AETNA PPO PLAN - My Benefits Portfolio - Trinity Health

Non-Urgent Care includes, but is not limited to, the following:
• Routine or preventive care (this includes immunizations);
• Follow-up care;
• Physical therapy;
• Elective surgical procedures; and
• Any lab and radiologic exams which are not related to the treatment of the Urgent Condition.
TREATMENT OF ALCOHOLISM, DRUG ABUSE, OR MENTAL DISORDERS
Certain expenses for the treatment shown below are Covered Expenses.
INPATIENT TREATMENT
The following coverage applies if a Covered Individual is a full-time Inpatient in either a Hospital or a
Residential Treatment Facility:
HOSPITAL
Covered Expenses include:
• Treatment of the medical complications of alcoholism or drug abuse (this means such as cirrhosis of the
liver, delirium tremens, or hepatitis)
• Effective Treatment of Alcoholism or Drug Abuse
• Effective Treatment of Mental Disorders
RESIDENTIAL TREATMENT FACILITY
Covered Expenses for the Effective Treatment of Alcoholism or Drug Abuse or the Treatment of Mental
Disorders include:
• Board and room (however, any charge for daily room and board in a private room over the Private Room
Limit is not covered)
• Other necessary services and supplies
OUTPATIENT TREATMENT
The following coverage applies if a Covered Individual is not a full-time Inpatient either a Hospital or a
Residential Treatment Facility:
Expenses for the Effective Treatment of Alcoholism or Drug Abuse or the Treatment of Mental Disorders are
covered.
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