Benefits

Covered services

A full list of covered services is found in your member handbook. All services must be medically necessary. Your doctor may have to ask us for prior approval before you can get some services. There is no cost to Aetna Better Health of Maryland members for medically necessary covered services.

If you have questions about coverage or getting services, call Member Services at 1-866-827-2710, TTY 711.

Your PCP arranges all of your health care, including sending you to a specialist if you need one. It’s important that you have a PCP that you like and will visit regularly.

Your PCP name and phone number are included on your member ID card. If you want to change your PCP, choose one from the list of providers. Call Member Services at 1-866-827-2710, TTY 711, for help to change your PCP or request a print copy of the directory. You can also submit the PCP change through our secure member portal or mobile app.

Once you choose your PCP, make your appointment right away for a first “well” checkup. This helps your PCP get to know you and catch any problems early. Your PCP will be there for you whenever you’re hurt or sick. Your children’s PCP will make sure your children get their shots on time. And, your PCP can refer you to a specialist if you need it.

If you’re pregnant, it’s important that you see a provider as soon as possible. Getting your pregnancy off to a good start is important for both you and your baby’s health. If you don’t have a provider, call Member Services at 1-866-827-2710, TTY 711, and we will help you find one.

Aetna Better Health of Maryland uses Superior Vision to give you vision services. You can call Superior Vision at 1-800-879-6901, TTY 711 (Monday-Friday 8 a.m. to 9 p.m.). You don’t need a referral to see a network vision provider. You can search for a vision provider. You can also call us for help at 1-866-827-2710, TTY 711.

Your covered services include:

  • Free eye exam every year (adults and children)
  • Children (up to age 18) receive free covered frames/lenses
  • Adults - additional benefit - $25 maximum benefit toward glasses or contacts every year

For Adults 21 and Over
Aetna Better Health of Maryland uses Avesis to provide dental services. Contact Aetna Member Services at 1-866-827-2710, TTY 711 for more information or to find a dentist.

Your covered services effective 5/1/2018 include:

  • Oral exam: 2 times each year
  • Teeth cleaning: 2 times each year
  • Bitewing X‑rays: 1 time each year
  • Fluoride (topical or varnish): 2 times each year
  • Tooth extractions: up to 4 each year
  • Fillings: up to 6 minor fillings or 12 surface fillings each year
  • Maximum benefit of $750 per year (not including basic care like exams and cleanings)
  • You can also get palliative treatment when you need it. This is for emergencies to relieve pain or fix a problem. It might include:
    • Smoothing the sharp edge of a broken tooth
    • Placing medicine on a minor cut

For Pregnant Women and Children
Dental care is directly provided by the Maryland Healthy Smiles Dental Program. Contact Scion at 1-855-934-9812 or visit the Scion Dental website for more information or to find a dentist.

Pharmacy copay: None

Check the list of network pharmacies and look for one in your area. If you need help, just call Member Services at 1-866-827-2710, TTY 711. They’ll be glad to help you find a network pharmacy near you. You can also find a pharmacy via our secure member portal.

Always remember to fill your prescription at a network pharmacy. Your prescriptions won’t be covered at other pharmacies.

Access to a nurse is available at 1-866-827-2710, 24-hours a day, 7 days a week to answer your health care questions. The nurse line does not take the place of your PCP. But, if it’s late at night or you can’t reach your PCP, the nurses can help you decide what to do. The nurses can also give you helpful hints on how to help you feel better and stay healthy.

 

Care management can make your life easier
Our care management unit has nurses and social workers that can help you:

  • Get services and care including information on how to get a referral to special care facilities for highly specialized care.
  • Work with health care providers, agencies and organizations.
  • Learn more about your condition.
  • Make a care plan that is right for you.
  • Access services after hours for crisis situations.
  • Arrange services for children with special health care needs such as well-child care, health promotion, disease prevention and specialty care services. You may have special needs and have an existing relationship with an out-of-network provider. Sometimes you can continue to see that provider if it’s in your best interest. The provider must first get approval from us.

Members with special health care needs may need to see specialists on a long term basis. Sometimes this is called a “standing referral”. The specialists must contact us for approval to make this happen. If it is in your best interest, you may have a specialist as your PCP. If you want a specialist to be your PCP, talk to the specialist about it. If you have special needs and you have not talked with one of our case managers yet, call Member Services at 1-866-827-2710, TTY 711 and ask to be transferred to a case manager.

If you have special needs or have questions about care management call Member Services at 1-866-827-2710, TTY 711. Ask to be transferred to a care manager.

Disease management program can help if you have certain conditions
We have a disease management program to help if you have certain conditions such as: 

  • Asthma
  • Chronic obstructive pulmonary disease (COPD)
  • Congestive heart failure (CHF)
  • Diabetes
  • Major Depression
  • Coronary Artery Disease (CAD)
  • Hypertension (HTN)
  • HIV
  • Severe Mental Illness (SMI)
  • Substance Abuse
  • Severe Cognitive and/or Developmental limitations

Call us at 1-866-827-2710, TTY 711 for help in managing your disease. We can help you or your child learn to manage these chronic conditions and lead a healthier life. You can learn about these programs in your member handbook.

As a member you are eligible to participate
If you are diagnosed with any of these chronic conditions, or at risk for them, you may be enrolled in our disease management program. You can also ask your provider to request a referral. If you want to know more about our disease management programs, call us at 1-866-827-2710, TTY 711.

I don’t want to participate
You have the right to make decisions about your health care. If we contact you to join in one of our programs, you may refuse. If you’re already in one of our programs, you may choose to stop at any time by contacting us at 1-866-827-2710, TTY 711

Additional benefits

Aetna Better Health of Maryland offers additional benefits to members beyond the basic covered services.

If you’re expecting a baby, our Promise program is for you. Our maternity care program helps you learn how to take care of yourself and your baby. You’ll get support and help throughout your pregnancy. Our Promise program is a benefit for you before and after your baby is born.

  • You will earn a $10 gift card when you complete at least 7 prenatal visits.
  • You will earn a $25 gift card when you complete your postpartum visit. This visit must be within 21-56 days after your baby is born.

  • You can earn an addition $5 gift card for attending each of the below:

- A birthing class
- A parenting class
- A first aid, safety or CPR class

Sometimes babies are born early even with pregnancy care. If this does happen, we still want to reward you for taking care of yourself and the baby:

  • If you meet with your care manager and take a parenting class you can earn a $5 gift card
  • If you complete a CPR class and attend all training at the hospital prior to baby’s discharge you will earn a $5 gift card
  • Attend a parenting class you can earn a $5 gift card

Plus sign up for Text4baby™ a free text service on your cell phone that sends you health tips and reminders throughout your pregnancy. 

  • For Ted. E. Bear, M.D. Kids Club members we will pay the cost for an annual Scout membership. This applies to both Boy Scouts and Girl Scouts. As a bonus, Club members who stay in Boy Scouts get the Boys’ Life magazine. Girl Scouts members can get A Girl’s Guide to Girl Scouting plus one Journey book or a basic uniform after 6 months of joining. OR we will pay the annual membership for the local YMCA ($60 annual value).
  • We offer a weight management program. Members receive gifts for joining the program. Each member then works with a case manager to set goals based on the child’s weight and height needs. Members can earn gift cards from $15 to $30 as they meet the weight loss goals.
  • For school-age kids with asthma, we offer a second inhaler; one to stay at home and one to go to school.
  • We offer teens a program to help them stop smoking. This includes members who use cigarettes, smokeless tobacco, hookah, e-cigs, even second hand-smoke. Teens work with a case manager to create a stop smoking plan. They will throw away all tobacco products and receive a $10 gift card. If they remain tobacco free for 30 days they will get another $10 gift card.
  • Members with asthma can get a $10 gift card for managing their asthma by having an asthma action plan and reducing ED visits.
  • You can get a $10 gift card for follow-up with a PCP visit after an ED episode.
  • We also offer a $10 gift card for an in-home environmental assessment for members diagnosed with asthma.

For everyone 6 months and older - free yearly flu shots.