The federal COVID-19 emergency is over.Plan Disclosures
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These disclosure documents describe Texas Health Aetna health benefits and health insurance plans. Find your plan type.
Medical
How Texas Health Aetna Pays Out-of-Network Benefits
Note about employer-funded plans: State mandates do not apply to most self-funded plans governed by ERISA. If you are unsure if your plan is self-funded and/or governed by ERISA, please confer with your benefits administrator. Plan documents may supersede the information on this website.
HMO based plans - Texas Health | Aetna
Traditional PPO based plans - Texas Health | Aetna
Dental
Texas Health Aetna members receive dental benefits from Aetna. Aetna provides certain management services to Texas Health Aetna. Please refer to aetna.com for more information.
Important benefits for women
Women’s Health and Cancer Rights Act of 1998
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:
- All stages of reconstruction of the breast on which the mastectomy was performed;
- Surgery and reconstruction of the other breast to produce a symmetrical appearance;
- Prostheses; and
- Treatment of physical complications of the mastectomy, including lymphedema.
Benefits will be provided to a person who has already undergone a mastectomy as a result of breast cancer while covered under a different health plan. Coverage is provided in accordance with your plan design and is subject to plan limitations, copays, deductibles, coinsurance and referral requirements, if any, as outlined in your plan documents. For more information, please contact Member Services at the number on your ID card, or the links below.
Centers for Medicare & Medicaid Services fact sheet
U.S. Department of Labor website
Transparency in coverage
Texas Health|Aetna – machine readable files
If you are looking for Small Group AFA plans click here.
Health benefits and health insurance plans are offered and/or underwritten by Texas Health + Aetna Health Plan Inc. and Texas Health + Aetna Health Insurance Company (Texas Health Aetna). Each insurer has sole financial responsibility for its own products. Texas Health Aetna are affiliates of Texas Health Resources and of Aetna Life Insurance Company and its affiliates (Aetna). Aetna provides certain management services to Texas Health Aetna.
Self-funded plans are administered by Texas Health + Aetna Health Insurance Company.
This material is for information only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Health benefits and health insurance plans contain exclusions and limitations. Providers are independent contractors and not our agents. Provider participation may change without notice. We do not provide care or guarantee access to health services. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability are subject to change and may vary by location. If you are in a plan that requires the selection of a primary care physician and your primary care physician is part of an integrated delivery system or physician group, your primary care physician will generally refer you to specialists and hospitals that are part of the delivery system or physician group. Information is believed to be accurate as of the production date; however, it is subject to change.
Aetna, CVS Pharmacy® and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health® family of companies. For a complete list of other participating pharmacies, log in to texashealthaetna.com
Physicians on the medical staff practice independently and are not agents or employees of the hospital or Texas Health Resources.
©2023 Texas Health + Aetna Health Plan Inc. & Texas Health + Aetna Health Insurance Company