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Summary of Benefits & Coverage

Important information for individuals

What you need to know

It’s easy to know about your benefits and coverage

In March 2010, Congress passed a historic health care reform law called the Affordable Care Act (ACA). Under it, health plans are required to provide consumers with a document giving them information about health plan benefits and coverage. This is a Summary of Benefits and Coverage (SBC) document.

The SBC gives you helpful information about what the plan covers. It also has examples of how much you might pay for certain health events or conditions. Remember, the SBC is only a summary. So, we’ve added other details about your plan here for you.

Be sure to visit these links for more information:

Find out what the bolded words in the SBC mean. Check out our glossary of coverage and medical terms. (Note: Some of the terms may not have the same meaning when used in your policy or plan. Your policy or plan governs)

Need to know which providers are in Texas Health Aetna’s network or have questions about prescription drug coverage?

  • Current Texas Health Aetna members: Just login to your secure member website using the link in the navigation bar to get information about your current plan.

  • Not a member yet:
  1. To check if a doctor is in network, go to our provider search tool and make sure to choose the plan that matches the one you are considering.

  2. For pharmacy benefit information, visit our pharmacy resources page. Texas Health Aetna pharmacy benefits are administered by Aetna. Aetna provides certain management services to Texas Health Aetna.

    Please note that these formularies are standard and may not reflect the formulary in your specific plan.

To obtain the terms of your policy or a copy of your plan document, please see below. Which policy or plan document do you need?

  • Does your employer have less than 50 employees?
    • Read more about our 2-50 policy certificatesClick here.

Questions?

Already a Texas Health Aetna member? Call Member Services at the toll-free number on your member ID card.

Not a member yet? Call the toll-free number on your SBC if you have any questions.

Important information for employers

Texas Health Aetna will give employers the information they need, but the law says employers have to give the SBCs to their employees. There are very specific rules about what employers have to provide and when. Read more about the standards to create and provide an accurate SBC.

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 Texas Health Aetna Network Team.

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