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Program Provisions

Discount Program Disclaimer

Discount offers provide access to discounted services and are not part of an insured plan or policy. Discount offers are rate-access offers and may be in addition to any plan benefits. Check any insurance benefits you have before using these discount offers, as those benefits may result in lower costs to you than using these discounts. Texas Health Aetna and its affiliates make no payment to the discount vendor. The member is responsible for the full cost of the discounted services. We may receive a percentage of the fee paid to a discount vendor.

Texas

Discount programs are not insurance and program features are not guaranteed under the plan contract and may be discontinued at any time. Discount programs are in addition to any plan benefits and may require a separate charge to access such programs. Discounts offered hereunder are not insurance.

Simple Steps Disclaimer

This information is not meant to be either a recommendation for medical treatment or a diagnosis of medical condition. Please consult your health care provider for the advice and care appropriate for your specific medical needs. The availability of a program may vary by plan design. While this material is believed to be accurate as of the staging date, it is subject to change. These programs are NOT insured benefits. Aetna and its affiliates provide certain management services for Texas Health.

Personal Health Record

The Aetna Personal Health Record is offered by Aetna Life Insurance Company and should not be used as the sole source of information about the member's medical history. Aetna and its affiliates provide certain management services for Texas Health Aetna. Information is believed to be accurate as of the staging date; however, it is subject to change.

Informed Health Line Disclaimer

While only your doctor can diagnose, prescribe or give medical advice, the Informed Health Line® nurses can provide information on more than 5,000 health topics. Contact your doctor first with any questions or concerns regarding your health care needs. While this material is believed to be accurate as of this date, it is subject to change.

Note: Topics discussed by nurses, or online are not necessarily covered by your health plan.

Pharmacy Disclaimers

Aetna Pharmacy Management may at times collaborate with, or delegate to, another entity to carry out a function that it would otherwise perform. The goal is to make any of these processes seamless to our members. Thus Aetna does not notify our members and providers when a service is delegated. We continuously review any delegated activities to ensure that the collaborator is properly performing the assigned functions and to meet the requirements of the accreditation agency URAC, the National Committee for Quality Assurance (NCQA), the Centers for Medicare & Medicaid services (CMS), as well as state regulations.

Aetna receives rebates from drug manufacturers that may be taken into account in determining Aetna’s Drug List. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions.  Aetna Rx Home Delivery refers to Aetna Rx Home Delivery, LLC, a subsidiary of Aetna Inc., which is a licensed pharmacy providing prescription services by mail.  This pharmacy is a for-profit entity.  Aetna Specialty Pharmacy refers to Aetna Specialty Pharmacy, LLC, a subsidiary of Aetna Inc., which is a licensed pharmacy that operates through specialty pharmacy prescription fulfillment.  This pharmacy is a for-profit entity.  The charges that Aetna negotiates with Aetna Rx Home Delivery and Aetna Specialty Pharmacy may be higher than the cost they pay for the drugs and the cost of the mail order pharmacy services they provide. For these purposes, the pharmacies’ cost of purchasing drugs takes into account discounts, credits and other amounts that they may receive from wholesalers, manufacturers, suppliers and distributors.

Aetna and its affiliates provide certain management services for Texas Health Aetna.

Health Care Provider Network Disclaimer

Providers are independent contractors and are not our agents. Provider participation may change without notice. We do not provide care or guarantee access to health services.

Health Information Program Disclaimer

Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional.

The Partnership

Together, Texas Health Resources and Aetna are taking a new approach to the way health care is offered. With this innovative partnership, these two industry leaders aim to provide more efficient and effective member care at a more affordable cost. By joining the right medical professionals with the right technology, members receive the benefit of quality, personalized health care.

Texas Health Aetna
612 E. Lamar Blvd., Suite 100
Arlington, TX 76011

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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.

Physicians on the medical staff practice independently and are not agents or employees of the hospital or Texas Health Resources.

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Texas Health + Aetna Health Plan Inc. and Texas Health + Aetna Health Insurance Company (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.

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Texas Health + Aetna Health Plan Inc. and Texas Health + Aetna Health Insurance Company (Texas Health Aetna) are affiliates of Texas Health Resources and of Aetna Life Insurance Company and its affiliates (Aetna). Texas Health Resources provides certain management services to Texas Health Aetna.

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Are you interested in becoming a participating provider with Texas Health Aetna?

Please send an e-mail to the North Texas Network Team.

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