Important info about your Aetna Better Health® of Florida 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/florida/member-materials-forms.html.
Prefer a hard copy? Call us to have one mailed to you. Let us know if you need it in another language, a larger font or other formats.
Member Services
Medicaid Medical Manages Assistance (MMA): 1-800-441-5501 (TTY: 711)
Florida Health Kids (FHK): 1-844-528-5815 (TTY: 711)
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/florida/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/florida/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 us. We 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
Click here to learn more about our programs 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 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/florida/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/florida/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
- Disability status
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/florida/notice-of-non-discrimination.html for more info.
ENGLISH: Attention: If you speak English, free language assistance services are available to you. Appropriate auxiliary aids and services to provide information in accessible formats are also available free of charge. Call 1-800-385-4104 (TTY: 711) or speak to your provider.
SPANISH: ATENCIÓN: Si habla español, tiene a su disposición servicios de idiomas gratuitos. También, están disponibles sin cargo ayudas y servicios auxiliares apropiados para brindarle información en formatos accesibles. Llame al 1-800-385-4104 (TTY: 711) o hable con su proveedor.
FRENCH CREOLE: ATANSYON: Si w pale Kreyòl Ayisyen, gen asistans pou lang gratis ki disponib pou ou. Èd ak sèvis oksilyè pou bay sèvis nan fòma ki aksesib disponib tou gratis. Rele 1-800-385-4104 (TTY: 711) oswa pale ak founisè w la.
VIETNAMESE: CHÚ Ý: Nếu bạn nói tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Bạn cũng sẽ được cung cấp miễn phí các dịch vụ và hỗ trợ bổ sung thích hợp để nhận thông tin ở các định dạng dễ tiếp cận. Hãy gọi số 1-800-385-4104 (TTY: 711) hoặc trao đổi với nhà cung cấp dịch vụ của bạn.
PORTUGUESE: Atenção: se você fala português, serviços gratuitos de assistência linguística estão disponíveis para você. Além disso, oferecemos, sem custo adicional, recursos auxiliares adequados para disponibilizar informações em formatos acessíveis. Ligue para 1-800-385-4104 (TTY: 711) ou fale com o profissional de saúde responsável pelo seu cuidado.
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，亦可以免費獲得 適當的輔助工具和服務，以便您無障礙地使用資訊。請致電 1-800-385-4104 (TTY: 711)或 諮詢您的醫療保健提供者。
FRENCH: ATTENTION: Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Des aides et services auxiliaires adéquats visant à fournir des informations dans des formats accessibles sont également proposés gratuitement. Appelez le 1-800-385-4104 (TTY: 711) ou adressez-vous à votre prestataire.
TAGALOG: Paunawa: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyong tulong sa wika. Magagamit din nang libre ang mga naaangkop na pantulong na device at serbisyo para magbigay ng impormasyon sa mga naa-access na format. Tumawag sa 1-800-385-4104 (TTY: 711) o makipag-usap sa iyong provider.
RUSSIAN: ВНИМАНИЕ: если вы говорите на русском языке, вам могут предоставить бесплатные услуги перевода. Кроме того, бесплатно предоставляются соответствующие вспомогательные средства и услуги по передаче информации в доступных форматах. Позвоните по номеру 1-800-385-4104 (TTY: 711) или обратитесь к своему поставщику услуг.
ARABIC: ذا كنت تتحدث اللغة العربیة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان . وكما
تتوفر ً أیضا معینات وخدما ت مساعدة مناسبة لتقدیم المعلومات بتنسیقات یسھل الوصول
أو تحدث إلى مقدم الخدمة الخاص بك.
(TTY: 711) 1-800-385-4104
إلیھا مجانا اتصل على الرقم
ITALIAN: ATTENZIONE: Nel caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguis ca gratuita. Sono inoltre disponibili gratuitamente adegua aiu e servizi ausiliari per fornire informazioni in forma accessibili. Chiamare il numero 1-800-385-4104 (TTY: 711) o parlare con il proprio fornitore.
GERMAN: ACHTUNG:Wenn Sie Deutsch sprechen, stehen Ihnen kostenlose Sprachassistenzdienste zur Verfügung. Geeignete Hilfsmitel und Dienstleistungen zur Bereitstellung von Informa onen in zugänglicher Form sind ebenfalls kostenlos erhältlich. Rufen Sie 1-800-385-4104 ((TTY: 711) an oder sprechen Sie mit Ihrem Anbieter.
KOREAN: 주의: 한국어를 구사하는 경우, 무료 언어 지원 서비스를 이용할 수 있습니다. 접근 가능한 형식으로 정보를 제공하는적절한 보조 도구와 서비스도 무료로 이용할 수 있습니다. 1-800-385-4104 (TTY: 711)로 전화하거나 제공업체와 통화하세요.
POLISH: UWAGA: Jeśli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Dodatkowe środki pomocnicze oraz usługi, zapewniające informacje w dostępnych formatach, są również dostępne nieodpłatnie. Zadzwoń pod numer 1-800-385-4104 (TTY: 711) albo zwróć się do swojego dostawcy.
GUJARATI: ધ્યાન આપો: જો તમે ુજરાતી બોલતા હો, તો ન: ુલ્ક ભાષા સહાયતા સેવાઓ તમારા માટે ઉપલબ્ધ છે. ુલભ ફોમ ટમાં મા હતી મેળવવા માટે યોગ્ય સહાયક સહાયતા અને સેવાઓ પણ ન: ુલ્ક ઉપલબ્ધ છ.ે 1-800-385-4104 (TTY: 711) પર કૉલ કરો અથવા તમારા પ્રદાતા સાથે વાત કરો.
THAI: ข้อควรระวัง: ถ้าคุณพูดภาษาไทย คุณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรี มีความช่วยเหลือและบริการเสริมจัดไว้ให้เพื่อใช้ตรวจสอบข้อมูลผ่านรูปแบบที่เข้าถึงได้โดยไม่เสีย ค่าใช้จ่ายใด ๆ ติดต่อหมายเลข 1-800-385-4104 (TTY:711) หรือพูดคุยกับผู้ให้บริการของคุณโดย ตรง
