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Accessing Benefits During a Disaster or Emergency

What you need to know

You'll have access to your benefits during a public health emergency or disaster. When one of these events is declared, and until it ends, we'll: 

  • Cover out-of-network services and benefits at network rates
  • Waive referral requirements, where applicable
  • Make changes that benefit you effective immediately, without the required 30-day notice

Who declares a disaster or public health emergency?

The Centers for Medicare and Medicaid Services (CMS) states that a declaration of disaster may be made by: 

  • A presidential declaration of disaster or emergency under either:

- The Stafford Act
- The National Emergencies Act

  • A secretarial declaration of a public health emergency under Section 319 of the Public Health Service Act
  • A declaration by the governor of your state or territory 

If the president declares a disaster, the Secretary of Health and Human Services may also authorize waivers or modifications under Section 1135 of the Public Health Service Act.

When does a disaster or public health emergency end?

The public health emergency or state of disaster ends when any of these occur:

  • The source that declared the public health emergency or state of disaster says it's over
  • CMS declares that the public health emergency or state of disaster is over
  • Thirty days have passed since the public health emergency or state of disaster was declared

We'll let CMS know if we can’t resume normal operations by the end of the public health emergency or state of disaster.

CMS also requires us to:

  • Explain your payment terms and conditions if you live in a disaster area and get care from an out-of-network provider during a declared emergency or disaster
  • Notify you each year of any special requirements that are in effect during a disaster or emergency
  • Share these special requirements with you on our website

Disclaimers

Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.

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.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.

Participating physicians, hospitals and other health care providers are independent contractors. They're neither agents nor employees of Coventry. The availability of any particular provider can't be guaranteed. Provider network make-up is subject to change. 

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. 


       Y0001_4006_10830 Approved 10/27/2017
       Page last updated: Sun Oct 01 00:15:06 EDT 2017

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