Aetna Advantage Plans for Individuals, Families and Sole Proprietors

Transcription

1 Aeta Advatage Plas for Idividuals, Families ad Sole Proprietors Health Coverage For You ad Your Family Arizoa AZ (4/06)

2 Aeta Advatage Plas for Idividuals, Families ad Sole Proprietors Icludig 2 HSA Compatible Plas QUESTIONS? Please us at MyHealthAZ@Aeta.com or call MY-HEALTH ( ) for more iformatio. Aeta is the brad ame used for products ad services provided by oe or more of the Aeta group of subsidiary compaies. The PPO product is uderwritte by Aeta Life Isurace Compay, Ic. through a out-of-state blaket trust.

3 Why Choose Aeta? Ejoy the Advatages of the Aeta Plas for Idividuals ad Families: Established Aeta offers experiece ad stability with isurace products A strog fiacial positio A history of coverig promiet compaies Customer Service Aeta provides a customer support system, icludig: Skilled ad well-traied service represetatives Iformed Health Lie *: members ca get the aswers to health questios aytime day or ight. The 24 hour toll-free Iformed Health Lie is a team of registered urses who ca provide iformatio o a variety of health issues. Iformed Health Lie urses ca oly provide basic medical iformatio; they ca ot diagose, prescribe or give medical advice. Specific questios should be addressed by a doctor. Aeta Voice Advatage system to check claims, chage doctors ad order ID cards. Plus, accurate ad efficiet claims processig ad a hassle-free reewal process. Specialty Programs Alterative Health Care Programs Offers reduced rates o alterative therapies for members, icludig visits to chiropractors, acupucturists, utritioal couselors ad massage therapists. Plus, members ca save o over-the-couter vitamis ad utritioal supplemets through the Vitami Advatage TM Program. Visio Oe Discout Program** Offerig special member discouts o eye care products ad services at participatig optical ceters. Members also ca receive up to 15 percet savigs o LASIK visio correctio ad cotact les replacemets. Fitess Program*** Provides special membership rates at participatig health clubs cotracted with Global Fit ad discouts o certai equipmet. Plus, members may eve try out the facility before joiig. Natioal Medical Excellece Program Helps coordiate covered beefits ad provides access to covered treatmet for trasplats ad trasplat-related services through the Istitute of Excellece etwork. *Iformed Health Lie urses ca oly provide basic medical resource iformatio. They caot diagose, prescribe or give medical advice. Members should cotact their physicias first with ay questios or cocers regardig their health care eeds. **Visio Oe is a registered trademark of Cole Maaged Visio. ***Availability varies by site. ****Based upo Treasury guidace available as of the prit date. Choice Choose from our medical plas, icludig 2 HSA compatible plas.**** Participatig provider etwork offerig a wide selectio of physicias ad hospitals. Affordability Affordable premiums! Coverage for a wide variety of services. Coverage for depedets livig away from home. Simplicity Aeta Navigator ( ad select Aeta Navigator) allows you to order ID cards olie, iquiries to Member Services, ad access a vast amout of health iformatio. DocFid ( ad select Aeta Advatage) allows you to search olie for physicias, hospitals, pharmacies ad eyewear providers i your area. Aeta IteliHealth SM ( our awardwiig health iformatio site for health, welless ad disease-specific iformatio. Service First Claim ad First Call Resolutio for accurate admiistratio ad paymet of claims. Do t have access to the Iteret? Call MY-HEALTH ( ) for assistace i locatig a provider. 1

4 New! Aeta Advatage PPO Plas ad High Deductible HSA Compatible Plas Welcome to the Aeta Advatage Product Overview We are committed to puttig you at the ceter of everythig we do. Our cosumer-friedly health care coverage ad related programs are desiged to give you the tools ad iformatio you eed to lead a healthier life. NEW! Aeta Advatage PPO Plas effective 8/1/04 The Aeta Advatage PPO Pla offers members the freedom to go directly to ay recogized provider for covered expeses, icludig specialists. If members choose a provider from Aeta s etwork of participatig physicias ad hospitals, out-of-pocket costs will be lower. No referrals are required. Worldwide emergecy care coverage. Extesive provider etwork with atioal reciprocity. No claim forms i-etwork. First dollar coverage ad o deductible for geeric prescriptios. Urget care beefits. Chiropractic beefits icluded. First dollar coverage ad o deductible for i-etwork physicia office visits. NEW! Aeta High-Deductible HSA Compatible Plas effective 9/1/04 Whe you eroll i oe of Aeta s high-deductible PPO plas, you ca take advatage of a flexible health beefits pla tied to a Health Savigs Accout (HSA). HSA s are tax-advataged* accouts created for the purpose of payig for qualified out-of-pocket medical expeses. For example: Tax advatages HSA cotributios made by you are tax-free ad ear iterest tax-free. Cotributios ca be made i a lump sum amout ad your withdrawals to pay for qualified health care expeses are tax free too! Owership fuds i your HSA roll over from year to year ad are yours to keep, eve if you chage health plas, jobs, or are self-employed. A opportuity to save for future medical, COBRA, certai log-term care isurace expeses. *Members should cosult with their tax advisors to determie eligibility requiremets, cotributio limits, ad tax advatages for participatig i the HSA pla. 2

5 Aeta s Idividual Purchaser Solutio aother reaso to select oe of Aeta Advatage Idividual PPO plas! We have built a website that will make it easier for you to eroll i a Aeta health pla. It s fast, it s easy, ad it s coveiet! All you have to do is click o Get A Quote to review all the Aeta Advatage Plas available i your area. We offer a variety of plas for idividual, families ad sole proprietors*. You ca view the pla beefits, request a quote ad receive rates, as well as dowload the Aeta Advatage Erollmet Form. If you choose to apply for a Aeta Advatage Pla, you will also be able to track your erollmet status o-lie. Gettig a quick quote is as easy as ) Log o to: members/idividual.html 2) Oce o the page, click your state, ad the click Get a Quick Quote Now o the subsequet page. (see scree shot to your left). 3) You the be i the ew Idividual Purchaser Solutio system *I some states Sole Proprietors ca be eligible for Small Group healthcare plas. 3

6 Aeta Advatage Pla Service Areas for Arizoa Use DocFid ( to search olie for physicias, hospitals, pharmacies, ad eyewear providers i your area. Cocoio Apache Mohave Navajo Yavapai La Paz Maricopa Gila Greelee Yuma Pial Graham Pima Cochise Sata Cruz PPO Plas available i these couties oly. 4

7 ARIZONA AETNA ADVANTAGE PLAN OPTIONS PPO 500 MEMBER BENEFITS Deductible Idividual/Family Coisurace Out-of-Pocket Maximum Idividual/Family Lifetime Maximum* No-specialist Office Visit (Geeral Physicia, Family Practitioer, Pediatricia or Iterist) Specialist Visit** Hospital Admissio** Outpatiet Surgery Emergecy Room Aual Routie Gy Exam (Aual Pap/Mammogram) Prevetive Health (Aual Physical) ($200 per caledar year*) Lab/X-Ray Skilled Nursig (i lieu of hospital) (30 days per caledar year*) Physical/Occupatioal Therapy ad Chiropractic Care (24 visits per caledar year*) Home Health Care (30 visits per caledar year*) Durable Medical Equipmet ($2,000 per caledar year*) Urget Care PHARMACY Caledar Year Deductible per Idividual Geeric (Cotraceptives Icluded) Preferred Brad/No-Preferred Brad (Cotraceptives Icluded) Caledar Year Maximum per Idividual* I-Network $500/$1,000 $2,000/$4,000 $5,000,000 per isured $20 Copay $35 Copay $100 Copay (waived if admitted) $35 Copay $20 Copay (Aeta will pay a maximum of $25 per visit) $50 Copay $250 (does ot apply to geeric) $15 Copay $25/$40 Copay after deductible $5,000 Out-of-Network + $1,000/$2,000 $2,500/$5,000 $5,000,000 per isured $100 Copay (waived if admitted) (Aeta will pay a maximum of $25 per visit) $250 (does ot apply to geeric) $15 Copay plus 50% $25/$40 Copay plus $5,000 *Maximum applies to combied i ad out of etwork beefits **Materity ad pregacy related expeses are ot covered. + Paymet for out-of-etwork facility care is determied based upo Aeta s Allowable Fee Schedule. Paymet for other out-of etwork care is determied based upo the egotiated charge that would apply if such services or supplies were received from a Preferred Provider. For a full list of beefit coverage ad exclusios refer to the pla documets. 5

8 ARIZONA AETNA ADVANTAGE PLAN OPTIONS PPO 1500 MEMBER BENEFITS I-Network Out-of-Network + Deductible Idividual/Family $1,500/$3,000 $3,000/$6,000 Coisurace Out-of-Pocket Maximum Idividual/Family $3,000/$6,000 $4,500/$9,000 Lifetime Maximum* $5,000,000 per isured $5,000,000 per isured No-specialist Office Visit (Geeral Physicia, Family Practitioer, Pediatricia or Iterist) $20 Copay Specialist Visit** $35 Copay Hospital Admissio** Outpatiet Surgery Emergecy Room $100 Copay (waived if admitted) $100 Copay (waived if admitted) Aual Routie Gy Exam (Aual Pap/Mammogram) $35 Copay Prevetive Health (Aual Physical) $20 Copay ($200 per caledar year*) Lab/X-Ray Skilled Nursig (i lieu of hospital) (30 days per caledar year*) Physical/Occupatioal Therapy ad Chiropractic Care (Aeta will pay a maximum of (Aeta will pay a maximum of (24 visits per caledar year*) $25 per visit) $25 per visit) Home Health Care (30 visits per caledar year*) Durable Medical Equipmet ($2,000 per caledar year*) Urget Care $50 Copay PHARMACY Caledar Year Deductible $250 $250 per Idividual (does ot apply to geeric) (does ot apply to geeric) Geeric $15 Copay $15 Copay plus 50% (Cotraceptives Icluded) Preferred Brad/No-Preferred Brad $25/$40 Copay $25/$40 Copay plus (Cotraceptives Icluded) after deductible Caledar Year Maximum per Idividual* $5,000 $5,000 *Maximum applies to combied i ad out of etwork beefits **Materity ad pregacy related expeses are ot covered. + Paymet for out-of-etwork facility care is determied based upo Aeta s Allowable Fee Schedule. Paymet for other out-of etwork care is determied based upo the egotiated charge that would apply if such services or supplies were received from a Preferred Provider. For a full list of beefit coverage ad exclusios refer to the pla documets. 6

9 ARIZONA AETNA ADVANTAGE PLAN OPTIONS PPO 2500 MEMBER BENEFITS I-Network Out-of-Network + Deductible Idividual/Family $2,500/$5,000 $5,000/$10,000 Coisurace Out-of-Pocket Maximum Idividual/Family $5,000/$10,000 $7,500/$15,000 Lifetime Maximum* $5,000,000 per isured $5,000,000 per isured No-specialist Office Visit (Geeral Physicia, Family Practitioer, Pediatricia or Iterist) $25 Copay Specialist Visit** $40 Copay Hospital Admissio** Outpatiet Surgery Emergecy Room $100 Copay (waived if admitted) $100 Copay (waived if admitted) Aual Routie Gy Exam (Aual Pap/Mammogram) $40 Copay Prevetive Health (Aual Physical) $25 Copay ($200 per caledar year*) Lab/X-Ray Skilled Nursig (i lieu of hospital) (30 days per caledar year*) Physical/Occupatioal Therapy ad Chiropractic Care (Aeta will pay a maximum of (Aeta will pay a maximum of (24 visits per caledar year*) $25 per visit) $25 per visit) Home Health Care (30 visits per caledar year*) Durable Medical Equipmet ($2,000 per caledar year*) Urget Care $50 Copay PHARMACY Caledar Year Deductible $500 $500 per Idividual (does ot apply to geeric) (does ot apply to geeric) Geeric $15 Copay $15 Copay plus 50% (Cotraceptives Icluded) Preferred Brad/No-Preferred Brad $25/$40 Copay $25/$40 Copay plus (Cotraceptives Icluded) after deductible Caledar Year Maximum per Idividual* $5,000 $5,000 *Maximum applies to combied i ad out of etwork beefits **Materity ad pregacy related expeses are ot covered. + Paymet for out-of-etwork facility care is determied based upo Aeta s Allowable Fee Schedule. Paymet for other out-of etwork care is determied based upo the egotiated charge that would apply if such services or supplies were received from a Preferred Provider. For a full list of beefit coverage ad exclusios refer to the pla documets. 7

10 ARIZONA AETNA ADVANTAGE PLAN OPTIONS PPO 5000 MEMBER BENEFITS I-Network Out-of-Network + Deductible Idividual/Family $5,000/$10,000 $10,000/$20,000 Coisurace Out-of-Pocket Maximum Idividual/Family $7,500/$15,000 $12,500/$25,000 Lifetime Maximum* $5,000,000 per isured $5,000,000 per isured No-specialist Office Visit (Geeral Physicia, Family Practitioer, Pediatricia or Iterist) $25 Copay Specialist Visit** $40 Copay Hospital Admissio** Outpatiet Surgery Emergecy Room $100 Copay (waived if admitted) $100 Copay (waived if admitted) Aual Routie Gy Exam (Aual Pap/Mammogram) $40 Copay Prevetive Health (Aual Physical) $25 Copay ($200 per caledar year*) Lab/X-Ray Skilled Nursig (i lieu of hospital) (30 days per caledar year*) Physical/Occupatioal Therapy ad Chiropractic Care (Aeta will pay a maximum of (Aeta will pay a maximum of (24 visits per caledar year*) $25 per visit) $25 per visit) Home Health Care (30 visits per caledar year*) Durable Medical Equipmet ($2,000 per caledar year*) Urget Care $50 Copay PHARMACY Caledar Year Deductible $500 $500 per Idividual (does ot apply to geeric) (does ot apply to geeric) Geeric $15 Copay $15 Copay plus 50% (Cotraceptives Icluded) Preferred Brad/No-Preferred Brad $25/$40 Copay $25/$40 Copay plus (Cotraceptives Icluded) after deductible Caledar Year Maximum per Idividual* $5,000 $5,000 *Maximum applies to combied i ad out of etwork beefits **Materity ad pregacy related expeses are ot covered. + Paymet for out-of-etwork facility care is determied based upo Aeta s Allowable Fee Schedule. Paymet for other out-of etwork care is determied based upo the egotiated charge that would apply if such services or supplies were received from a Preferred Provider. For a full list of beefit coverage ad exclusios refer to the pla documets. 8

11 ARIZONA AETNA ADVANTAGE PLAN OPTIONS HIGH DEDUCTIBLE PPO 1 (HSA COMPATIBLE) MEMBER BENEFITS I-Network Out-of-Network+ Deductible Idividual/Family $2,750 Id/$5,500 Family $5,500 Id/$11,000 Family Coisurace 20% 50% Out-of-Pocket Maximum Idividual/Family $5,000 Id/$10,000 Family $10,000 Id/$20,000 Family Lifetime Maximum $5,000,000 per member lifetime No-specialist Office Visit (Geeral Physicia, Family Practitioer, Pediatricia or Iterist) 20% 50% Specialist Visit** 20% 50% Hospital Admissio** 20% 50% Outpatiet Surgery 20% 50% Emergecy Room 20% after $100 copay 50% after $100 copay Waived if admitted Waived if admitted Aual Routie Ob/Gy Exam 0% (Aual Pap/Mammogram) Not Subject to deductible 50% Prevetive Health (Aual Physical) $20 copay ($200 per caledar year*) Not Subject to deductible 50% Lab/X-Ray 20% 50% Skilled Nursig (i lieu of hospital (30 days per caledar year*) 20% 50% Physical/Occupatioal Therapy Chiropractic Care 20% 50% (24 visits per caledar year*) (Aeta will pay a maximum of $25 per visit.) (Aeta will pay a maximum of $25 per visit.) Home Health (30 visits per caledar year*) 20% 50% Durable Medical Equipmet ($2,000 per caledar year*) 20% 50% Urget Care 20% 50% PHARMACY Caledar Year Deductible Itegrated Medical/RX deductible Itegrated Medical/RX deductible per Idividual Geeric (Cotraceptives Icluded) $15 copay $15 copay plus 50% Preferred Brad/No-Preferred Brad (Cotraceptives Icluded) $25/$40 copay $25/$40 copay plus 50% Caledar Year Maximum per Idividual* $5,000 $5,000 *Maximum applies to combied i ad out of etwork beefits **Materity ad pregacy related expeses are ot covered. Note: Paymet for out-of-etwork facility care is determied based upo Aeta s Allowable Fee Schedule. Paymet for other out-of etwork care is determied based upo the egotiated charge that would apply if such services or supplies were received from a Preferred Provider. For a full list of beefit coverage ad exclusios refer to the pla documets. 9

12 ARIZONA AETNA ADVANTAGE PLAN OPTIONS HIGH DEDUCTIBLE HIGH DEDUCTIBLE PPO 2 (HSA COMPATIBLE) MEMBER BENEFITS I-Network Out-of-Network + Deductible Idividual/Family $5,000 Id/$10,000 Family $10,000 Id/$20,000 Family Coisurace 0% 50% Out-of-Pocket Maximum Idividual/Family $5,000 Id/$10,000 Family $10,000 Id/$20,000 Family Lifetime Maximum* $5,000,000 per member lifetime No-specialist Office Visit (Geeral Physicia, Family Practitioer, Pediatricia or Iterist) 0% 50% Specialist Visit** 0% 50% Hospital Admissio** 0% 50% Outpatiet Surgery 0% 50% Emergecy Room 0% 50% after $100 copay Waived if admitted Aual Routie Ob/Gy Exam 0% (Aual Pap/Mammogram) Not Subject to deductible 50% Prevetive Health (Aual Physical) $25 copay ($200 per caledar year*) Not Subject to deductible 50% Lab/X-Ray 0% 50% Skilled Nursig (i lieu of hospital (30 days per caledar year*) 0% 50% Physical/Occupatioal Therapy Chiropractic Care 0% 50% (24 visits per caledar year*) (Aeta will pay a maximum of $25 per visit.) (Aeta will pay a maximum of $25 per visit.) Home Health (30 visits per caledar year*) 0% 50% Durable Medical Equipmet ($2,000 per caledar year*) 0% 50% Urget Care 0% 50% PHARMACY Caledar Year Deductible Itegrated Medical/RX deductible Itegrated Medical/RX deductible per Idividual Geeric (Cotraceptives Icluded) 0% $15 copay plus 50% Preferred Brad/No-Preferred Brad (Cotraceptives Icluded) 0% $25/$40 copay plus 50% Caledar Year Maximum per Idividual* $5,000 $5,000 *Maximum applies to combied i ad out of etwork beefits **Materity ad pregacy related expeses are ot covered. Note: Paymet for out-of-etwork facility care is determied based upo Aeta s Allowable Fee Schedule. Paymet for other out-of etwork care is determied based upo the egotiated charge that would apply if such services or supplies were received from a Preferred Provider. For a full list of beefit coverage ad exclusios refer to the pla documets. 10

13 Aeta Advatage Pla Erollmet Guidelies To qualify for erollmet you must be: Uder age 64 3/4 (applicat ad erollig spouse). Uder age 19 (depedet childre of the subscriber or erollig spouse). Betwee the ages of 19 ad 23 (umarried depedet childre with proof of full-time studet status). Legal residets withi the state ad Aeta Advatage Pla Service Area. Legal U.S. residet for at least 6 cotiuous moths. Medical Uderwritig Requiremets The Aeta Advatage Plas are ot guarateed issue plas ad require medical uderwritig. Some idividuals ca be federally eligible uder the Health Isurace Portability ad Accoutability Act (HIPAA) for a guarateed issued idividual pla. All applicats, erollig spouses ad depedets are subject to medical uderwritig to determie eligibility ad appropriate level of coverage. Aeta offers various levels of coverage based o the kow ad predicted medical risk factors of each applicat. A member with miimal health risks should ot be required to subsidize the cost of coverig a member predicted to require costly care. Levels of Coverage ad Erollmet You may be erolled i your selected pla at the stadard premium charge. You may be erolled i your selected pla at a higher rate, based o medical fidigs. You may be declied coverage based o sigificat medical risk factors. Duplicate Coverage Applicats who are curretly covered by aother carrier must agree to discotiue the other coverage prior to or o the effective date of the Aeta Advatage Pla. Pre-existig Coditios Durig the first twelve moths followig a member s effective date of coverage, o coverage will be provided for the treatmet of pre-existig coditios uless the idividual has a Creditable Coverage HIPAA certificate i which case o pre-existig coditio limitatio will apply. A pre-existig coditio is a illess or ijury for which medical advice or treatmet was recommeded or received withi six moths precedig the effective date of coverage. Terms of Coverage Coverage remais i effect as log as the required premium charges are paid o time ad as log as you maitai membership eligibility. Coverage will be termiated if you become ieligible due to: 1. No-paymet of premiums 2. Residecy requiremets 3. Obtaiig duplicate coverage 4. No loger meetig the defiitio of a eligible depedet. 11

14 Medical Limitatios ad Exclusios These medical plas do ot cover all health care expeses ad iclude exclusios ad limitatios. Members should refer to their pla documets to determie which health care services are covered ad to what extet. The followig is a partial list of services ad supplies that are geerally ot covered. However, your pla documets may cotai exceptios to this list based o state madates or the pla desig or rider(s) purchased. Services ad supplies that are geerally ot covered iclude, but are ot limited to: All medical ad hospital services ot specifically covered i, or which are limited or excluded by your pla documets, icludig costs of services before coverage begis ad after coverage termiates. Cosmetic surgery. Custodial care. Door egg retrieval. Weight cotrol services icludig surgical procedures for the treatmet of obesity, medical treatmet, ad weight cotrol/loss programs. Experimetal ad ivestigatioal procedures, (except for coverage for medically ecessary routie patiet care costs for Members participatig i a cacer cliical trial). Medical expeses for a pre-existig coditio are ot covered (full postpoemet rule) for the first 365 days after the member s effective date. Lookback period for determiig a pre-existig coditio (coditios for which diagosis, care or treatmet was recommeded or received) is 180 days prior to the effective date. The pre-existig coditio limitatio period will be reduced by the umber of days of prior creditable coverage the member has as of the effective date. Nomedically ecessary services or supplies. Orthotics. Over-the-couter medicatios ad supplies. Radial keratotomy or related procedures. 12 Charges i coectio with pregacy care other tha for pregacy complicatios. Immuizatios for travel or work. Implatable drugs ad certai ijectable drugs icludig ijectable ifertility drugs. Ifertility services icludig artificial isemiatio ad advaced reproductive techologies such as IVF, ZIFT, GIFT, ICSI ad other related services uless specifically listed as covered i your pla documets. Reversal of sterilizatio. Services for the treatmet of sexual dysfuctio or iadequacies icludig therapy, supplies or couselig. Special duty ursig. Therapy or rehabilitatio other tha those listed as covered i the pla documets. Metal health i-etwork services for PPO plas ot covered, except for severe biologically based metal or ervous disorders. Not covered out-of-etwork.

15 10-day Right to Review Do ot cacel your curret isurace util you are otified that you have bee accepted for coverage. We ll review your applicatio to determie if you meet uderwritig requiremets. If deied, you ll be otified by mail. If approved, you ll be set a Aeta Advatage Pla cotract ad ID card. If, after reviewig the cotract, you fid that you re ot satisfied for ay reaso, retur the cotract to us withi 10 days. We will refud ay premium paid (icludig ay cotract fees or other charges, if ay) less the cost of ay services paid o behalf of the Subscriber or ay covered depedet. Aeta Advatage Plas for Idividuals, Families ad Sole Proprietors Icludig 2 HSA Compatible Plas QUESTIONS? Please us at MyHealthAZ@Aeta.com or call MY-HEALTH ( ) for more iformatio.

16 Aeta Advatage Plas for Idividuals, Families ad Sole Proprietors Icludig 2 HSA Compatible Plas QUESTIONS? Please us at MyHealthAZ@Aeta.com or call MY-HEALTH ( ) for more iformatio. This material is for iformatioal purposes oly ad is either a offer of coverage or medical advice. It cotais oly a partial, geeral descriptio of pla beefits or programs ad does ot costitute a cotract. Aeta arrages for the provisio of healthcare services. However, Aeta itself is ot a provider of healthcare services ad therefore caot guaratee results or outcomes. Cosult the pla documets (Summary of Coverage ad booklet-certificate) to determie goverig cotractual provisios, icludig procedures, exclusios ad limitatios relatig to the pla. The availability of a pla or program may vary by service area. With the exceptio of Aeta Rx Home Delivery service, participatig providers ad vedors are idepedet cotractors i private practice ad are either employees or agets or Aeta or its affiliates. Certai primary care providers are affiliated with itegrated delivery systems or other provider groups (such as idepedet practice associatios ad physicia-hospital orgaizatios), ad members who select these providers will geerally be referred to specialists ad hospitals withi those systems or groups. However, if a system or group does ot iclude a provider qualified to meet member s medical eeds, member may request to have services provided by o-system or o-group providers. Member s request will be reviewed ad will require prior authorizatio from the system or group ad/or Aeta to be a covered beefit. Aeta assumes o resposibility for ay circumstace arisig out of the use, misuse, iterpretatio or applicatio of ay iformatio supplied by Aeta IteliHealth. Iformatio supplied by Aeta IteliHealth is for iformatioal purposes oly, is ot medical advice ad is ot iteded to be a substitute for proper medical care provided by a physicia. Iformed Health Lie urses caot diagose, prescribe or give medical advice. Specific questios should be addressed by your doctor. Alterative health care programs, Visio Oe ad the fitess program are rate-access programs ad may be i additio to ay pla beefits. Program providers are solely resposible for the products ad services provided thereuder. Aeta does ot edorse ay vedor, product or service associated with these programs. Discouts offered hereuder are ot isurace. Some beefits are subject to limitatios or visit maximums. Members or providers may be required to precertify or obtai prior approval of coverage for certai services, such as o-emergecy ipatiet hospital care.if your pla covers outpatiet prescriptio drugs, your pla may iclude a drug formulary (preferred drug list). A formulary is a list of prescriptio drugs geerally covered uder your prescriptio drug beefits pla o a preferred basis subject to applicable limitatios ad coditios. Your pharmacy beefit is geerally ot limited to the drugs listed o the formulary. The medicatios listed o the formulary are subject to chage i accordace with applicable state law. For iformatio regardig how medicatios are reviewed ad selected for the formulary, formulary iformatio, ad iformatio about other pharmacy programs such as precertificatio [ad step therapy], please refer to Aeta s website at or the Aeta Medicatio Formulary Guide. May drugs, icludig may of those listed o the formulary, are subject to rebate arragemets betwee Aeta ad the maufacturer of the drugs. Rebates received by Aeta from drug maufacturers are ot reflected i the cost paid by a member for a prescriptio drug. I additio, i circumstaces where your prescriptio pla utilizes copaymets or coisurace calculated o a percetage basis or a deductible, use of formulary drugs may ot ecessarily result i lower costs for the member. Members should cosult with their treatig physicias regardig questios about specific medicatios. Refer to your pla documets or cotact Member Services for iformatio regardig the terms ad limitatios of coverage. While this iformatio is believed to be accurate as of the prit date, it is subject to chage AZ (4/06) 2006 Aeta Ic.