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2021 Plans
Allina Health | Aetna Medicare
Discover Plus (PPO) H3219-001
Summary of Benefits (includes a pre-enrollment checklist)
Evidence of Coverage (coverage details)
Over the counter (OTC) benefit catalog
Formulary - Prescription Drug Coverage
Annual Notice of Change (cost and coverage changes)
Low Income Subsidy (Extra Help paying for prescriptions)
2021 Allina Health|Aetna Medicare Advantage with Rx Plan Handbook
Allina Health | Aetna Medicare
Discover Premier (PPO) H3219-002
Summary of Benefits (includes a pre-enrollment checklist)
Evidence of Coverage (coverage details)
Over the counter (OTC) benefit catalog
Formulary - Prescription Drug Coverage
Annual Notice of Change (cost and coverage changes)
Low Income Subsidy (Extra Help paying for prescriptions)
2021 Allina Health|Aetna Medicare Advantage with Rx Plan Handbook
You can request a copy of your EOC or Formulary if you need one.
Allina Health | Aetna Medicare
Discover Grand (PPO) H3219-003
Summary of Benefits (includes a pre-enrollment checklist)
Evidence of Coverage (coverage details)
Over the counter (OTC) benefit catalog
Formulary - Prescription Drug Coverage
Annual Notice of Change (cost and coverage changes)
Low Income Subsidy (Extra Help paying for prescriptions)
2021 Allina Health|Aetna Medicare Advantage with Rx Plan Handbook
Allina Health | Aetna Medicare
Discover Elite (PPO) H3219-004
Summary of Benefits (includes a pre-enrollment checklist)
Evidence of Coverage (coverage details)
Over the counter (OTC) benefit catalog
Formulary - Prescription Drug Coverage
Annual Notice of Change (cost and coverage changes)
Low Income Subsidy (Extra Help paying for prescriptions)
2021 Allina Health|Aetna Medicare Advantage with Rx Plan Handbook
Allina Health | Aetna Medicare
Discover Value (PPO) H3219-005
Summary of Benefits (includes a pre-enrollment checklist)
Evidence of Coverage (coverage details)
Over the counter (OTC) benefit catalog
Annual Notice of Change (cost and coverage changes)
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Formulary - Prescription drug coverage
Referrals & prior authorizations
Looking for referral and pre-approval requirements?
Check your plan’s Evidence of Coverage.Check your claims
Flu shot coverage
Protect yourself from the flu.
Learn about your flu shot benefitMedicare coverage changes
The Centers for Medicare & Medicaid Services periodically issues National Coverage Determinations. They issue these when a service’s or drug’s coverage rules change.
View a list of coverage determinationsCoverage during a disaster or emergency
We want to make sure you can access your benefits even during urgent situations - like a public health emergency or state of disaster.
How we decide which health care services to cover
We help you get medically necessary health care services in the most cost-effective way under your health plan. And we work with you and doctors to evaluate services for medical appropriateness, timeliness and cost.
Specifically, we:
- Base our decisions on appropriateness of care, service and plan coverage
- Use nationally recognized guidelines and resources to make changes
- Don’t pay or reward providers, employees or others for denying coverage or care
- Focus on reviewing the risks of members who aren’t fully using certain services
How we review new technologies
Doctors and health care companies continuously develop new technologies. This can include anything from a new procedure to a new way to use a device.
When we learn about a new technology, we:
- Carefully review the latest information and ask experts for their opinions
- Compare the information with well-known standards
- Base all of our decisions on making sure you have the right care and services
Using an out-of-network provider
If you’re enrolled in an Allina Health | Aetna Medicare Plan (PPO)
You have flexibility to receive covered services from network providers or out-of-network providers. Out-of-network/non-contracted providers are under no obligation to treat Allina Health | Aetna Medicare members, except in emergency situations. For a decision about whether we’ll cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call us or see your Evidence of Coverage for more information, including the cost share for out-of-network services.
Although you don’t have to choose a primary care provider, we encourage you to do so. If you receive covered services from an out-of-network doctor, it’s important to confirm that they:
- Accept your PPO plan
- Are eligible to receive Medicare payment
Telehealth coverage
Telehealth – or telemedicine – means virtual care you can get at home or away. These visits are live, video conferences between you and a doctor over a computer or smart phone. Consider using telehealth when you have a time sensitive medical need or can’t get to the doctor in person.
Your plan covers certain telehealth visits with in-network
- Primary care doctors
- Mental health providers, and
- Urgent care facilities
Not all provider visits can be handled through telehealth. You can view and download a list of potentially covered telehealth services here. Ask your doctor whether they offer these services via telehealth and how to schedule a visit.
Telehealth visits with out-of-network providers are not covered. Please refer to your provider directory to find an in-network provider.
Note: Certain services may require a prior authorization (pre-approval). See your Evidence of Coverage for details.
See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.
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