Aetna MedicareSM Plan (HMO) (PPO)

If you are traveling outside of the Aetna Medicare(HMO) (PPO) plan service area, you are covered foremergency and urgently needed care. Urgent caremay be obtained from a private practice physician, awalk-in clinic, an urgent care center or an emergencyfacility. If, after reviewing information submitted to usby the provider that supplied care, the nature of theurgent or emergency problem does not qualify forcoverage, it may be necessary to provide us withadditional information.Follow-up care after emergenciesAll follow-up care should be coordinated by your PCP.Follow-up care with nonparticipating providers is onlycovered with a referral from your PCP and priorauthorization from Aetna. Whether you were treatedinside or outside your Aetna Medicare service area, ifyour plan requires referrals, you must obtain a referralbefore any follow-up care can be covered. If your plandoes not require referrals you should contact Aetna atthe number on your ID card before care is received atnon–network facilities. Suture removal, cast removal,X-rays and clinic and emergency room revisits aresome examples of follow-up care.PPO plans: All in-network and out-of-network followupcare will be covered under the terms andconditions of your plan.Emergency care can always be obtained in or out ofthe service area from the nearest available provider.When in the service area HMO plan members mustuse plan providers for urgent care. When out of theservice area urgent care may be obtained from thefirst available provider. In addition, when out of theservice area you can obtain dialysis treatment from anyqualified dialysis provider. If HMO plan membersobtain routine care from out-of-network providersneither Medicare nor Aetna Medicare will beresponsible for the costs.What is the service area for the AetnaMedicare (HMO) (PPO) plan?The counties in our service area are listed below.Individual and Employer Group Service AreaCounties:See Service Area Maps at the front of this directory forproduct detail.Frederick, Howard, Montgomery, Prince George’sHow do you find Aetna Medicare (HMO)(PPO) plan providers in your area?To find a plan provider near your home, look underthe plan provider section of your choice (for example,“Primary Care Physicians”). The county and city arelisted alphabetically in each plan provider section.If you have questions about your Aetna MedicareHMO or PPO plan or require assistance in selecting aPCP, please call our Member Service Department at1-800-282-5366, 8 am to 8 pm, 7 days a week.TTY/TDD users should call 1-888-760-4748.Or, visit www.aetnamedicare.com.VIII