Benefits

See below of the lists of benefits offered to Aetna Better Health members. They will help you understand what is covered by your plan, what is not and how you can get the right care when you need it.

You have access to services like doctor’s visits, lab testing, X-rays and much more. These benefits and programs help you live a healthier life. Your benefits also include preventive care and help for serious health concerns. These may be chronic diseases or mental health issues. We also can connect you with resources in your community for extra help.

Some services need prior approval before you can get them. Check with your Primary Care Provider (PCP) or call Member Services with questions at 1-866-638-1232 or TTY 7-1-1.

SKYGEN USA handles your dental benefits. Your dental benefits include:

  • All preventive care
  • Dental checkups every 6 months
  • Deep cleanings every 6 months
  • X-rays
  • Fillings

Dental benefits questions? Need help finding a dentist or scheduling an appointment? Call Member Services at 1-866-638-1232 (PA Relay: 711)

If you get a bill or statement

You shouldn’t get a bill from or have to pay a network provider for covered benefits for pre‑approved services.

If your provider didn’t receive payment from us on a provided covered benefit or service, he or she is NOT allowed to bill you for what we didn’t pay. This is called balance billing.

Also, you don’t have to pay if we don’t pay a network provider for covered benefits or services.

Finally, you’re not liable to pay for a provided covered benefit or service in the event that we didn’t receive payment from the Department.

If you receive a bill from a network provider, you should call the health care provider listed on the bill and make sure they have all your insurance information. If the provider has your insurance information and you were billed or if you get a bill that you think you should not have gotten, call Member Services.

You may get billed for these services:

  • Services by out‑of‑network providers
  • Services without pre‑approval or prior authorization
  • Services not covered under the HealthChoices benefits programs
  • Co‑payments that are your responsibility billed by network providers
  • Co‑payments and deductible amounts over the medical assistance (MA) allowable when you have other insurance

We’re only liable for services that are our responsibility.