Member materials and benefits

Coverage from head to toe

Looking to live a healthier life? Our benefits and programs are designed to help you do just that.

This coverage includes preventive services like doctor’s visits, lab testing, X-rays and more. Plus, we can help with serious health concerns. These may be chronic diseases or mental health issues. We also can connect you with resources in your community for other services.

Look at this section closely so that you can better understand your benefits. You’ll know what’s covered, what is not, and how you can find the right care when you need it.

ATTENTION: If you speak Spanish or Somali, language services, free of charge, are available to you. Call 1-855-364-0974 (TTY: 711), 24 hours a day, 7 days a week. The call is free.

ATENCIÓN: Si habla español, tiene a su disposición servicios de idiomas gratuitos. Llame Al 1-855-364-0974 (TTY: 711) las 24 horas del día, los 7 días de la semana. Esta llamada es gratuita.

FIIRI: Haddii aad ku hadasho Soomaali, adeegyada lluqadda, oo bilaash ah, ayaa laguu heli karaa adiga. Wac 1-855-364-0974 (TTY: 711), 24 saacadood maalintii, 7 maalmood todobaadkii. Wicitaanku waa bilaash.

If you wish to make or change a standing request to receive all materials in a language other than English or in an alternate format, you can call Aetna Better Health of Ohio Member Services at 1-855-364-0974 (TTY: 711), 24 hours a day, 7 days a week.

Member Handbook

Annual Notice of Change

Summary of Benefits

List of Covered Drugs

Prior Authorization Criteria

Manual del Miembro

Aviso Anual de Cambios (Annual Notice of Changes, Spanish)

Resumen de Beneficios (Summary of Benefits, Spanish)

Lista de Medicamentos Cubiertos/Formulario (List of Covered Drugs, Spanish)

Step Therapy Criteria

Stay in-network and save
You must receive services covered by the health plan, from facilities and/or providers in the Aetna Better Health of Ohio network. The only time you can use providers that are not in the Aetna Better Health of Ohio provider network is for:

  • Emergency services
  • Federally qualified health centers/rural health clinics
  • An out-of-panel provider that Aetna Better Health of Ohio has approved you to see during or after your transition of care time period
  • Members that choose both their Medicare and Medicaid benefits through Aetna Better Health of Ohio can also receive urgently needed care and hospice services from non-contracting providers.

We provide services in only certain counties in Ohio. When you are out of our service area, you are only covered for emergency services. If you are out of the service area and need non-emergency services, call your PCP or Member Services.

Out-of-network and emergency care
Except in certain cases, like emergencies, you cannot visit a care provider outside of our network. “In network” providers are listed in our directory. These care providers have agreed to charge less for many services. If you do not use in-network providers, you may be responsible for these charges.

If you have questions about this, call Member Services at 1-855-364-0974 (TTY: 711), 24 hours a day, seven days a week. You also can use the Find a Provider tool. 

How do I know if it’s an emergency?
For more information about emergency care, please review your Member Handbook. You can also call your PCP or our 24/7 Nurse Advice Line at 1-855-364-0974.

Behavioral health 
Your mental health is important
Behavioral health benefits cover services to help you improve your mental health. For example, if you suffer from mental illness, alcohol or drug addiction, you may need therapy or medicine. Your Aetna Better Health of Ohio covers many kinds of services for mental health. For more information, view your Summary of Benefits.

Care management
As a member of Aetna Better Health of Ohio, you will have your own care manager as part of our care management program. Your care manager can help you find the right care and services. Your care manager will contact you soon after you are enrolled with Aetna Better Health of Ohio.

A care manager will work with you, your doctors and other providers to make sure you receive the right care and services, with your needs in mind. The goal is to build a treatment plan just for you to help you live a healthier life. Your care manager will meet with you by phone or where you live as often as needed.

A care manager can help guide you if you have had any of these or other issues:

  • You are having to go to the ER a lot
  • You are having trouble getting things your doctor has ordered
  • Your doctor just told you that you have a disease like CHF (congestive heart failure) or diabetes but you would like to get more information about a disease or treatment
  • You need services to help you at home and need help getting long term services and support
  • Your doctor wants you to see a specialist, but you don't know what to do

If you want to discuss your health care needs and questions with your case manager, call Member Services to ask to speak to your care manager. Your care manager is there for you!

Disease management
Extra support to care for you

Our disease management programs are designed just for members with chronic (ongoing) conditions. This may include things like asthma, diabetes, lung disease or a heart issue.

What is a disease management program?

These programs provide education and outreach to you based on your medical needs. The goal is to help you be healthier and get quality care. If you choose to be part of our program, we work with the doctor to create a plan for your care. This plan will include goals that will help you and your doctor track your results. We will also provide education to you about how to stay well.

We have disease management programs for:

  • Asthma
  • Diabetes
  • Depression
  • Chronic Obstructive Pulmonary Disorder (COPD)
  • Congestive Heart Failure (CHF)

When you sign up for one of our disease management programs, we give you all the help we can. We will also connect you with other resources to help you manage your condition.

If you want to know more about our disease management programs, talk to your care manager or call the 24-hour Care Management line at 1-855-364-0974 (TTY: 711), 24 hours a day, seven days a week. The call is free.

Extra Benefits Card*

 

Members with specific chronic conditions have access to an Extra Benefits Card. This card can be used to pay for utilities, rent or healthy foods. The benefits mentioned are a part of special supplemental program for the chronically ill. Not all members qualify.

  • $50 allowance every month to help with utilities, rent, and healthy foods for qualifying members. Funds do not roll over. The funds will automatically be added to your Nations Benefits prepaid debit cardif you qualify. The card can be used:
    • Online at AetnaMMP.com
    • Over the phone at 1-833-838-1307 (TTY: 711)or
    • At partner grocer locations
  • Check if you are eligible for the Extra Benefits Card by calling Member Services at 1-855-364-0974 (TTY: 711).

Click here to view the 2024 Healthy Foods catalog

SilverSneakers®

SilverSneakers® membership to members at no additional cost. SilverSneakers is the nation’s leading community fitness program specifically designed for older adults, promotes greater health engagement and accountability by providing members with regular exercise (strength training, aerobics, flexibility) and social opportunities. Benefit includes:

  • Access to thousands of participating fitness locations, use of basic amenities (weights, treadmills, pools, etc.), fitness classes, group activities and classes outside the traditional gym setting (Community FLEX classes).
  • Online resources including a member portal, live classes, on-demand classes, SilverSneakers app with reminders to move and more.
  • One Home kit or Steps kit available each calendar year.

Visit SilverSneakers.com to learn more, or call Member Services at 1-855-364-0974 (TTY:711) .

Federal Free Cell Phone Program

Aetna Better Health of Ohio members who are interested in the Lifeline, federal free cell phone program, are provided our contracted Lifeline vendor’s website, phone number and application to complete in order to determine if they qualify. The vendor notifies Aetna Better Health of Ohio of those members who are approved and opt-in to the program.

  • Qualified members are then eligible to receive a smartphone with voice minutes, unlimited texts, data, voicemail, call waiting, caller ID and 911 access. Aetna Better Health of Ohio members receive unlimited free calls to the plan’s Member Services toll-free number that has been zero rated so these calls do not apply to monthly minute allotment and as appropriate, free health-related texts and free texts from the plan.

Please visit the Lifeline website to see how you qualify.

Non-Emergency Transportation

  • Transportation for 30 round trips or 60 one-way trips to plan-approved health-related locations.

Aetna Better Health of Ohio requires that you call 1-855-364-0974 (TTY: 711) at least 3 days before your appointment to schedule a trip.

Dental services  

  • 1 exam, cleaning, x-rays, fluoride every six months

To access these services, go to a dentist in the Aetna Better Health of Ohio network and show your Aetna Better Health of Ohio ID card.  If you have questions or need help finding a dentist call Member Services at 1-855-364-0974 (TTY: 711). This benefit is available to both Duals (Medicare and Medicaid) and Medicaid-Only members.

Over-the-counter allowance

 

$35 monthly allowance to purchase OTC items. Funds do not roll over. Members can buy items with their OTC benefit in three ways:

  • Online at NationsBenefits.com
  • Over the phone by calling 1-833-838-1307 (TTY: 711)
  • Using their Nations Benefits Prepaid debit card at participating retail locations that include: 
    • CVS
    • Walmart
    • Kroger
    • Giant Eagle and more

Click here to view the 2024 OTC Catalog

For more information about the benefit, call Member Services at 1-855-364-0974 (TTY: 711), 24 hours a day, 7 days a week.

If you do not already have an OTC prepaid debit card, you can call 1-833-838-1307 (TTY: 711)

 

Podiatry

6 routine foot care visits each year.

 

Meals after Hospitalization

The plan offers 10 home-delivered nutritional meals after an in-patient hospitalization.

Smoking cessation counseling

  • 42 additional smoking cessation counseling sessions each year.