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What’s
covered?

This page has information about CHIP (Children Health Insurance Program) coverage. As a member, you’ll enjoy benefits and services to help you reach your health goals. Plus, it’s easy to choose us as your plan.

 

Choose your plan

Ready to enroll?

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. Here’s a list of your extra benefits (PDF).

Pregnancy and newborn care

Are you expecting a child? We’ll help you stay healthy during your pregnancy. And you can earn rewards when you make healthy choices while pregnant and after the baby is born.

Kids' health

As your child grows, we’ll reward you when you help them stay healthy. For example, you can earn money toward the cost of a health-related summer camp.

Teens’ and preteens’ health

Members between the ages of 12 and 18 can also earn rewards for healthy choices. Earn a $25 gift card for a teen or preteen’s yearly wellness visit and more.

Diabetes care

If you have diabetes, we’re here to help you take care of it. You can also earn rewards when you take steps to manage your diabetes. For example, you can get a $25 gift card for completing an eye exam.

Benefits in your plan

Benefits in your plan

Learn about all your plan benefits, from vision and dental care to maternity care. You can learn more about all these topics in your member handbook (PDF).

 

Fee-For-Service benefits

 

Some benefits, like nursing facilities or organ transplant, are covered by Medicaid, not Aetna Better Health. Those are called Fee-For-Service benefits. You can find a list of them in your member handbook.

 

Copays

 

Members may have copays for some services. There are three groups in the CHIP plan, and each has a different copay amount. But there are no copays for maternity services for pregnant women over age 19. You can check your member handbook for more details. Questions? Just call us at 1-888-348-2922 (TTY: 711). We’re here for you 24 hours a day, 7 days a week.

 

Referrals

 

You don’t need a referral from your primary care provider (PCP) to see another in-network doctor. Just be sure to tell your PCP if you plan to see another doctor. That way they can coordinate your care. 

 

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.

 

You can also get a wide range of preventive care and vaccines. Start by finding a provider today. 

 

Find a provider

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.

 

Check your member ID card from your dental plan. Then, call your plan for answers to questions about care and coverage.

 

Learn more about dental benefits

Routine eye exams are an easy way to keep your eyes healthy. We work with VSP® Vision Care to offer you covered services like:

 

  • Eye exams, lenses, frames and needed repairs for children under 21
  • Contact lenses for adults and children with certain conditions
  • Treatment and one pair of glasses after cataract surgery

 

You don’t need a referral to see a provider in the network. Just be sure to show your member ID card at every appointment. To learn more, contact VSP Vision Care at 1-800-877-7195.

 

To find a vision provider, visit the VSP website.

We help you manage drugs you get while at your doctor’s office, in the hospital or at an infusion center. We do not handle the drugs your doctor prescribes that you pick up at a pharmacy. Gainwell Technologies, your pharmacy benefits manager (PBM), handles those.

 

Learn more about pharmacy benefits

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:

 

Learn about mental and behavioral health care

We can help you and your baby be as healthy as possible. When you take part in our Healthy Pregnancies and Healthy Babies program, here are some benefits you’ll enjoy:

 

  • Healthy pregnancy and baby care tips
  • Rewards you can earn
  • Help from a case manager if you have a high-risk pregnancy
  • Support from local programs and resources

 

Learn more about pregnancy care

We’ll help you get birth control counseling and supplies. You can see any in-network or out-of-network provider. Any family planning care that you get is private. You can call us at 1-888-348-2922 (TTY: 711) to choose a family planning provider. Or you can read more about family planning.

With EPSDT, kids under 19 can get full preventive health care services at no cost. This includes health and wellness visits, like:

 

  • Annual checkups
  • Dentist visits
  • Eye doctor visits

 

Why do these visits matter? They can help doctors treat symptoms before they get worse. And in some cases, they can help prevent health issues before they start.

 

Have questions? Just call us at 1-888-348-2922 (TTY: 711).

 

More about EPSDT

Do you need help getting care? Our care management team is here for you. 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. 

 

Learn more about care management

 

Chronic disease management

 

Some health issues need more care. Our case managers can help you manage chronic conditions like asthma, diabetes, chronic obstructive pulmonary disease (COPD) and more.  

 

Learn more about chronic disease management

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.

 

To reach the 24-Hour Nurse Line, just call 1-855-200-5975 (TTY: 711).  

You can get a smartphone with an Android™ platform and Assurance Wireless Lifeline cell service at no extra cost to you. If you already have Lifeline, you can switch to Assurance Wireless. You’ll get:

 

  • A smartphone with an Android platform
  • Data each month
  • Unlimited texts
  • Voice minutes each month
  • Health tips and reminders by text
  • One-on-one texting with your health care team
  • Calls to Member Services that won’t count against your monthly minutes


Apply for your smartphone

 

Special programs

 

These programs can help you live life as healthy as you can. We have special programs and services to help you get the care you need. And prevent health issues in the future.

 

Learn more about special programs

Other language and format needs

 

Need language help? Just call us at 1-888-348-2922 (TTY: 711). We’re here for you ${member_services_hours}. 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 audio CD-ROM, large print and braille
  • Materials in other languages if your primary language isn’t English

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