Aetna Integration A detailed description

There is a brochure on the Aetna website that provides details about the Integration plan.  It is a good summary of the plan.  Unfortunately, I can't link to it because you need a user id to get to the site and you can only get one if you are enrolled.  If you are considering getting the insurance I suggest you call and ask Aetna to email you a copy of the brochure.  Here is the table of contents:

Table of Contents

Preface ........................................................................1

Important Information Regarding Availability of

Coverage

Coverage for You .....................................................1

Health Expense Coverage.......................................1

Treatment Outcomes of Covered Services

When Your Coverage Begins............................2

Who Can Be Covered ..............................................2

Retirees

Determining if You Are in an Eligible Class

Obtaining Coverage for Dependents

How Your Medical Plan Works........................5

Common Terms........................................................5

About Your Comprehensive Medical Plan...........5

Using the Plan

Cost Sharing

Emergency and Urgent Care...................................6

Coverage for Emergency Medical Conditions

In Case of an Urgent Condition

Coverage for an Urgent Condition

Non-Urgent Care

Follow-Up Care After Treatment of an

Emergency or Urgent Medical Condition

Requirements For Coverage.............................8

Clinical Review Criteria Requests

What The Plan Covers ......................................10

Comprehensive Medical Plan .................................10

Wellness......................................................................10

Routine Physical Exams

Preventative Health Care Services Expenses

Routine Cancer Screenings

Early Intervention Services

Bone Mineral Density Measurement or Test,

Drug and Devices

Vision Care Services

Limitations

Hearing Exam

Primary and Preventive Obstetric and

Gynecological Care

Physician Services .....................................................13

Physician Visits

Surgery

Anesthetics

Hospital Expenses ....................................................14

Room and Board

Other Hospital Services and Supplies

Outpatient Hospital Expenses

Coverage for Emergency Medical Conditions

Coverage for Urgent Conditions

Alternatives to Hospital Stays.................................16

Outpatient Surgery and Physician Surgical

Services

Birthing Center

Ambulatory Care

Home Health Care

Hospice Care

Other Covered Health Care Expenses .................19

Acupuncture

Ambulance Service

Diagnostic and Preoperative Testing ....................19

Outpatient Diagnostic Lab Work and

Radiological Services

Outpatient Preoperative Testing

Durable Medical and Surgical Equipment (DME)

.....................................................................................20

Experimental or Investigational Treatment .........21

Pregnancy Related Expenses..................................21

Prosthetic Devices....................................................22

Hearing Aids

Benefits After Termination of Coverage

Short-Term Rehabilitation Therapy Services.......23

Cardiac and Pulmonary Rehabilitation Benefits

Outpatient Cognitive Therapy, Physical Therapy,

Occupational Therapy and Speech Therapy

Rehabilitation Benefits

Reconstructive or Cosmetic Surgery and Supplies

.....................................................................................24

Reconstructive Breast Surgery

Specialized Care........................................................24

Chemotherapy

Radiation Therapy Benefits

Outpatient Infusion Therapy Benefits

Diabetic Equipment, Supplies and Education.....26

Treatment of Infertility............................................26

Advanced Reproductive Technology (ART)

Benefits

Enteral Formulas......................................................28

Treatment of Mental Disorders and Substance Use

.....................................................................................29

Treatment of Substance Abuse

Oral and Maxillofacial Treatment (Mouth, Jaws and

Teeth) .........................................................................30

Medical Plan Exclusions .........................................31

When Coverage Ends..............................................31

When Coverage Ends For Retirees

Your Proof of Prior Medical Coverage

Continuation of Coverage.......................................32

Continuing Health Care Benefits

Extension of Benefits ..............................................33

COBRA Continuation of Coverage......................33

Continuing Coverage through COBRA

Who Qualifies for COBRA

Disability May Increase Maximum Continuation

to 29 Months

Determining Your Premium Payments for

Continuation Coverage