In CA : Some hospitals and other providers do not provide one or more of the following services that may be covered under your policy and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you become a policyholder or select a network provider. Call your prospective doctor or clinic, or call Member Services using the number of the back of your ID card to ensure that you can obtain the health care services that you need.

A paper directory is also available at no cost to members and members of the public.

To request a print directory:

Aetna Members:

• You can call us at the toll-free number on your ID card.
• Visit Member Services and log in by choosing Contact Us to complete a request, or
• Request a copy in writing at:
  
     Aetna
  
     PO Box 14079
  
     Lexington, KY 40512- 4079

Members of the Public:

• You can call us at 800-445-5299,
• Visit Member Services to complete a request, or
• Request a copy in writing at:
  
     Aetna
  
     PO Box 14079
  
     Lexington, KY 40512- 4079
  
  

If eligible health services are not available from a network provider, we will arrange for you to get the services from an out-of-network provider. Your claim will be paid at the network provider cost sharing level. This means you will pay the in-network copayments and coinsurance and the cost will apply to your in-network deductible (if any) and in-network maximum out-of-pocket limit.

To receive the highest level of benefits under the plan, you may be required to get an authorization or referral from your PCP before you can see a provider (for e.g. a network specialist). A ''referral'' is a written request for you to see another doctor. Some doctors can send the referral right to your specialist for you.

• Title VI of the Civil Rights Act of 1964
• Age Discrimination Act of 1975
• Americans with Disabilities Act of 1990
• Section 504 of the Rehabilitation Act of 1973
• Laws that apply to those who receive federal funds
• All other laws that protect your rights to receive health care

In Massachusetts, , all primary care physicians and specialists are reimbursed on a fee schedule unless otherwise noted.
Definitions for compensation methodologies:

• Capitation: Provider receives a fixed, age/sex-adjusted, periodic prepayment based upon the members in a Provider's panel. Primary Care Physicians also receive a Quality Enhancement payment for maintaining open panels.
• Fee Schedule:Provider is paid a fee for each service rendered as billed by Provider.
• Discount from Charges: Provider receives an agreed upon percentage discount from the Provider's billed charges for services rendered.
• Per Diem: Provider receives a fixed payment per day of service. Payment amount may depend upon services provided and length of stay.
• Case Rate: Provider receives a fixed payment for providing services to a member based upon the diagnosis of the patient.

Massachusetts hospitals are reimbursed based upon a combination of payment methodologies including Per Diems, Case Rates, Fee Schedules, Discount From Charges, Capitation.

In Texas, members covered under Aetna Open Access® (HMO) or Aetna Choice® POS, PCP means physician (primary care).

For Utah members covered under Aetna HMO, Aetna Choice® POS, Aetna Health Network Only^SM, and Aetna Health Network Option^SM:

You may be entitled to coverage for health care services from the following non-participating providers if you live or reside within 30 paved road miles of the listed providers, or if you live or reside in closer proximity to the listed providers than to Aetna participating providers:

• Halchita Clinic, San Juan County, Utah

If you have questions concerning your rights to see a provider on this list, you may contact Customer Service at the number located on the ID card. If we do not resolve your problem, you may contact the Office of Consumer Health Assistance in the Utah Insurance Department toll free at 1-866-350-6242.

In Washington,
When a referral is needed from your primary care provider
As an Aetna Open Choice and Aetna Whole Health Open Choice plan member, you never need a referral (a written request for you to see another doctor) from your regular doctor to see a specialist. You also do not need to select a primary care provider (PCP), but we encourage you to do so to help you navigate the health care system.

With Aetna Managed Choice plans, you may choose a doctor in our network with or without a PCP referral. You may also choose to visit an out-of-network doctor. We cover the cost of care based on your choices. With Aetna Elect Choice plans, you are required to get a referral from your PCP before you can see a specialist. A "referral" is a written request for you to see another doctor. Some doctors can send the referral right to your specialist for you. There's no paper involved! Talk to your doctor to understand why you need to see a specialist. And remember to always get the referral before you receive the care.

Help for those who speak another language
If you need help in another language ask an English speaking family member or friend to contact your doctor or medical facility. Ask if multi-lingual employees are on staff. If not, you can also ask if they provide over-the-phone interpretation through a service like the AT&T Language Line. These types of services can provide interpretation for up to 170 languages. If this is a service offered by your doctor or medical facility, they'll connect you to the number associated with their practice and ask for an interpreter that speaks your native language. A member of the practice will remain on the line to answer your questions through the interpreter. This directory is also available in other languages at no cost to you.

Handicapped accessibility
Health care providers participating in the Aetna network are required to have all areas physically accessible to all members, including but not limited to the office entrance, parking, and bathroom facilities.