like in physician offices and clinics.

Aetna Better Health may also discuss several opportunities with you to help you take advantage of job training, education, and job placement assistance to help you find the work situation that is right for you.

What is a Health Screening?

Within four months after you enroll with us, an Aetna Better Health representative will contact you or your authorized representative via telephone or in person to ask some questions about your health needs and social circumstances. These questions will make up what is called the “Health Screening.” The representative will ask about any medical conditions you currently have or have had in the past, your ability to do everyday things, and your living conditions.

Your answers will help Aetna Better Health understand your needs and identify whether or not you have medically complex needs.

If you meet the medically complex criteria, you will transfer from the Medicaid Managed Care Medallion 4.0 program to the CCC Plus program. If it is determined you do not have medically complex needs, you will remain in the Medallion 4.0 program. Also, if we are unable to contact you, or you refuse to participate in the entire health screening, you will remain enrolled in the Medallion program. You will stay with Aetna Better Health no matter which program you are in. If you prefer to change health plans, you can change within the first 90 days of enrolling into the Medallion 4.0 program.

If you do not meet medically complex criteria and do not agree, you have a right to submit a complaint or grievance to us. See the Your Right to File a Complaint (Grievance) section for details.

Please contact Aetna Better Health if you need accommodations to participate in the health screening. If you have questions about the health screening, please contact Member Services at 1-800-279-1878 (TTY: 711). This call is free.

Translation services and alternative formats

This handbook is available for free in other languages and formats including online, large print, braille or audio CD. To request this handbook in an alternate format and/or language, contact Member Services at 1‑800‑279‑1878 (TTY: 711). Alternate formats will be provided within 5 business days.

Learn more about our multi-language translation and interpreter services available to members.