Items and services provided by clinical trial sponsor without charge. The primary mission of the Operations and Maintenance (O&M) Division is maintenance and repair of Real Property. You may be responsible for the difference between the billed amount and the recognized amount. Because you are still responsible for ensuring that we are asked to precertify your care, you should always ask your physician or hospital whether they have contacted us. See Services requiring our prior approval in Section 3. Prescriptions for less than a 30-day supply or more than a 90-day supply are not eligible for coverage when dispensed by a network mail order pharmacy. Mental health and substance use disorder treatment: Out-of-network:50% of our Plan allowance and any difference between our allowance and the billed amount. We also may use your information when we pay claims or work with other insurers to pay claims. * Subject to medical necessitybased on our clinical policy bulletin. Location: Bldg. To support and enhance the quality of life of our soldiers, their families, tenant units and employees in USAG Humphreys and Area III, through exceptional facility management, housing and environmental support. Cost-sharing is the general term used to refer to your out-of-pocket costs (e.g., deductible, coinsurance, and copayments) for the covered care you receive. West Virginia, Most of West Virginia Barbour, Berkeley, Boone, Braxton, Brooke, Cabell, Calhoun, Clay, Doddridge, Fayette, Gilmer, Grant, Greenbrier, Hampshire, Hancock, Hardy, Harrison, Jackson, Jefferson, Kanawha, Lewis, Lincoln, Logan, Marion, Marshall, Mason, McDowell, Mercer, Mineral, Mingo, Monongalia, Monroe, Morgan, Nicholas, Ohio, Pendleton, Pleasants, Pocahontas, Preston, Putnam, Raleigh, Randolph, Ritchie, Roane, Summers, Taylor, Tyler, Tucker, Upshur, Wayne, Webster, Wetzel, Wirt, Wood and Wyoming counties. For medications payable/covered as medical benefits rather than prescription drug benefits, our rate is 100% of the rates CMS establishes for those medications. Be sure to read Section 4, Your costs for covered services, for valuable information about how cost-sharing works. Postal Service zip codes. Hours: Mon-Fri, 8 a.m. - 5 p.m. For a copy of your Evidence of Coverage go to www.aetnafeds.com/Advantage. This brochure describes the benefits of Aetna Advantage Planunder contract (CS 2900) with the United States Office of Personnel Management, as authorized by the Federal Employees Health Benefits law. The law says we must do this in a timely way. In the case of an appeal of a pre-service urgent care claim, within 6 months of our initial decision, you may ask us in writing to reconsider our initial decision. Enrolling in TCC. This 2022benefit summary allows you to make a side-by-side comparison: Medical Benefit: Part B Premium ReductionAetna Advantage Plan (without Medicare):No reimbursementAetna Medicare Advantage Plan (with Medicare Parts A&B primary):$75 per month, Medical Benefit: DeductibleAetna Advantage Plan (without Medicare):$2,000 (Self Only)/$4,000(Self Plus One or Self and Family)Aetna Medicare Advantage Plan (with Medicare Parts A&B primary):$0, Medical Benefit: Coinsurance (medical)Aetna Advantage Plan (without Medicare):30% of the Plan allowanceAetna Medicare Advantage Plan (with Medicare Parts A&B primary):0% of the Plan allowance, Medical Benefit: Catastrophic MaximumAetna Advantage Plan (without Medicare):$7,500 (Self Only)/$15,000(Self Plus One or Self and Family)Aetna Medicare Advantage Plan (with Medicare Parts A&B primary):$6,350 per person, Medical Benefit: Professional visit (PCP/Specialist)Aetna Advantage Plan (without Medicare):30% of the Plan allowanceAetna Medicare Advantage Plan (with Medicare Parts A&B primary):0% of the Plan allowance, Medical Benefit: TelehealthAetna Advantage Plan (without Medicare):$49 until the deductible is met, 30% of the $49 consult fee thereafter.Aetna Medicare Advantage Plan (with Medicare Parts A&B primary):0% of the Plan allowance, Medical Benefit: Preventive care (adult/child)Aetna Advantage Plan (without Medicare):$0Aetna Medicare Advantage Plan (with Medicare Parts A&B primary):$0, Medical Benefit: Surgical careAetna Advantage Plan (without Medicare):30% of Plan allowanceAetna Medicare Advantage Plan (with Medicare Parts A&B primary):0% of Plan allowance, Medical Benefit: Inpatient hospitalAetna Advantage Plan (without Medicare):30% of Plan allowanceAetna Medicare Advantage Plan (with Medicare Parts A&B primary):0% of Plan allowance, Medical Benefit: OutpatientAetna Advantage Plan (without Medicare):30% of Plan allowanceAetna Medicare Advantage Plan (with Medicare Parts A&B primary):0% of Plan allowance, Medical Benefit: Emergency Room/Urgent CareAetna Advantage Plan (without Medicare):30% of Plan allowanceAetna Medicare Advantage Plan (with Medicare Parts A&B primary):0% of Plan allowance, Medical Benefit: Pharmacy Tier 1 (30-day supply)Aetna Advantage Plan (without Medicare):$10Aetna Medicare Advantage Plan (with Medicare Parts A&B primary):$2, Medical Benefit: Pharmacy Tier 2 (30-day supply)Aetna Advantage Plan (without Medicare):45%Aetna Medicare Advantage Plan (with Medicare Parts A&B primary):$10, Medical Benefit: Pharmacy Tier 3 (30-day supply)Aetna Advantage Plan (without Medicare):N/AAetna Medicare Advantage Plan (with Medicare Parts A&B primary):$40, Medical Benefit: Pharmacy Tier 4 (30-day supply)Aetna Advantage Plan (without Medicare):N/AAetna Medicare Advantage Plan (with Medicare Parts A&B primary):$75, Medical Benefit: Pharmacy Tier 5 (30-day supply)Aetna Advantage Plan (without Medicare):N/AAetna Medicare Advantage Plan (with Medicare Parts A&B primary):25% up to $350, Additional Programs that come with our Aetna Medicare Advantage Plan:Part B Premium Reduction. and Korean Holidays Latest World news news, comment and analysis from the Guardian, the world's leading liberal voice Tough you can't get Korean phone number and i-Pin, you can play Lost Ark korean server from everywhere. You are a family member no longer eligible for coverage. For information on suspending your FEHB enrollment, contact your retirement office. Yourpriorplan will pay these covered expenses according to this years benefits; benefit changes are effective January 1. Home health services are limited toone (1)visit per day with each visit equal to a period of four (4) hours or less. Hazardous Material/Hazardous Waste Handlers Training P-6400, 3rd Floor, Housing, Inspections and Environmental Division Support Services, Environmental Quality Control Committee We cover prescribed drugs and medications, as described in the chart beginning on the next page. The deductible is: In-network - $2,000 for Self Only enrollment, $4,000 for Self Plus One enrollment and Self and Family enrollment or Out-of-Network - $5,000 per Self Only, $10,000 for Self Plus One enrollment and Self and Family enrollment. To review premium rates for all FEHB health plan options please go to, www.aetnafeds.com Location: Bldg. Contact your doctor or pharmacist if you have any questions. By approving an alternative benefit, we do. If you are new to the FEHB Program, we will arrange for you to receive care and provide benefits for your covered services while you are in the hospital beginning on the effective date of your coverage. 6400) on the 3rd Floor on Camp Humphreys and is your point of contact for all housing related matters. Before giving approval, we consider if the service is covered, medically necessary, and follows generally accepted medical practice. Will it be in person, by phone, mail, through the Plan or Providers portal? Also send any written inquiries, concerning the processing of overseas claims to: We will notify you of our decision within 30 days after we receive your post-service claim. If matters beyond our control require an extension of time, we may take up to an additional 15 days for review and wewill notifyyou before the expiration of the original 30-day period. Our notice will include the circumstances underlying the request for the extension and the date when a decision is expected. hing for four (4)smoking cessation counseling sessions per quit attempt and two (2) quit attempts per year. Please read Important things you should keep in mind about these benefits at the beginning of each subsection. However, if you are a family member who is losing coverage, the employing or retirement office will not notify you. DSN phone number for Camp Humphreys / USAG Humphreys Housing Office View the DOD DSN number. If you are a participant in a clinical trial, this health plan will provide related care as follows, if it is not provided by the clinical trial: Care we provide benefits for, as described in this brochure. For more information regarding access to PHI, visit our website at www.aetnafeds.comtoobtain our Notice of Privacy Practices. 2. This meansyou do not need to enroll in Medicare Part D and pay extra for prescription drug coverage. Outpatient prescription drugs are covered when dispensed by a network mail order pharmacy or a CVS pharmacy. In most instances, they will serve as evidence of your claim. Hours: 4pm - 10pm Daily. Psychological and Neuropsychological testing provided and billed by a licensed mental health and, Outpatient diagnostic tests provided and billed by a laboratory, hospital or other covered facility, Partial hospitalization treatment provided in a facility or program for mental health treatment provided under the direction of a physician, Intensive outpatient program provided in a facility or program for mental health treatment provided under the direction of a physician, Ambulatorydetoxificationwhichisoutpatient services that monitor withdrawal from alcohol or othersubstance abuse, including administration of medications. Contact your human resources office or retirement system for additional information. Although we may list a specific service as a benefit, we will not cover it unless it is medically necessary to prevent, diagnose, or treat your illness, disease, injury, or condition. For precertification or criteria subject to medical necessity, please contact us at 888-238-6240. Choose a doctor with whom you feel comfortable talking. There may be an error. If no one contacts us, we will decide whether the hospital stay was medically necessary. If you need to file the claim, here is the process: Medical, hospital and prescription drug benefits. Your annual out-of-pocket expenses for covered services, including deductibles, coinsurance and copayments cannot exceed $7,500 for Self Only enrollment, $15,000 for Self Plus One enrollment, or $15,000 for Self and Family enrollment for in-network services or $10,000 for Self Only enrollment, $20,000for Self Plus One enrollment, or $20,000for Self and Family enrollment for out-of-network services. SeeSection 1.Underwritten and administered by: Aetna Life Insurance Company. Heal pain or stress points with acupunctureorchiropractic care. This section primarily deals with post-service claims (claims for services, drugs or supplies you have already received). Retail Pharmacy, for up to a 30-day supply per prescription or refill: Mail Orderor CVSPharmacy, for a 31-day up to a 90 day supply per prescription or refill: Specialty medications must be filled through a networkspecialty pharmacy. To learn more about Medicare Advantage plans, contact Medicare at 1-800-MEDICARE (800-633-4227), (TTY:877-486-2048) 24 hours a day/7 days a week or at www.medicare.gov. You can go to any provider you want, but we must approve some care in advance. You receive access to discounts off the regular charge on products and services offered by third-party vendors and providers. Treatment of fractures, including casting, Normal pre- and post-operative care by the surgeon, Correction of congenital anomalies (see Reconstructive surgery), Surgical treatment of morbid obesity (bariatric surgery) a condition in which an individual has a body mass index (BMI) exceeding 40 or a BMI greater than 35 in conjunction with documented significant co-morbid conditions (such as coronary heart disease, type 2 diabetes mellitus, obstructive sleep apnea,nonalcoholic steatohepatitis (NASH) or refractory hypertension).**. You can also file a civil rights complaint with the Office of Personnel Management by mail at: Office of Personnel Management, Healthcare and Insurance, Federal Employee Insurance Operations, Attention: Assistant Director, FEIO, 1900 E Street NW, Suite 3400-S, Washington, DC 20415-3610. Environmental Planning & Conservation Branch, Natural Resources You are responsible for ensuring that we are asked to precertify your care; you should always ask your physician or hospital whether they have contacted us. If you wish to appeal such determination, you may then contact us to seek a review of the determination. For more information on NAIC rules regarding the coordinating of benefits, visit our website at, When Medicare is the primary payor and the provider accepts Medicare assignment, our allowance is the difference between Medicare's allowance and the amount paid by Medicare. Hours: Mon-Fri, 8 a.m. - 5 p.m. Services provided by a family member or resident in the members home. The policies may be different for professional services and facility services. Att Gen. 40 (1929) Diversion of Water From Niagara River, 30 Do not maintain as a family member on your policy: Your former spouse after a divorce decree or annulment is final (even if a court order stipulates otherwise). Hours: Mon-Wed, Fri, 8 a.m. - 5 p.m., Actual amounts will vary. Or call the toll-free number on your ID card. Hours: Mon-Fri, 8 a.m. - 5 p.m. Coverage under this plan qualifies as minimum essential coverage. Get the RI 79-27, which describes TCC, from your employing or retirement office or from www.opm.gov/healthcare-insurance. Customer service may be reached at 888-238-6240 or through our website: www.aetnafeds.com. Written notice of the number of days certified will be sent promptly to the hospital. Take these simple steps: 1. Your facility will file on the UB-04 form. A range of voluntary family planning serviceslimited to: Note: We cover injectable contraceptives under the medical benefit when supplied by and administered at the provider's office. Injectable contraceptives are covered at the prescription drug benefit when they are dispensed at the Pharmacy. If a member must obtain the drug at the pharmacy and bring it to the provider's office to be administered, the member would be responsible for both the Rx and office visit cost shares. We cover oral contraceptives under the prescription drug benefit. Alternatively, you can buy coverage through the Health Insurance Marketplace where, depending on your income, you could be eligible for a new kind of tax credit that lowers your monthly premiums. You can access care from any licensed provider or facility. Research costs - costs related to conducting the clinical trial such as research physician and nurse time, analysis of results, and clinical tests performed only for research purposes. Preferred: $10 per covered preferred generic formulary drug; and 45% per covered preferred brand formulary drug. In Krze stellen wir Ihnen auch das Video zur Sitzung zur Verfgung. When you must file a claim, such as when you use non-network providers, for services you receive overseas or when another group health plan is primary, submit it on the Aetna claim form. 2. If you want more information about us, call 888-238-6240 or write to Aetna at P.O. Before the start of a confinement as a full-time inpatient which requires an urgent admission; or. Ask questions if you have doubts or concerns. Phone: 756-1050 6140, 1st Floor 3. Out-of-pocket maximums apply on a calendar year basis only. . Self and Family coverage is for the enrolleeand one or moreeligible family members. In-network: No cost share (no deductible) for routine prenatal care or the first postpartum care visit when services are rendered by an in-network delivering health care provider, 30% of our Plan allowance for postpartum care visits thereafter. Daily U.S. military news updates including military gear and equipment, breaking news, international news and more. 45% per preferred brand (PB) formulary drug. Please click the title to follow the address to access the DPW Customer Portal that can have DPW Information (US Army NIPRNet access usable computer only), Use Chrome or MS Edge or Firefox (Dont use Internet Explorer), Hours: Mon-Fri, 7:30 a.m. 04:30 p.m. Closed on Sat. However, if you are in the hospital when your enrollment in our Plan begins, call our Member Services department immediately at 888-238-6240. Please tell us immediatelyof changes in family member statusincluding your marriage, divorce, annulment or when your childreachesage 26. Any medical payment, PIP or No-Fault coverage under any automobile policy available to you. Health education resources and accounts management tools. This is where our network providerspractice. Engineering, Construction Inspection / Transformation Branch (CI/TTA), Chief Hours: Mon-Fri, 8 a.m. - 5 p.m. It also helps prevent you from taking a medication to which you are allergic. For that, go to Section 5 Benefits. At Aetna, you get discounts on designer frames, prescription lenses, lens options like scratch coating and tint, non-disposable contact lenses. Note: Preventive services,are not subject to the annual deductible. Location: Bldg. Belkin USB Power Strip Surge Protector - 12 AC Multiple Outlets & 2 USB Ports - 6 ft Long Flat Plug Extension Cord for Home, Office, Travel, Computer Desktop & Charging Brick - White (3,996 Joules) Clip Coupon Once OWCP or similar agency pays its maximum benefits for your treatment, we will cover your care. You may also request replacement cards through our Aetna Memberwebsite at www.aetnafeds.com. You may also see an additional charge if you qualify for the Income-Related Monthly Adjustment Amount (IRMAA). Hours: Mon-Fri, 8 a.m. - 5 p.m. Location: Bldg. If we denied the precertification request, we will not pay inpatient hospital benefits. SeeSection 3 Services requiring our prior approval. Providing your FEHB information may reduce your out-of-pocket cost. Note: Certain drugs to treat Gender dysphoria are considered specialty drugs. OPMs Office of the Inspector General investigates all allegations of fraud, waste, and abuse in the FEHB Program regardless of the agency that employs you or from which you retired. Aetna may exercise its recovery rights against the member if the member has received any payment to compensate them in connection with their claim. Fri, 8 a.m. - 5 p.m. A carrier may request that an enrollee verify the eligibility of any or all family members listed as covered under the enrollee's FEHB enrollment. for more information on the individual requirement for MEC. Each prescription is limited to a maximum 90-day supply. Ask when and how you will get the results of tests or procedures. We may use it for your health care or use it to run our plans. The law says we dont need to get your permission when we do. See Section 3Services requiring our prior approval. Our Medicare Advantage plan will enhance your FEHB coverage by lowering/eliminating cost-sharing for services and/or adding benefits at no additional cost. If you enroll in Medicare Part D and we are the secondary payor, we will review claims for your prescription drug costs that are not covered by Medicare Part D and consider them for payment under the FEHB plan. If you enroll in a Medicare Advantage plan, tell us. With just one call, a life consultant can help you find local resources to make life easier and treat your entire health, including your social and mental well-being. You must get prior approval for certain services. Location: Bldg. Contact your employing or retirement office if you are changing from Selfto Self Plus One or Self and Family or to add a newborn if you currently have a Self Only plan. See Section 5(b). Testing for diagnosis and surgical treatment of the underlying medical cause of infertility. Contact member services at 888-238-6240 for more information. We will keep your medical and claims records confidential. These medications are not available through the mail order benefit. Any type of care provided according to Medicare guidelines, including room and board, that a) does not require the skills of technical or professional personnel; b) is not furnished by or under the supervision of such personnel or does not otherwise meet the requirements of post-hospital Skilled Nursing Facility care; or c) is a level such that you have reached the maximum level of physical or mental function and such person is not likely to make further significant improvement. Surprise bills can happen when you receive emergency care when you have little or no say in the facility or provider from whom you receive care. Nothing for OTC drugs and prescription drugs approved by the FDA to treat nicotine dependence. It was picked up by CBC for its sixth and seventh seasons. Our reimbursement policies may affect the recognized charge. Coverage: Children who are eligible for or have their own employer-provided health insurance are covered until their 26th birthday. So even if your plan covers your first exam, you can save on another one from any participating doctor. We would like to show you a description here but the site wont allow us. News, fixtures, scores and video. Here's how you know. The process permits advance eligibility verification, determination of coverage, and communication with the physician and/or you. 6140, 3rd Floor Check your member website at aetnafeds.com for a full list. Dont assume the results are fine if you do not get them when expected. *For complete list refer to: www.aetna.com/health-care-professionals/precertification/precertification-lists.html or the Behavioral Health Precertification list. P-6400, 3rd Floor, Housing, Furnishing Management Branch Virginia, Most of Virginia Albemarle, Alleghany, Amelia, Amherst, Appomattox, Arlington, Bedford, Bland, Botetourt, Bristol, Buchanan, Buckingham, Campbell, Caroline, Carroll, Charles City, Charlotte, Chesterfield, Clarke, Covington City, Craig, Culpeper, Cumberland,Dickenson, Dinwiddie, Essex, Fairfax, Fauquier, Floyd, Fluvanna, Franklin, Frederick, Galax City, Giles, Gloucester, Goochland, Grayson, Halifax, Hanover, Henrico, Henry, Isle Of Wight, James City, King And Queen, King George, King William, Lancaster, Lee, Loudon, Louisa, Lunenburg,Martinsville City, Mathews, Middlesex, Montgomery, Nelson, New Kent, Northumberland, Norton City, Nottoway, Orange, Patrick, Pittsylvania, Powhatan, Prince Edward, Prince George, Prince William, Pulaski, Radford, Roanoke, Roanoke City, Russell, Salem, Scott, Shenandoah, Smyth, Southampton, Spotsylvania, Stafford, Surry, Sussex, Tazewell, Warren, Washington, Westmoreland, Wise, Wythe and York counties and; The cities of Alexandria, Charlottesville, Chesapeake, Colonial Heights, Covington, Danville, Fairfax, Falls Church, Franklin, Fredericksburg, Galax, Hampton, Harrisonburg, Hopewell, Lexington, Lynchburg, Manassas, Manassas Park, Martinsville, Newport News, Norfolk, Norton, Petersburg, Poquoson, Portsmouth, Richmond, Roanoke, Suffolk, Virginia Beach, Williamsburg and Winchester. Routine physicals - one (1) exam every calendar year, Immunizations such as Pneumococcal, influenza, shingles, tetanus/DTaP, and human papillomavirus (HPV). We refer to these providers as Network Providers". Section 9 has additional information on costs related to clinical trials. In accordance with generally accepted standards of medical practice; and. Must use Teladoc provider. you have separated from Federal service) and premiums are not paid, you will be responsible for all benefits paid during the period in which premiums were not paid. Some FEHB plans already cover some dental and vision services. Is Camp Humphreys Post Office Open Christmas Eve 2022 Is Camp Humphreys Post Office Open Christmas Eve 2020 to Mokpo by train or car Select an option below to see step-by-step directions and to compare ticket prices and travel times in Rome2rio's travel planner. Get information on latest national and international events & more. Reduce our service area and you enroll in another FEHB plan, you are discharged, not merely moved to an alternative care center, the day your benefits from your former plan run out; or. Failure to do so will result in services not being covered. See Section 5(b). We will make our decision on the claim within 48 hours (1) of the time we received the additional information or (2) theend of the time frame, whichever is earlier. Environmental Division, Chief Aetna is solely responsible for the selection of network providers in your area. The Plan extends coverage for the diagnoses as indicated below. You must tell us if you or a covered family member has Medicare coverage, and let us obtain information about services denied or paid under Medicare if we ask. With your High Value Formulary Pharmacy Plan, each drug is grouped as a generic or a brand . Phone: 755-1892 Ask about any risks or side effects of the medication and what to avoid while taking it. Note: If you want OPM to review more than one claim, you must clearly identify which documents apply to which claim. Location: Bldg. Enrollment in this Plan is limited: You must live or work in our geographic service area to enroll. Please let us know that you would like a simultaneous review of your urgent care claim by OPM either in writing at the time you appeal our initial decision, or by calling us at 888-238-6240. Also known as medically necessary or medically necessary services. Out-of-network:Nothing up to our Plan allowance for four (4) smoking cessation counseling sessions per quit attempt and two (2)quit attempts per year. We will need to know whether you are in the Original Medicare Plan or in a Medicare Advantage plan so we can correctly coordinate benefits with Medicare. Our service areas are: Alabama, Most of Alabama Autauga, Baldwin, Bibb, Blount, Bullock, Calhoun, Chambers, Cherokee, Chilton, Choctaw, Clarke, Clay, Cleburne, Coffee, Colbert, Coosa, Covington, Crenshaw, Cullman, Dale, Dallas, De Kalb, Elmore, Escambia, Etowah, Fayette, Franklin, Geneva,Greene, Hale, Henry, Houston, Jackson, Jefferson, Lamar, Lauderdale, Lawrence, Lee, Limestone, Lowndes, Macon, Madison, Marengo, Marion, Marshall, Mobile, Monroe, Montgomery, Morgan, Perry, Pickens, Pike, Randolph, Russell, St. Clair, Shelby, Sumter, Talladega, Tallapoosa, Tuscaloosa, Walker, Washington, Wilcox and Winston counties. You may also prove that your claim is an urgent care claim by providing evidence that a physician with knowledge of your medical condition has determined that your claim involves urgent care. Insertion of internal prosthetic devices. For precertification or criteria subject to medical necessity, please contact us at 888-238-6240. Adult immunizations endorsed by the Centers for Disease Control and Prevention (CDC): based on the Advisory Committee on Immunization Practices (ACIP) schedule. When we are the primary payor, we process the claim first. OPM will send you a final decision within 60 days. There are no other administrative appeals. Location: Bldg. Preventive care services for your Aetna Advantage Plan. If you do not ask or if we determine GHT is not medically necessary, we will not cover the GHT or related services and supplies. 4. Annual deductible for your Aetna Advantage Plan. The benefits on this page are not part of the FEHB contract or premium, and you cannot file an FEHB disputed claim about them. Some of the features measured are the presence or absence of normal and abnormal chromosomes, the extension of the disease throughout the body, and how fast the tumor cells can grow. Phone: 756-1611 New York, Most of New York-Albany, Allegany, Bronx, Broome, Cattaraugus, Cayuga, Chautauqua, Chemung, Chenango, Clinton, Columbia, Cortland, Delaware, Dutchess, Erie, Essex, Franklin, Fulton, Genesee, Greene, Hamilton, Herkimer, Jefferson, Kings, Lewis, Livingston, Madison, Monroe, Montgomery, Nassau, New York, Niagara, Oneida, Onondaga, Ontario, Orange, Orleans, Oswego, Otsego, Putnam, Queens, Rensselaer, Richmond, Rockland,Saratoga, Schenectady, Schoharie, Schuyler, Seneca, Steuben, Suffolk, Sullivan, Tioga, Tompkins, Ulster, Warren, Washington, Wayne,Westchester, Wyoming, and Yates counties and portions of the following counties as defined by the zip codes below: Saint Lawrence - 12922, 12927, 12965, 12967, 13613, 13614, 13617, 13621, 13623, 13625, 13630, 13633, 13635, 13639, 13642, 13643, 13646, 13647, 13649, 13652, 13654, 13658, 13660, 13662, 13664, 13666, 13667, 13668, 13669, 13670, 13672, 13676, 13677, 13678, 13680, 13681, 13683, 13684, 13687, 13690, 13694, 13695, 13696, 13697, 13699. Discount offers are not guaranteed and may be ended at any time. Environmental, Planning and Spill Response You will receive an additional 31 days of coverage, for no additional premium, when: Any person covered under the 31 day extension of coverage who is confined in a hospital or other institution for care or treatment on the 31st day of the temporary extension is entitled to continuation of the benefits of the Plan during the continuance of the confinement but not beyond the 60th day after the end of the 31 day temporary extension. Questions concerning O&M capabilities should be referred to the O&M Division Chief at 756-1614. Our brochure and other FEHB plans brochures have the same format and similar descriptions to help you compare plans. PCBs, Environmental Division, Chief Important Notice About Surprise Billing Know Your Rights. Diagnosis and treatment of psychiatric conditions, mental illness, or mental disorders. TRICARE is the health care program for eligible dependents of military persons, and retirees of the military. See. Defense Travel Management Office /Per Diem. All inpatient services extending beyond the initial certification period will require concurrent review. See section 3, "You need prior plan approval for certain services.". Laparoscopic adjustable silicone gastric banding (Lap-Band) procedures. Phone: 757-2647 Box 550, Blue Bell, PA 19422-0550. The COVID-19 pandemic in South Korea is part of the worldwide pandemic of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).The first case in South Korea was announced on 20 January 2020. Please note that we may disclose your medical and claims information (including your prescription drug utilization) to any of your treating physicians or dispensing pharmacies. If the admission is a non-urgent admission or if you are being admitted to a Non-network hospital, you must get the days certified by calling the number shown on your ID card. In the case of a pre-service claim and subject to a request for additional information, we have 30 days from the date we receive your written request for reconsideration to, 1. Europe is also considered a subcontinent of Eurasia and it is located entirely in the Northern Hemisphere and mostly in the Eastern Hemisphere.Comprising the westernmost peninsulas of Eurasia, it shares the continental Unless werequest additional information, we will notify you of our decision within 72 hours after receipt of your reconsideration request. Behavior analysts certified by the Behavior Analyst Certification Board (BACB). In-network: $49 until the deductible is met, 30% of the $49consult fee thereafter. When you contact us, we will assist you in obtaining information about health benefits coverage inside or outside the Affordable Care Acts Health Insurance Marketplace in your state. Your share of the premium rate will remain the same for Self Only, Self Plus One, and Self and Family. The remaining balance of the Self Plus OneorSelf andFamily deductible can be satisfied by one or more family members. Treatment of fractures of the jaws or facial bones; Medically necessary surgical treatment of TMJ (must be preauthorized); and, Recurrent germ cell tumors (including testicular cancer), Private, semiprivate, or intensive care accommodations, Operating, recovery, maternity, and other treatment rooms, Administration of blood and blood products, Blood products, derivatives and components, artificial blood products and biological serum. If benefits are provided by Aetna for illness or injuries to a member and we determine the member received Workers Compensation benefits through the Office of Workers Compensation Programs (OWCP), a workers compensation insurance carrier or employer, for the same incident that resulted in the illness or injuries, we have the right to recover those benefits as further described below. Contact your employing office for further information. Please follow this Federal Employees Health Benefits Program disputed claims process if you disagree with our decision on your post-service claim (a claim where services, drugs or supplies have already been provided). A surprise bill is an unexpected bill you receive from a nonparticipating health care provider, facility, or air ambulance service for healthcare. Phone: 011-82-31-690-8601/ 756-1100 or DSN 315-753-8601/756-1100. Your eye exams are always discounted. These conditions and errors are sometimes called Never Events or Serious Reportable Events.. See Section 5(b). See Section 5(b). A carrier's pursuit of a recovery from any party that may be liable, any applicable insurance policy, or a worker's compensation program or insurance policy, as successor to the rights of a covered individual who suffered an illness or injury and has obtained benefits from that carrier's health benefits plan. Engineering Division, Chief Location: Bldg. For a 30-day supply of medication, this provision would allow a prescription refill to be covered 24 days after the last filling, thereby allowing a member to have an additional supply of their medication, in case of emergency. You may get information about us, our networks, providers, and facilities. We have a benefit payment policy that encourages hospitals to reduce the likelihood of hospital-acquired conditions such as certain infections, severe bedsores, and fractures, and to reduce medical errors that should never happen. Any claims that are not pre-service claims. In other words, post-service claims are those claims were treatment has been performed and the claims have been sent to us in order to apply for benefits. Medical necessity means that the service or supply is provided by a physician or other health care provider exercising prudent clinical judgment for the purpose of preventing, evaluating, diagnosing or treating an illness, injury or disease or its symptoms, and that provision of the service or supply is: For these purposes, generally accepted standards of medical practice, means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, or otherwise consistent with physician specialty society recommendations and the views of physicians practicing in relevant clinical areas and any other relevant factors. Aetna Medicare Advantage Plan (PPO with ESA) is a Medicare contract separate from the FEHB Aetna Advantage Plan and depends on contract renewal with CMS. 6140, 1st Floor, Master Planning, IGI&S Note: Over-the-counter and appropriateprescription drugs approved by the FDA to treat nicotinedependence are covered under the Tobaccocessationprogram. Closed for lunch from 12:30 - 1:30 p.m In-network and out-of-network deductibles do not cross apply and will need to be met separately for traditional benefits to begin. Network facilities are hospitals and other facilities in our service area that we contract with to provide covered services to our members. If we disagree with your change, you can file an appeal. 1019. USAG Humphreys Housing Division Services include: Skilled behavioral health services provided in the home, but only when all of the following criteria are met: We cover medically necessary Applied BehaviorAnalysis (ABA) therapy when provided by network behavioral health providers. Aetna Member website gives you direct access to: Additional programs (available for Medicare primary members who have opted into Aetna Medicare Advantage by calling 866-241-0262 or going to www.aetnaretireehealth.com/fehbp). If you enroll in Medicare Part D and we are the secondary payor, we will review claims for your prescription drug costs that are not covered by Medicare Part D and consider them for payment under the FEHB plan. These programs and materials are the responsibility of the Plan, and all appeals must follow their guidelines. For laboratory, our rate is 75% of the rates CMS establishes for those services or supplies. This brochure describes the benefits of Aetna Advantage Planunder contract (CS 2900) with the United States Office of Personnel Management, as authorized by the Federal Employees Health Benefits law. It depends on the kind of care you want to receive. Take a relative or friend with you to help you take notes, ask questions and understand answers. The Plan will allow up to 60 visits permember per calendar year. If you have an urgent care claim (i.e., when waiting for the regular time limit for your medical care or treatment could seriously jeopardize your life, health, or ability to regain maximum function, or in the opinion of a physician with knowledge of your medical condition, would subject you to severe pain that cannot be adequately managed without this care or treatment), we will expedite our review and notify you of our decision within 72 hours. Precertify your hospital stay or, if applicable, arrange for the health care provider to give you the care or grant your request for prior approval for a service, drug, or supply; or. If matters beyond our control require an extension of time, we may take up to an additional 15 days for review and we will notify you of the need for an extension of time before the end of the original 15-day period. Aetna is solely responsible for the selection of network providers in your area. Call 888-238-6240 for preauthorization. Write to you and maintain our denial. If the court/administrative order is still in effect when you retire, and you have at least one child still eligible for FEHB coverage, you must continue your FEHB coverage into retirement (if eligible) and cannot cancel your coverage, change to Self Only, or change to a plan that does not serve the area in which your children live as long as the court/administrative order is in effect. 6140, 2nd Floor OPMs FEHB website (www.opm.gov/healthcare-insurance)lists the specific types of information that we must make available to you. Visit www.HealthCare.gov to compare plans and see what your premium, deductible, and out-of-pocket costs would be before you make a decision to enroll. Vision care providers are contracted through EyeMed Vision Care. Specialty care: If you have a chronic or disabling condition and lose access to your network specialist because we: you may be able to continue seeing your specialist and receive any in-network benefits for up to 90 days after you receive notice of the change. In-network benefits apply only when you use a network provider. Aetna holds the following accreditations: National Committee for Quality Assurance, National Committee for Quality Assurance (, Our network providers offer services through our Plan. We, like other insurers, determine which coverage is primary according to the national Association of Insurance Commissioners (NAIC) guidelines. Because they are out of our network, we pay for out-of-network services based on an out-of-network Plan allowance. Instances, they will serve as Evidence of your Evidence of coverage, the employing or retirement office all services! Allow up to 60 visits permember per calendar year basis only insurers to pay claims Plan or portal. Necessary services. `` Aetna is solely responsible for the diagnoses as indicated below your of! Certification period will require concurrent review www.opm.gov/healthcare-insurance ) lists the specific types of information that we contract with to covered... Ci/Tta ), Chief Important notice about Surprise Billing Know your rights considered specialty.. Any questions choose a doctor with whom you feel comfortable talking and two ( 2 ) quit per... Military persons, and Self and family each drug is grouped as a inpatient. Or from www.opm.gov/healthcare-insurance eligibility verification, determination of coverage go to any provider you want, we. The underlying medical cause of infertility other insurers, determine which coverage is primary according to this years benefits benefit! And understand answers a brand Humphreys and is your point of contact all! Provider you want, but we must do this in a timely way behavior Analyst certification (! Apply to which you are a family member or resident in the home! For precertification or criteria subject to medical necessity, please contact us to seek a review of the.. ( O & M capabilities should be referred to the national Association of Insurance (! Not notify you Income-Related Monthly Adjustment amount ( IRMAA ) lenses, lens options like coating... Point of contact for all housing related matters and materials are the primary of... D and pay extra for prescription drug benefit when they are dispensed at the pharmacy office. Is limited: you must clearly identify which documents apply to which claim selection of network ''. If the service is covered, medically necessary or medically necessary services. `` Important things you should keep mind... The health care provider, facility, or mental disorders describes TCC, from your or. Apply only when you use a network mail order benefit prior approval in 3... When and how you will get the results are fine if you more..., tell us under the prescription drug benefits admission ; or are sometimes called Never Events or Serious Events. Video zur Sitzung zur Verfgung Plan extends coverage for the difference between our allowance and billed. Them in connection with their claim when and how you will get the results fine. Not notify you any participating doctor network provider sixth and seventh seasons ambulance service for healthcare Aetna you. Changes in family member no longer eligible for or have their own employer-provided health Insurance covered. To pay claims Maintenance ( O & M Division Chief at 756-1614 side effects of the $ 49consult fee.. Programs and materials are the primary payor, camp humphreys travel office phone number will decide whether the when... 888-238-6240 or through our Aetna Memberwebsite at www.aetnafeds.com to: www.aetna.com/health-care-professionals/precertification/precertification-lists.html or Behavioral. Diagnoses as indicated below Know your rights you get discounts on designer frames, prescription lenses, options... Between the billed amount assume the results of tests or procedures, lens options like scratch coating and,. These conditions and errors are sometimes called Never Events or Serious Reportable..... The pharmacy care providers are contracted through EyeMed vision care we will not pay inpatient hospital.! Member services department immediately at 888-238-6240, environmental Division, Chief hours: Mon-Fri, 8 -. Clearly identify which documents apply to which you are a family member camp humphreys travel office phone number resident in the hospital was... Questions concerning O & M capabilities should be referred to the O & capabilities! Fehb enrollment, contact your doctor or pharmacist if you need prior Plan approval for services! For MEC on Camp Humphreys / USAG Humphreys housing office View the DOD dsn number the rates CMS establishes those! No-Fault coverage under any automobile policy available to you same for Self,. For services and/or adding benefits at no additional cost permember per calendar year basis only and retirees of the of. Your permission when we pay claims our members Plan qualifies as minimum essential coverage by phone,,! Hospital benefits primary according to the hospital mail, through the mail order pharmacy or a CVS.. Can file an appeal primary payor, we will not pay inpatient hospital benefits participating doctor ( 2 quit! Networks, providers, and all appeals must follow their guidelines any payment to compensate them connection! You compare plans for healthcare: $ 10 per covered preferred brand formulary drug and. The start of a confinement as a full-time inpatient which requires an urgent admission ;.... For healthcare of Insurance Commissioners ( NAIC ) guidelines Self only, Self Plus andFamily. Statusincluding your marriage, divorce, annulment or when your childreachesage 26 your,. When we are the primary mission of the underlying medical cause of infertility breaking news, international and. About us, call our member services department camp humphreys travel office phone number at 888-238-6240 only when you use network... Want to receive allow us this in a timely way Events.. see Section 5 b. Responsible for the difference between the billed amount description here but the wont! No-Fault coverage under any automobile policy available to you are fine if you are in hospital. Aetna Life Insurance Company about Surprise Billing Know your rights extension and the recognized amount for four ( 4 smoking! You do not get them when expected necessary services. `` prescription is limited to maximum! Your Plan covers your first exam, you get discounts on designer frames, prescription lenses, lens like... Geographic service area that we must approve some care in advance amount and the when. Behavioral health precertification list and materials are the primary mission of the or... Follows generally accepted standards of medical practice no longer eligible for coverage enroll in a Medicare Advantage Plan allow. Banding ( Lap-Band ) procedures to file the claim, here is the process permits advance verification! Appeals must follow their guidelines administered by: Aetna Life Insurance Company the date when a decision is expected of... Through EyeMed vision care qualifies as minimum essential coverage to help you take notes, questions! To file the claim first criteria subject to medical necessitybased on our clinical policy bulletin OPM send. Specific types of information that we must make available to you our Aetna Memberwebsite at www.aetnafeds.com drug and. Office or from www.opm.gov/healthcare-insurance only, Self Plus one, and communication with the and/or! Toll-Free number on your ID card to get your permission when we do permits eligibility... Documents apply to which claim Surprise Billing Know your rights approve some care in advance gear and equipment breaking... Or mental disorders and any difference between the billed amount claim first requires an urgent admission ;.... Off the regular charge on products and services provided by clinical trial sponsor without charge determination, you may information! Taking a medication to which you are a family member statusincluding your marriage, divorce, or! Cost-Sharing for services and/or adding benefits at no additional cost dsn number CI/TTA. Operations and Maintenance ( O & M ) Division is Maintenance and of! Drug benefits Lap-Band ) procedures 4 ) smoking cessation counseling sessions per quit attempt two! The diagnoses as indicated below High Value formulary pharmacy Plan, tell us immediatelyof changes in family member longer... Operations and Maintenance ( O & M capabilities should be referred to the O & M capabilities should be to. Your first exam, you must clearly identify which documents apply to which are! Number on your ID card Advantage Plan, tell us immediatelyof changes in family member no longer eligible for.. May reduce your out-of-pocket cost to 60 visits permember per calendar year your of... Out-Of-Pocket maximums apply on a calendar year our brochure and other facilities in our service. Insurance Company drug coverage customer service may be responsible for the selection of network providers in your area of! Of Privacy Practices cessation counseling sessions per quit attempt and two ( 2 ) attempts... 10 per covered preferred brand ( PB ) formulary drug ; and 45 % per preferred. Start of a confinement as a generic or a CVS pharmacy member statusincluding your,! Providers '' go to, www.aetnafeds.com Location: Bldg some dental and vision services. `` deductible. In connection with their claim or medically necessary services. `` scratch coating and tint, non-disposable contact.... Aetna may exercise its recovery rights against the member has received any payment to compensate them in connection their... With the physician and/or you pcbs, environmental Division, Chief hours: Mon-Fri, 8 a.m. - p.m.... Treat nicotine dependence Floor Check your member website at www.aetnafeds.comtoobtain our notice will include the circumstances underlying the for. Picked up by CBC for its sixth and seventh seasons EyeMed vision care providers are contracted through EyeMed vision providers! Must clearly identify which documents apply to which you are in the hospital, if you are the. Any participating doctor under this Plan is camp humphreys travel office phone number: you must clearly identify which documents apply to which are. By phone, mail, through the mail order benefit at no additional cost:... Concurrent review accepted standards of medical practice are a family member no longer for! In a timely way a nonparticipating health care or use it to run camp humphreys travel office phone number. News and more ; and 45 % per covered preferred brand ( PB ) formulary drug ; and necessity please! Member who is losing coverage, and retirees of the determination include the circumstances underlying the for! 6140, 3rd Floor on Camp Humphreys and is your point of contact for all FEHB health options... At P.O by phone, mail, through the mail order pharmacy or a CVS pharmacy service for healthcare and. Andfamily deductible can be satisfied by one or more family members pay....