Important info about your Aetna Better Health® of Kentucky plan
Get to know your rights and responsibilities, quality and case management programs, accessing benefits and services like pharmacy, privacy info and more.
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Where to find important info about your plan
Your rights and responsibilities
How we make decisions about your health care (utilization management)
Where to find important info
Your Aetna Better Health member handbook covers everything you need to know about your health plan. You can find info on:
- What your plan covers, and what it does not
- How to get your medicine and use your pharmacy benefits
- Copays and other costs you may need to pay
- What’s covered outside the Aetna Better Health network
- How to get language help at no cost
- How to ask for auxiliary aids and services at no cost
- How to submit a claim
- How to get info about providers in the Aetna Better Health network
- How to get primary care services
- How to get specialty care. This includes:
- Behavioral health care
- Hospital services
- Care for specific conditions
- How to get a referral
- How to get care after normal office hours
- How and when to use emergency room care
- How to get care outside of your service area
- How to file a complaint or grievance
- How to appeal a decision that affects your coverage, benefits or relationship with your plan
- How we decide which new services or tools we cover
- How we make decisions about your care (called utilization management)
- Your member rights and responsibilities
- Notice of privacy practices
We update the handbook every year. If we make major changes, we will send you a letter at least 30 days before they start.
You can view your handbook online at AetnaBetterHealth.com/kentucky/member-materials-forms.html.
Prefer a hard copy? Call us at 1-855-300-5528 (TTY: 711) to have one mailed to you. Let us know if you need it in another language, a larger font or other formats.
Get the most out of your benefits
Your rights and responsibilities
As an Aetna Better Health member, you have certain rights and responsibilities.
Your rights include:
- A right to get info about:
- The organization and its services
- The organization’s practitioners and providers
- Your member rights and responsibilities
- A right to be treated with respect and dignity
- A right to privacy
- A right to work with your providers to make decisions about your health care
- A right to talk openly about treatment options, regardless of cost or benefit coverage
- A right to voice complaints or submit appeals about the organization or the care it provides
- A right to give feedback on the organization’s member rights and responsibilities policy
Your responsibilities include:
- A responsibility to give info that the organization and its providers need to provide you with care
- A responsibility to follow plans for care that you have agreed to with your providers
- A responsibility to understand your health problems and join in developing treatment goals
Go to AetnaBetterHealth.com/kentucky/medicaid-rights-responsibilities.html for a complete list of your rights and responsibilities.
Your pharmacy benefits
Learn more about your pharmacy benefits at AetnaBetterHealth.com/kentucky/pharmacy-prescription-drug-benefits.html. You can find info such as:
- Preferred drug list (PDL) or formulary
- Medications that require prior authorization and coverage criteria
- A list and explanation of medications that have limits or quotas
- Copayment and coinsurance requirements and the medications or classes to which they apply
- Steps for getting clinical or PDL prior authorization, generic substitution or preferred brand interchange
- Info on pharmaceutical management procedures
- Criteria used to add new medicines to the formulary
- How to ask for a coverage exception
How we make decisions about your health care
Our utilization management (UM) program ensures you get the right care in the right setting when you need it. UM staff can help you and your providers make decisions about your health care.
When we make decisions, it’s important for you to remember the following:
- We make UM decisions by looking at your benefits and clinical guidelines for the most appropriate care and service. We consider:
- Your needs
- Evidenced-based practice
- Availability of care
- You also must have active coverage.
- We don’t reward providers or other people for denying coverage or care.
- Our employees do not get any incentives to reduce the services you get.
If you have questions about UM, call Member Services. They can also help if you need language translation or support.
Get extra support for your health care needs
Every Aetna Better Health member is on their own health care journey. We can help guide you in managing and improving your health. Our population health management programs can help with things like:
- Managing a health condition
- Pregnancy care
- When to use urgent care
- What to do after a hospital stay
- Staying healthy and preventing health problems
You can learn more about our programs at AetnaBetterHealth.com/kentucky or in your member handbook.
For most programs, we will automatically enroll you if you are eligible. You can choose to join or leave a program at any time by calling Member Services.
You can also get a referral to a management program. Referrals can come from:
- Your provider
- A medical management program
- Hospital discharge planner
- A caregiver
- Yourself
Call us at 1-855-300-5528 (TTY: 711) or go to our website for a member referral into case management.
Care you can trust
Our network providers follow proven care guidelines. These guidelines:
- Are based on strong medical evidence or agreement among experts in the field
- Take members’ needs into account
- Are created with input from the providers we work with
- Are checked and updated at least every two years
You or your provider can call us for a copy of these guidelines. Find out more at AetnaBetterHealth.com/kentucky/providers/clinical-guidelines-policy-bulletins.html.
Quality matters
You deserve the best care. And we work with your provider to make sure that happens.
Our Quality Improvement (QI) program helps us make our services better. We share info about our QI program with members every year. You can find this info at AetnaBetterHealth.com/kentucky/quality-improvement-program.html.
We care about your privacy
We protect your personal health information (PHI). That includes your:
- Race
- Ethnicity
- Language
- Sexual orientation
- Social needs info
We only share your info when needed and as allowed by law.
You have rights over your health data. That includes how it’s used and who can access it. Go to AetnaBetterHealth.com/health-optimization-disclaimer.html to learn more about your privacy rights and how we safeguard your data.
Language assistance
Aetna follows applicable Federal civil rights laws. Aetna does not discriminate on the basis of race, color, national origin, age, disability, or sex.
Don't speak English or need auxiliary aids and services? Aetna provides interpreter services at no cost, including sign language interpreters. Call the number on the back of your ID card for help. You can also ask for written info in another language or format, including:
- Large print
- Audio
- Accessible electronic formats
Go to AetnaBetterHealth.com/kentucky/notice-of-non-discrimination.html for more info.
ENGLISH: ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call the number on the back of your ID card or 1-800-385-4104 (TTY: 711).
SPANISH: ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al número que aparece en el reverso de su tarjeta de identificación o al 1-800-385-4104 (TTY: 711).
CHINESE: 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電您的 ID 卡背面的電話號碼或 1-800-385-4104 (TTY: 711)。
GERMAN: ACHTUNG: Wenn Sie deutschen sprechen, können Sie unseren kostenlosen Sprachservice nutzen. Rufen Sie die Nummer auf der Rückseite Ihrer ID-Karte oder 1-800-385-4104 (TTY: 711) an.
VIETNAMESE: CHÚ Ý: nếu bạn nói tiếng việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Hãy gọi số có ở mặt sau thẻ id của bạn hoặc 1-800-385-4104 (TTY: 711).
ARABIC: يمكن للأشخاص الذين يعانون من ضعف في السمع أو من الصمم التواصل مع خدمات المساعدة اللغوية المجانية من خلال الاتصال برقم 1-800-895-4728 (الهاتف النصي: 711).
SERBO-CROATIAN: OBAVEŠTENJE: Ako govorite srpski, usluge jezičke pomoći dostupne su vam besplatno. Pozovite broj na poleđini vaše identifikacione kartice ili broj 1-800-385-4104 (TTY – telefon za osobe sa oštećenim govorom ili sluhom: 711).
JAPANESE: 注意事項:日本語をお話になる方は、無料で言語サポートのサービスをご利用いただけます。IDカード裏面の電話番号、または 1-800-385-4104 (TTY: 711)までご連絡ください。
FRENCH: ATTENTION: si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le numéro indiqué au verso de votre carte d’identité ou le 1-800-385-4104 (ATS: 711).
KOREAN: 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 귀하의 ID 카드 뒷면에 있는 번호로나 1-800-385-4104 (TTY: 711) 번으로 연락해 주십시오.
PENN DUTCH: Geb Acht: Wann du Deitsch Pennsilfaanisch Deitsch schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf die Nummer uff, ass hinne uff dei ID card iss, odder ruf 1-800-385-4104 (TTY: 711).
NEPALI: ध्यान दिनुहोस्: यदि तपाईं नेपाली भाषा बोल्नुहुन्छ भने तपाईंका लागि निःशुल्क रूपमा भाषा सहायता सेवाहरू उपलब्ध छन्। तपाईंको आइडी कार्डको पछाडि रहेको नम्बर वा 1-800-385-4104 (TTY: 711) मा फोन गर्नुहोस्।
OROMO (CUSHITE): Hubadhu: yoo Oromoo dubbatta ta’ee, gargaarsa tajaajiiloota afaanii, kaffaalttii bilisaa ni jiraa siif. Lakkoofsa bilbiilaa ID kee duuba irraa jiruun yookiin 1-800-385-4104 (TTY: 711).
RUSSIAN: ВНИМАНИЕ: если вы говорите на русском языке, вам могут предоставить бесплатные услуги перевода. Позвоните по номеру, указанному на обратной стороне вашей идентификационной карточки, или по номеру 1-800-385-4104 (TTY: 711).
TAGALOG: PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. Tumawag sa numero na nasa likod ng iyong ID card o sa 1-800-385-4104 (TTY: 711).
KIRUNDI (BANTU): ICITONDERWA: Namba uvuga Ikirundi, serivisi zigufasha kugusigurira ururimi, ku buntu, ziraboneka ushobora kuzironswa. Hamagara inomero iri inyuma ku gakarata k’akarangamuntu kawe canke iyi nomero 1-800-385-4104 (Ufise ubumuga bwo kutumva neza ifashishe (TTY): 711).
