Provider
|
Aetna U.S. Healthcare of Texas
1-800-992-7947
www.aetna.com
(no online provider directory)
|
Primary care physician (PCP)
required
|
Yes
|
Deductible
|
None
|
Out-of-pocket maximum
|
None
|
Office visit
|
100% after $10.
100% after $15 (after-hours or home visit).
|
X-ray, lab tests
|
100% after $10 (waived if part of office visit).
|
Hospital
|
100%
|
Chiropractic
|
Not covered.
|
• Office visit
|
Not covered.
|
• Benefit maximum
|
Not applicable.
|
Emergency room
(participating facility)
|
100% after $25 if life threatening (waived if admitted).
|
Emergency room
(non-participating facility)
|
100% after $25 if life threatening (waived if admitted).
|
Prescription drug
|
Closed formulary.
Drugs prescribed by dentists are covered.
|
• Deductible
|
None
|
• Brand
|
100% after $5 for 30-day supply; must be on approved
list.
|
• Generic
|
100% after $5 for 30-day supply; must be on approved
list.
|
• Mail order
|
100% after $10 for 90-day supply (two times retail
drug copay).
|
Mental health (outpatient)
|
Please refer to the Value Options for coverage info.
You must call Value Options at 1-866-269-5800.
|
Mental health (inpatient)
|
Please refer to the Value Options for coverage info.
You must call Value Options at 1-866-269-5800.
|
Substance abuse (outpatient)
|
Please refer to the Value Options for coverage info.
You must call Value Options at 1-866-269-5800.
|
Substance abuse (inpatient)
|
Please refer to the Value Options for coverage info.
You must call Value Options at 1-866-269-5800.
|
Regardless of whether you have Managed Choice POS or HMO
coverage, dental benefits are provided by Unicare. Vision
and hearing benefits are provided by the specific networks
established by Aetna.
For more information, please consult the Aetna U.S. Healthcare
of Texas Web site at:
www.aetna.com
