![]() Subject you to severe pain that cannot be adequately managed without the requested care or treatmentĪs soon as possible but not later than 72 hours.Seriously jeopardize your life or health, or your ability to regain maximum function, or.Urgent care claim: a claim for medical care or treatment where delay could: Please see Complaints and Appeals for more information about appeals. The notice you receive from Aetna will provide important information that will assist you in making an appeal of the adverse benefit determination, if you wish to do so. These time frames may be extended under certain limited circumstances. it is not included in the list of covered benefits,Īetna will provide you with written notices of adverse benefit determinations within the time frames shown below.Aetna determines that a benefit or service is not covered by the Plan because:.The individual is not eligible to participate in the Plan, or.Adverse benefit determinations can be made for one or more of the following reasons: It also means a decision not to provide a benefit or service. For other types of claims, you may only receive notice if Aetna makes an adverse benefit determination.Īdverse benefit determinations are decisions Aetna makes that result in denial, reduction, or termination of a benefit or the amount paid for it. For concurrent care claims, Aetna will send you written notification of an affirmative benefit determination. You must submit a claim form within two calendar years from the date of a service.Īetna will make a decision on your claim using coverage policies and the definitions found in the Key Terms section of this document. Send the itemized bill for payment with your identification number clearly marked to the address shown on your ID card. However, if you receive a bill for covered services, the bill must be submitted promptly to Aetna for payment. You do not need to submit a claim for most of your covered healthcare expenses. Payment for items or services received.An authorization or referral from a participating provider or Aetna, or.Medication information and disclosure formsĪ claim occurs whenever a plan participant requests:.Family Adjustment, Family Income, Contributory Group Life Insurance (Grandfathered).Financial Fitness Program (EY Financial Planning Center).Illinois Consumer Coverage Disclosure Act Information. ![]() New Benefits Plan deadlines due to COVID-19.Information on COVID OTC Test for Medicare Participants.COVID OTC Test - International Medical Dental Plan.ExxonMobil Vision Plan: ID cards update.Retiree Medical Plan summary plan descriptions. ![]()
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