[PDF] Directory - Aetna Medicare

Additional Important DisclosureInformationAetna Golden Choice Plan OnlyMember Copays and DeductiblesYour plan of benefits may contain some or all of thefollowing features:■ Copayments or Coinsurance - These are fees thatyou must pay for some covered medical expenses.■ Calendar Year Deductible - The amount of coveredmedical expenses you pay each calendar yearbefore benefits are paid. There is a calendar yeardeductible that applies to each person.■ Inpatient Hospital Deductible - This is the amountof covered inpatient hospital expenses you pay foreach hospital confinement.■ Emergency Room Deductible - A separate hospitalemergency room deductible applies to each visit bya person to a hospital emergency room unless theperson is admitted to the hospital as an inpatientwithin 24hours after a visit to a hospital emergencyroom.The applicability and amount of each copay anddeductible listed above will be determined by yourplan sponsor and described in your plan documents.Role of Primary Care Physicians (“PCPs”)For some plans, members are required or encouragedto select a PCP who participates in the network. ThePCP can provide primary care as well as coordinateyour overall care. Members should consult their PCPwhen they are sick or injured to help determine thecare that is needed.Under the Aetna Golden Choice Plan, you may godirectly to a provider or facility for covered services,subject to cost sharing requirements. You may be ableto reduce your out-of-pocket expenses considerably byusing the network providers listed in the ProviderDirectory. With the Aetna Golden Choice Plan, youmay go directly to a network specialist without areferral from a PCP, and pay the applicable copay.Please refer to your plan documents for details.Emergency CareIf you need emergency care, you are covered 24 hoursa day, 7 days a week, anywhere in the world. Anemergency medical condition is one manifesting itselfby acute symptoms of sufficient severity such that aprudent layperson, who possesses average knowledgeof health and medicine, could reasonably expect theabsence of immediate medical attention to result inserious jeopardy to the person's health, or withrespect to a pregnant woman, the health of thewoman and her unborn child. Whether you are in orout of an Aetna service area, we simply ask that youfollow the guidelines below when you believe youneed emergency care.■ Call the local emergency hotline (ex. 911) or go tothe nearest emergency facility. If a delay would notbe detrimental to your health, call your PCP. Notifyyour PCP as soon as possible after receivingtreatment.■ If you are admitted to an inpatient facility, you or afamily member or friend on your behalf shouldnotify your PCP or Aetna as soon as possibleAfter-Hours CareYou may call your doctor’s office 24 hours a day, 7days a week if you have medical questions orconcerns. You may also consider visiting participatingUrgent Care facilities.www.aetna.comXXIII