Rights & Responsibilities

It is the policy of Aetna Better Health of Virginia (HMO SNP) to treat you with respect. We also care about keeping a high level of confidentiality with respect for your dignity and privacy. As a member, you have certain rights, to learn more view our member materials to view the Evidence of Coverage, Notice of Privacy Practice and multi-language insert.

Your Rights

Our plan has people and free language interpreter services available to answer questions from non-English speaking members. We can also give you information in Braille, in large print, or other alternate formats if you need it. If you are eligible for Medicare because of a disability, we are required to give you information about the plan’s benefits that is accessible and appropriate for you. It's free. To get information from us in a way that works for you, please call Member Services 1-855-463-0933 (TTY: 711) 8 a.m. to 8 p.m., 7 days a week. The call is free.

Our plan must obey laws that protect you from discrimination or unfair treatment. We do not discriminate based on a person’s race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability, or geographic location within the service area.

If you want more information or have concerns about discrimination or unfair treatment, please call the Department of Health and Human Services’ Office for Civil Rights at 1-800-368-1019 (TTY: 1-800-537-7697) or your local Office for Civil Rights.

If you have a disability and need help with access to care, or if you have a complaint, such as a problem with wheelchair access, call Member Services at 1-855-463-0933 (TTY: 711) 8 a.m. to 8 p.m., 7 days a week.

As a member of our plan, you have the right to choose a primary care provider (PCP) in the plan’s network to provide and arrange for your covered services (Chapter 3 in the Evidence of Coverage explains more about this). Please call Member Services at 1-855-463-0933 (TTY: 711) 8 a.m. to 8 p.m., 7 days a week to learn which doctors are accepting new patients. You also have the right to go to a women’s health specialist (such as a gynecologist) without a referral.

As a plan member, you have the right to get appointments and covered services from the plan’s network of providers within a reasonable amount of time. This includes the right to get timely services from specialists when you need that care. You also have the right to get your prescriptions filled or refilled at any of our network pharmacies without long delays.

Federal and state laws protect the privacy of your medical records and personal health information. We protect your personal health information as required by these laws.

  • Your “personal health information” includes the personal information you gave us when you enrolled in this plan as well as your medical records and other medical and health information.
  • The laws that protect your privacy give you rights related to getting information and controlling how your health information is used. We give you a written notice, called a “Notice of Privacy Practice,” that tells about these rights and explains how we protect the privacy of your health information.

How do we protect the privacy of your health information?

  • We make sure that unauthorized people don’t see or change your records.
  • In most situations, if we give your health information to anyone who isn’t providing your care or paying for your care, we are required to get written permission from you first. Written permission can be given by you or by someone you have given legal power to make decisions for you.
  • There are certain exceptions that do not require us to get your written permission first. These exceptions are allowed or required by law.
    • For example, we are required to release health information to government agencies that are checking on quality of care.
    • Because you are a member of our plan through Medicare, we are required to give Medicare your health information including information about your Part D prescription drugs. If Medicare releases your information for research or other uses, this will be done according to Federal statutes and regulations.

You can see the information in your records and know how it has been shared with others

You have the right to look at your medical records held at the plan, and to get a copy of your records. We are allowed to charge you a fee for making copies. You also have the right to ask us to make additions or corrections to your medical records. If you ask us to do this, we will work with your health care provider to decide whether the changes should be made.

You have the right to know how your health information has been shared with others for any purposes that are not routine.

If you have questions or concerns about the privacy of your personal health information, please call Member Services at 1-855-463-0933 (TTY: 711) 8 a.m. to 8 p.m., 7 days a week.

As a member of Aetna Better Health of Virginia (HMO SNP), you have the right to get several kinds of information from us. You have the right to get information from us in a way that works for you. This includes getting the information in languages other than English and in large print or other alternate formats. It's free.

If you want any information, please call Member Services at 1-855-463-0933 (TTY: 711) 8 a.m. to 8 p.m., 7 days a week. The call is free.

  • Information about our plan.
  • Information about our network providers including our network pharmacies.
  • Information about your coverage and the rules you must follow when using your coverage.
  • Information about why something is not covered and what you can do about it.

You have the right to get full information from your doctors and other health care providers when you go for medical care. Your providers must explain your medical condition and your treatment choices in a way that you can understand.

You also have the right to participate fully in decisions about your health care.

Learn more about your rights in the Evidence of Coverage.

If you have any problems or concerns about your covered services or care, the Evidence of Coverage tells what you can do. It gives the details about how to deal with all types of problems and complaints. What you need to do to follow up on a problem or concern depends on the situation. You might need to ask our plan to make a coverage decision for you, make an appeal to us to change a coverage decision, or make a complaint. Whatever you do – ask for a coverage decision, make an appeal, or make a complaint – we are required to treat you fairly.

You have the right to get a summary of information about the appeals and complaints that other members have filed against our plan in the past. To get this information, please call Member Services at 1-855-463-0933 (TTY: 711) 8 a.m. to 8 p.m., 7 days a week.

If it is about discrimination, call the Office for Civil Rights
If you believe you have been treated unfairly or your rights have not been respected due to your race, disability, religion, sex, health, ethnicity, creed (beliefs), age, or national origin, you should call the Department of Health and Human Services’ Office for Civil Rights at 1-800-368-1019 (TTY: 1-800-537-7697), or call your local Office for Civil Rights.

Is it about something else?
If you believe you have been treated unfairly or your rights have not been respected, and it’s not about discrimination, you can get help dealing with the problem you are having:

  • You can call Member Services at 1-855-463-0933 (TTY: 711) 8 a.m. to 8 p.m., 7 days a week.
  • You can call the State Health Insurance Assistance Program. For details about this organization and how to contact it, go to  the Evidence of Coverage.
  • Or, you can call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

There are several places where you can get more information about your rights:

  • You can call Member Services  at 1-855-463-0933 (TTY: 711) 8 a.m. to 8 p.m., 7 days a week.
  • You can call the State Health Insurance Assistance Program. For details about this organization and how to contact it, go to Chapter  the Evidence of Coverage.
  • You can contact Medicare.
    • You can visit the Medicare website to read or download the publication “Your Medicare Rights & Protections.”
    • Or, you can call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

To end your membership in our plan, you simply enroll in another Medicare plan. However, if you want to switch from our plan to Original Medicare but you have not selected a separate Medicare prescription drug plan, you must ask to be disenrolled from our plan. There are two ways you can ask to be disenrolled:

  • You can make a request in writing to us or contact Member Services at 1-855-463-0933 (TTY: 711) 8 a.m. to 8 p.m., 7 days a week
  • --or-- You can contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

Generally, your membership will end on the last day of the month after we get your request to switch to Original Medicare or another plan.

Have questions about ending your coverage? You can call us at 1-855-463-0933 (TTY: 711) 8 a.m. to 8 p.m., 7 days a week.

Your Responsibilities

Use the Evidence of Coverage to learn what is covered for you and the rules you need to follow to get your covered services.

  • The Evidence of Coverage give the details about your medical services, including what is covered, what is not covered, rules to follow, and what you pay.
  • The Evidence of Coverage give the details about your coverage for Part D prescription drugs.

Please call Member Services at 1-855-463-0933 (TTY: 711) 8 a.m. to 8 p.m., 7 days a week to let us know.

We are required to follow rules set by Medicare and Medicaid to make sure that you are using all of your coverage in combination when you get your covered services from our plan. This is called “coordination of benefits” because it involves coordinating the health and drug benefits you get from our plan with any other health and drug benefits available to you. We’ll help you coordinate your benefits.

Show your Aetna Better Health of Virginia membership card and your Medicaid card whenever you get your medical care or Part D prescription drugs.

  • To help your doctors and other health providers give you the best care, learn as much as you are able to about your health problems and give them the information they need about you and your health. Follow the treatment plans and instructions that you and your doctors agree upon.
  • Make sure your doctors know all of the drugs you are taking, including over-the-counter drugs, vitamins, and supplements.
  • If you have any questions, be sure to ask. Your doctors and other health care providers are supposed to explain things in a way you can understand. If you ask a question and you don’t understand the answer you are given, ask again.

We expect all our members to respect the rights of other patients. We also expect you to act in a way that helps the smooth running of your doctor’s office, hospitals, and other offices.

As a plan member, you are responsible for these payments:

  • In order to be eligible for our plan, you must have Medicare Part A and Medicare Part B. For most Aetna Better Health of Virginia (HMO SNP) members, Medicaid pays for your Part A premium (if you don’t qualify for it automatically) and for your Part B premium. If Medicaid is not paying your Medicare premiums for you, you must continue to pay your Medicare Aetna Better Health of Virginia (HMO SNP) premiums to remain a member of the plan.
  • For most of your medical services or drugs covered by the plan, you must pay your share of the cost when you get the service or drug. This will be a copayment (a fixed amount) OR coinsurance (a percentage of the total cost). The Evidence of Coverage tells what you must pay for your medical services. The Evidence of Coverage tells what you must pay for your Part D prescription drugs.
  • If you get any medical services or drugs that are not covered by our plan or by other insurance you may have, you must pay the full cost.
  • If you disagree with our decision to deny coverage for a service or drug, you can make an appeal. Please see the Evidence of Coverage for information about how to make an appeal.
  • If you are required to pay the extra amount for Part D because of your higher income (as reported on your last tax return), you must pay the extra amount directly to the government to remain a member of the plan.

If you are going to move, it’s important to tell us right away. Call Member Services at 1-855-463-0933 (TTY: 711) 8 a.m. to 8 p.m., 7 days a week.

  • If you move outside of our plan service area, you cannot remain a member of our plan. (the Evidence of Coverage tells about our service area.) We can help you figure out whether you are moving outside our service area. If you are leaving our service area, you will have a Special Enrollment Period when you can join any Medicare plan available in your new area. We can let you know if we have a plan in your new area.
  • If you move within our service area, we still need to know so we can keep your membership record up to date and know how to contact you.
  • If you move, it is also important to tell Social Security (or the Railroad Retirement Board). You can find phone numbers and contact information for these organizations in the Evidence of Coverage.

You must file Form 1040, US Individual Income Tax Return, along with Form 8853, “Archer MSA and Long-Term Care Insurance Contracts” with the Internal Revenue Service (IRS) for any distributions made from your Medicare MSA account to ensure you aren’t taxed on your MSA account withdrawals. You must file these tax forms for any year in which an MSA account withdrawal is made, even if you have no taxable income or other reason for filing a Form 1040. MSA account withdrawals for qualified medical expenses are tax free, while account withdrawals for non-medical expenses are subject to both income tax and a fifty (50) percent tax penalty.

Tax publications are available on the IRS website or from 1-800-TAX-FORM (1-800-829-3676).

 

We also welcome any suggestions you may have for improving our plan.

  • Please call Member Services at 1-855-463-0933 (TTY: 711) 8 a.m. to 8 p.m., 7 days a week.