Member Materials

Want to understand the details of your health plan? Review the documents below. These documents go over your health plan and show what is covered and what is not. Plus, they also explain our care management and pharmacy programs. They give you information about how to file grievances and appeals and find a doctor.

Evidence of Coverage - Bexar and Guadalupe counties

English/Español

Evidence of Coverage - Johnson and Tarrant counties

English/Español

Summary of Benefits - Bexar and Guadalupe counties

English/Español

Summary of Benefits - Johnson and Tarrant counties

English/Español

 

List of Covered Drugs 

(English/Español)

 

Prescription Drug Search Tool

Pharmacy Search Tool

LIS Premium Summary Chart

This information is not a complete description of benefits. Contact the plan for more information. Benefits and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network and/or provider network may change at any time.  You will receive notice when necessary. Limitations, copayments and restrictions may apply. You must receive all routine care from plan providers. This is general health information and is not meant to replace care or advice you get from your doctor. Always ask your doctor or other health care provider for information about your own health care needs.

Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna Medicare Dual Core. The availability of any particular provider cannot be guaranteed, and the provider network is subject to change. You will receive notice when necessary.