Cover your bases
Aetna® Accident Plan
Be prepared for the unexpected Accidents are just that — accidents. You can’t plan for them. But, you can protect yourself financially as much as possible.
An Aetna Accident Plan can help
The Aetna Accident Plan pays benefits when you get treatment for an accidental injury. The plan pays for a long list of covered minor and more serious injuries. You can use the benefits to help pay out-of-pocket medical costs or personal expenses.
How is this different from a major medical plan?
Medical plans help pay providers for services and treatment. But, they don’t cover the unexpected costs that might come with an accidental injury.
The Aetna Accident Plan pays benefits directly to you, giving you extra cash when you need it most. It can help fill in the gaps, making it a great companion to your major medical plan.
How can you use the cash benefits?
It’s completely up to you. You can use the money any way you want. It can help you pay your:
Deductibles or copays
Mortgage or rent
Groceries or utility bills
...or anything else you choose.
Easy to use
Online tools make it easy to manage your plan on our app or member portal You can file a claim in about 90 seconds or less if you or a family member experience a covered injury or treatment. And, benefits get paid directly to you by check or direct deposit.
“What ifs” are everywhere
The average cost of all non-fatal injuries per person initially treated in an emergency department was approximately $6,6201. Home accidents injure one person every four seconds in the U.S.2
Because you never know
Miguel* didn’t expect to get rear-ended in the middle of rush hour on his drive home. But it happened, and now his back and his car need some work.
Luckily, he had the Aetna Accident Plan and filed his claim online. Because Miguel is an Aetna Medical member, he didn’t need to submit any medical bills.
His benefits were deposited directly into his bank account. He used some of the money to pay out-of-pocket medical costs. The rest went towards getting his car back into shape.
A Simplified Claims Experience™
Just register on the My Aetna Supplemental app or the member portal at MyAetnaSupplemental.com to view plan documents, submit and track claims, and sign up for direct deposit. Aetna Medical members can also visit Aetna.com access the member portal
Filing a claim is easy! Click “Report New Claim” and answer a few quick questions. Filing claims is even easier for Aetna Medical Plan members. Aetna Easy File™ uses information from your medical claim to process your accident plan claim. That’s less paperwork for you. Don’t have Aetna Medical? No problem- just upload a picture of your medical bill.
You can also print and mail a paper claim form to Aetna Voluntary Plans.
1Average medical cost of fatal and non-fatal injuries by type in the USA. National Library of Medicine. February 27, 2021. Available at: https://pubmed.ncbi.nlm.nih.gov/31888976/ . Accessed June17, 2022.
2About Home Safety. U.S. Department of Housing and Urban Development. 2022. Available at: https://www.hud.gov/program_offices/healthy_homes/healthyhomes/homesafety. Accessed June 17, 2022.
*This is a fictional example of how the plan could work.
THIS PLAN DOES NOT COUNT AS MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT. THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR
MEDICAL COVERAGE.
This insurance plan provides limited benefits. It pays fixed dollar benefits for covered services without regard to the health care provider’s actual charges. The benefits payments are not intended to cover the full cost of medical care. You are responsible for making sure the provider’s bills get paid. These benefits are paid in addition to any other health coverage you may have. This material is for information only. Insurance plans contain exclusions and limitations. Not all health services are covered, and coverage is subject to applicable laws and regulations, including economic and trade sanctions. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features, rates, eligibility and availability may vary by location and are subject to change. For more information about Aetna plans, refer to Aetna.com.
Policy forms issued Oklahoma include: GR-96841, AL HPOL-VOL Acc 01, AL HCOC-VOL Acc 01
Policy forms issued in Missouri include: GR-96842 01, AL HPOL-VOL Acc 01, AL HCOC-VOL Acc 01. ©2023 Aetna Inc. 57.03.501.1 (02/21)
BENEFIT SUMMARY
City of Haltom City 803272
Aetna Off/On Job Accident Plan
THIS IS NOT A MEDICARE SUPPLEMENT (MEDIGAP) PLAN. If you are or will become eligible for Medicare, review the free Guide to Health Insurance for People with Medicare available at www.medicare.gov.
Insurance plans are underwritten by Aetna Life Insurance Company.
The benefits in the table below will be paid when you receive covered treatment for a covered Accident. Unless otherwise indicated, all benefits and limitations are per covered person.
Note: Certain benefits are payable once per covered accident; while others are once per plan year. If a service or injury falls in more than one category, the plan will pay the greater of. Refer to the Certificate for more details.
Initial Care
Ambulance
Ground ambulance
Pays a benefit for when you are transported by a licensed professional ambulance company by a Ground ambulance to or from a hospital, or between medical facilities, where treatment for an accidental injury is received. Transportation to or from a hospital within 24 hours after an accidental injury.
Air ambulance
Pays a benefit for when you are transported by a licensed professional ambulance company by an Air ambulance to or from a hospital, or between medical facilities, where treatment for an accidental injury is received. Transportation to or from a hospital within 48 hours after an accidental injury.
$400
$1,750
Maximum trips per accident, air and ground combined 1
Initial Treatment
Emergency room/Hospital
Pays a benefit if an insured person requires initial examination and treatment in an emergency room as the result of an accidental injury. The initial examination and treatment must be received within 72 hours after the accidental injury.
Physician’s office/Urgent care facility
Pays a benefit if an insured person requires initial examination and treatment in a physician's office or urgent care center as the result of an accidental injury. The initial examination and treatment must be received within 72 hours after the accidental injury.
visits per accident, combined for all places of service
Maximum visits per plan year, combined for all places of service 3
X-ray/Lab
Pays if an insured person receives an X-ray due to an accidental injury. The X-ray(s) must be prescribed by a physician and performed by a licensed facility within 30 days after the accidental injury.
Medical imaging
Pays a benefit if an insured person receives a medical imaging test due to an accidental injury. Medical imaging tests include only the following:
1. Positron Emission Tomography (PET)
2. Computed Tomography Scan (CT)
3. Computed Axial Tomography (CAT)
4. Magnetic Resonance (MR) or Magnetic Resonance Imaging (MRI)
5. Electroencephalogram (EEG)
The test must be ordered by a physician and performed in a medical facility on an outpatient basis within 180 days after the accidental injury.
/ $50
Follow-up Care
Accident follow-up
Emergency room/Hospital
Pays a benefit if an insured person receives follow-up treatment in emergency room or hospital for an accidental injury within one year of the accident.
Physician’s office/Urgent care facility
Pays a benefit if an insured person receives follow-up treatment in a physician's office or urgent care center for an accidental injury within one year of the accident.
Major: Back brace, body jacket, knee scooter, wheelchair, motorized scooter or wheelchair
Minor: Brace, cane, crutches, walker, walking boot, other medical devices to aid in your physical movement
Pays
Hospital Care
Covered
Hospital stay – admission (initial day)
Non-ICU admission
Pays a benefit if an insured person is admitted into the hospital due to an accidental injury. We will not pay this benefit if you're admitted into an observation unit, treated in an emergency room or outpatient surgery. The stay must begin within 180 days after an accidental injury.
$1,500 ICU admission
Pays a benefit if an insured person is admitted directly to ICU due to an accidental injury. The stay must begin within 30 days after an accidental injury.
Hospital stay – daily*
Non-ICU daily
$3,000
Pays a benefit if an insured person has a stay in a hospital due to an accidental injury. $200
ICU daily
Pays a benefit if an insured person has a stay in an ICU due to an accidental injury. The stay must begin within 30 days after an accidental injury.
Step down intensive care unit daily
Maximum days per accident (combined for all stays due to the same accident) 365
Rehabilitation unit stay – daily
Pays a benefit if an insured person is transferred to a rehabilitation unit immediately after a stay in a hospital due to an accidental injury.
Maximum days per accident 30 Observation unit
Pays a benefit if an insured person requires services in an observation unit as the result of an accidental injury. The Hospital Stay Admission Benefit will not be payable if the Observation Unit Benefit is payable. Observation services must begin within 72 hours after the accidental injury. $200
* Important Note: All Hospital stay – daily benefits begin on day two.
Surgical Care
Blood/Plasma/Platelets
Pays a benefit if an insured person receives the transfusion of blood, plasma and/or platelets due to an accidental injury. The transfusion must take place within 90 days after the accidental injury
Eye Injury
Surgical repair
Removal of foreign object
Surgery (without repair)
Arthroscopic or exploratory
Pays a benefit if an insured person undergoes exploratory or arthroscopic surgery, and no repair is done, within 60 days of the accidental injury.
Surgery (with repair)
Cranial, open abdominal or thoracic
Pays a benefit if an insured person undergoes cranial, open abdominal or thoracic surgery, and repair is done, within 72 hours of the accidental injury.
Hernia
$1,500
Pays a benefit if an insured person undergoes hernia surgery as the result of an accidental injury. A physician must diagnose the hernia within 30 days after the accidental injury; and perform surgery within 60 days after the accidental injury. $250
Ruptured disc
Pays a benefit if an insured person sustains a ruptured disc in the spine as the result of an accidental injury. A physician must treat the ruptured disc within 60 days after the accidental injury; and repair it through surgery within one year after the accidental injury. $750
Tendon/Ligament/Rotator cuff
Torn knee cartilage
Pays a benefit if an insured person sustains a torn knee cartilage (meniscus) as the result of an accidental injury. A physician must treat the torn knee cartilage within 60 days after the accidental injury; and repair it through surgery within 180 days after the accidental injury.
Non-Specified
Maximum benefits per accident, combined for all Surgery (without repair) and Surgery (with repair) benefits 2
Transportation/Lodging Assistance
Pays for one motel/hotel room for a companion to accompany you for each day of a stay due to an accidental injury. Your stay must be more than 50 miles from your home.
We will pay the Transportation Benefit shown in the Schedule of Benefits for an insured person who must travel from his or her residence more than 50 miles one way on physician’s advice for treatment of a payable Accidental injury.
Dislocations and Fractures
Pays a benefit if an insured person sustains a dislocation as the result of an accidental injury. A physician must diagnose the dislocation within 90 days after the accidental injury and correct it by closed reduction (nonsurgical repair).
Pays a benefit if an insured person sustains a dislocation as the result of an accidental injury. A physician must diagnose the dislocation within 90 days after the accidental injury and correct it by open
(surgical repair).
Fractures - Closed Reduction*
Pays a benefit if an insured person sustains a fracture as the result of an accidental injury.
A physician must diagnose the fracture within 90 days after the accidental injury and correct it by closed reduction
Skull (except bones of the face or nose), depressed
Skull (except bones of the face or nose), non-depressed
Hip, thigh (femur)
Vertebrae, body of (excluding vertebral processes)
Pelvis (inc. ilium, ischium, pubis, acetabulum except coccyx)
Leg (tibia and/or fibula malleolus)
Bones of the face or nose (except mandible or maxilla)
jaw, maxilla (except alveolar process)
Upper arm between elbow and shoulder (humerus)
Lower jaw, mandible (except alveolar process)
(radius and/or ulna)
(patella)
25% Maximum fractures per accident 3 *Open reduction pays 2.0 times the closed reduction benefit value
Paralysis Benefits
Paralysis (complete, total and permanent loss)
Pays a benefit if an insured person sustains paralysis as a result of an accidental injury. A physician must diagnose paralysis within 60 days after the accidental injury; and confirm the paralysis continued for a period of 90 consecutive days.
Other Accidental Injuries
Pays a benefit if an insured person receives a second degree burn or third degree burn as a result of an accidental injury. Treatment must be received by a physician within 72 hours after the accidental injury.
Second degree burn, greater than 5% of total body surface
Third degree burn, less than 5% of total body surface
Third degree burn, 5-10% of total body surface
Third degree burn, greater than 10% of total body surface
Burn skin graft
of Burn
Pays a benefit if an insured person receives a skin graft for a burn as a result of an accidental injury. Treatment must be received by a physician within 365 days after the accidental injury.
Coma/Persistent vegetative state (PVS)
Pays a benefit if an insured person sustains a broken tooth as the result of an accidental injury and the tooth is repaired by a dental crown and/or dental extraction. The dental services must begin within 60 days after the accidental injury. Maximum 1 per accident
Pays a benefit if an insured person receives a laceration as the result of an accidental injury. The laceration must be repaired by a physician within 72 hours after the accidental injury.
stitches, less than 7.5 centimeters
stitches, 7.6 - 20.0 centimeters
stitches, greater than 20.0 centimeters
stress disorder (PTSD)
Waiver of Premium
Covered
If, as a result of an accidental injury you miss 30 continuous days of work we will waive the premium beginning on the first premium due date that occurs after the 30th day of your absence, through the next 6 months of coverage. During such absence, you must remain employed with the policyholder. The premium waiver does not apply to your covered dependents.
Organized Sports Rider
If while you are playing as a registered member of an organized sporting activity, you sustain an accidental injury, benefits payable under the certificate will be increased by the percentage shown, except for the excluded benefits below:
Excluded benefits for Organized Sports Rider
Burn skin graft
Animal bite
Burn
Gunshot wound
Service Dog
Health Screening Rider
Health screening $50
Pays once per member per plan year for covered preventive tests
Maximum per plan year 1
Covered Health Screenings
• Bone marrow screening
• Bone mass density measurement (DEXA, DXA)
• Biopsies for cancer
• Blood chemistry panel
• Breast sonogram
• Cancer antigen 125 blood test for ovarian cancer (CA 125)
• Carotid doppler ultrasound
• Chest x-ray (CXR)
• Cytologic screening
• Cancer antigen 15-3 blood test for breast cancer (CA 15-3)
• Carcinoembryonic antigen blood test for colon cancer (CEA)
• Clinical testicular exam
• Colonoscopy
• Complete blood count (CBC)
• Dental exam
• Digital rectal exam (DRE)
• Doppler screening for cancer
• Doppler screenings for peripheral vascular disease (also known as arteriosclerosis)
• Electroencephalogram (EEG)
• Electrocardiogram (EKG, ECG)
• Echocardiogram (ECHO)
• Endoscopy
• Eye exam
• Fasting blood glucose test
• Fasting plasma glucose test
• Flexible sigmoidoscopy
• Hearing test
• Hemoccult stool analysis
• Hemoglobin A1C
• Human papillomavirus vaccination (HPV)
• Immunizations
• Lipoprotein profile (serum plus HDL, LDL, total cholesterol, and triglycerides)
• Mammography
• Oral cancer screening
• Pap smear
• Prostate specific antigen (PSA) test
• Routine health check-up exam
• Skin cancer biopsy
• Skin cancer screening
• Skin exam
• Serum protein electrophoresis (blood test for myeloma)
• Successful completion of smoking cessation program
• Stress test on bicycle or treadmill
• Test for sexually transmitted infections (STIs)
• Thermography
• ThinPrep pap test
• Two-hour post-load plasma glucose test
• Ultrasound for cancer detection
• Ultrasound screening for abdominal aortic aneurysms
• Virtual colonoscopy
Note: COVID-19 testing is covered as an eligible health screening benefit
Accident Plan: Exclusions and Limitations
This plan has exclusions and limitations. Refer to the actual policy and certificate to determine which benefits are not payable. The following is a partial list of services and supplies that are generally not covered. However, the plan may contain exceptions to this list based on state mandates or the plan design purchased.
Benefits under the policy will not be payable for any care, service or supply for an accidental injury related to the following:
1. Certain competitive or recreational activities, including but not limited to: ballooning, bungee jumping, parachuting, skydiving;
2. Any semi-professional or professional competitive athletic contest, including officiating or coaching, for which you receive any payment;
3. Act of war, riot, war;
4. Operating, learning to operate or serving as a pilot or crew member of any aircraft, whether motorized or not;
5. Assault, felony, illegal occupation, or other criminal act;
6. Bacterial infections that are not caused by a cut or wound from an accidental injury;
7. Care provided by immediate family members or any household member;
8. Elective or cosmetic surgery;
9. Nutritional supplements;
10. Suicide or attempt at suicide, intentionally self-inflicted injury, or any attempt at self-inflicted injury, or any form of intentional asphyxiation, except when resulting from a diagnosed disorder;
11. Violating any cellular device use laws of the state in which the accident occurred, while operating a motor vehicle;
12. Accidental injury sustained while intoxicated or under the influence of any drug intoxicant, including those prescribed by a physician that are misused;
We will not pay any benefits for a service or supply rendered or received that are not specifically covered or not related to an accidental injury.
The stay visit or service must be on or after the effective date of coverage, while coverage is in force and take place in the United States or its territories.
Portability
Your plan includes a portability option which allows you to keep your existing coverage by making direct payments to the carrier. You may exercise this option, if your employment ceases for any reason. Refer to your Certificate for additional portability provisions.
Questions and Answers about the Accident Plan
Do I have to answer any questions about my health to enroll? No, you do not have to answer any questions about your health to enroll.
Can I have more than one Accident Plan?
No, you are not allowed to have more than one Aetna Accident Plan.
To whom are benefits paid?
Benefits are paid to you, the member.
Is my Aetna Accident policy compatible with a Health Savings Account (HSA)?
Yes, Aetna Accident policies are compatible with Health Savings Accounts.
How do I submit a claim?
Go to myaetnasupplemental.com and either “Log In” or “Register”, depending on if you’ve set up your account. Click the “Create a new claim” button and answer a few quick questions. You can even save your claim to finish later. You can also print/mail in form(s) to: Aetna Voluntary Plans, PO Box 14079, Lexington, KY 40512-4079, or you can ask us to mail you a printed form.
What if I don’t understand something I’ve read here, or have more questions?
Please call us. We want you to understand these benefits before you decide to enroll. You may reach one of our Customer Service representatives Monday through Friday, 8 a.m. to 6 p.m., by calling 1-800-607-3366 We’re here to answer questions before and after you enroll.
What should I do in case of an emergency?
In case of emergency, call 911 or your local emergency hotline, or go directly to an emergency care facility.
What happens if I lose my employment, can I take the Accident Plan with me?
Yes, you are able to coverage under the Portability provision; however, you will need to pay premiums directly to Aetna
Important information about your benefits
THESE PLANS DO NOT COUNT AS MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE
CARE ACT. THESE PLANS ARE A SUPPLEMENT TO HEALTH INSURANCE AND ARE NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. These plans
provide limited benefits. They pay fixed dollar benefits for covered services without regard to the health care provider's actual charges. These benefit payments are not intended to cover the full cost of medical care. You are responsible for making sure the provider's bills get paid. These benefits are paid in addition to any other health coverage you may have.
Complaints and appeals
Please tell us if you are not satisfied with a response you received from us or with how we do business. Call Member Services to file a verbal complaint or to ask for the address to mail a written complaint. You can also e-mail Member Services through the secure member website. If you’re not satisfied after talking to a Member Services representative, you can ask us to send your issue to the appropriate department.
If you don’t agree with a denied claim, you can file an appeal. To file an appeal, follow the directions in the letter or explanation of benefits statement that explains that your claim was denied. The letter also tells you what we need from you and how soon we will respond.
We protect your privacy
We consider personal information to be private. Our policies protect your personal information from unlawful use. By “personal information,” we mean information that can identify you as a person, as well as your financial and health information. Personal information does not include what is available to the public. For example, anyone can access information about what the plan covers. It also does not include reports that do not identify you.
When necessary for your care or treatment, the operation of our health plans or other related activities, we use personal information within our company, share it with our affiliates and may disclose it to: your doctors, dentists, pharmacies, hospitals and other caregivers, other insurers, vendors, government departments and third-party administrators (TPAs).
We obtain information from many different sources particularly you, your employer or benefits plan sponsor if applicable, other insurers, health maintenance organizations or TPAs, and health care providers.
These parties are required to keep your information private as required by law. Some of the ways in which we may use your information include: Paying claims, making decisions about what the plan covers, coordination of payments with other insurers, quality assessment, activities to improve our plans and audits.
We consider these activities key for the operation of our plans. When allowed by law, we use and disclose your personal information in the ways explained above without your permission. Our privacy notice includes a complete explanation of the ways we use and disclose your information. It also explains when we need your permission to use or disclose your information.
We are required to give you access to your information. If you think there is something wrong or missing in your personal information, you can ask that it be changed. We must complete your request within a reasonable amount of time. If we don’t agree with the change, you can file an appeal.
If you’d like a copy of our privacy notice, call 1-800-607-3366 or visit us at www.aetna.com.
If you require language assistance, please call Member Services at 1-800-607-3366 and an Aetna representative will connect you with an interpreter. If you’re deaf or hard of hearing, use your TTY and dial 711 for the Telecommunications Relay Service. Once connected, please enter or provide the Aetna telephone number you’re calling.
Si usted necesita asistencia lingüística, por favor llame al Servicios al Miembro a 1-800-607-3366, y un representante de Aetna le conectará con un intérprete. Si usted es sordo o tiene problemas de audición, use su TTY y marcar 711 para el Servicio de Retransmisión de Telecomunicaciones (TRS). Una vez conectado, por favor entrar o proporcionar el número de teléfono de Aetna que está llamando.
ATTENTION MASSACHUSETTS RESIDENTS:
As of January 1, 2009, the Massachusetts Health Care Reform Law requires that Massachusetts residents, eighteen (18) years of age and older, must have health coverage that meets the Minimum Creditable Coverage standards set by the Commonwealth Health Insurance Connector, unless waived from the health insurance requirement based on affordability or individual hardship. For more information call the Connector at 1-877-MA-ENROLL (1-877-623-6765) or visit the Connector website (www.mahealthconnector.org). THIS POLICY, ALONE, DOES NOT MEET MINIMUM CREDITABLE COVERAGE STANDARDS. If you have questions about this notice, you may contact the Division of Insurance by calling 1-617-521-7794 or visiting its website at www.mass.gov/doi.
Plans are underwritten by Aetna Life Insurance Company (Aetna). This material is for information only and is not an offer or invitation to contract. Each insurer has sole financial responsibility for its own products.
Providers are independent contractors and are not agents of Aetna. Aetna does not provide care or guarantee access to health services. Insurance plans contain exclusions and limitations. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Policies may not be available in all states, and rates and benefits may vary by location. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com
Financial Sanctions Exclusions Clause
If coverage provided by this policy violates or will violate any US economic or trade sanctions, the coverage is immediately considered invalid. For example, Aetna companies cannot make payments or reimburse for health care or other claims or services if it violates a financial sanction regulation. This includes sanctions related to a blocked person or entity, or a country under sanction by the United States, unless permitted under a valid written Office of Foreign Assets Control (OFAC) license. For more information on OFAC, visit https://www.treasury.gov/resource-center/sanctions/Pages/default.aspx
Policy forms issued in Idaho, Oklahoma and Missouri include: GR- 96841, GR-96842.
DiscriminationisAgainsttheLaw
AetnaInc.complieswithapplicableFederalcivilrightslawsanddoesnotdiscriminateonthebasis ofrace,color,nationalorigin,age,disability,orsex(consistentwith45CFR§92.101(a)(2)).Aetna Inc.doesnotexcludepeopleortreatthemlessfavorablybecauseofrace,color,nationalorigin, age,disability,orsex.
AetnaInc.:
• Providespeoplewithdisabilitiesreasonablemodificationsandfreeappropriateauxiliary aidsandservicestocommunicateeffectivelywithus,suchas:
o Qualifiedsignlanguageinterpreters
o Writteninformationinotherformats(largeprint,audio,accessibleelectronic formats,otherformats).
• Providesfreelanguageassistanceservicestopeoplewhoseprimarylanguageisnot English,whichmayinclude:
o Qualifiedinterpreters
o Informationwritteninotherlanguages.
Ifyouneedreasonablemodifications,appropriateauxiliaryaidsandservices,orlanguageassistance services,call1-800-872-3862(TTY:711)orthenumberonthebackofyourIDcard.
IfyoubelievethatAetnaInc.hasfailedtoprovidetheseservicesordiscriminatedinanotherwayon thebasisofrace,color,nationalorigin,age,disability,orsex,youcanfileagrievancewith:
CivilRightsCoordinator
Attn:1557Coordinator
CVSPharmacy,Inc.
1CVSDrive,MC2332, Woonsocket,RI02895
Phone:1-800-648-7817,TTY:711
Email:CRCoordinator@aetna.com
Youcanfileagrievanceinperson,bymail,oremail.Ifyouneedhelpfilingagrievance,theCivil RightsCoordinatorisavailabletohelpyou.
YoucanalsofileacivilrightscomplaintwiththeU.S.DepartmentofHealthandHumanServices, OfficeforCivilRights,electronicallythroughtheOfficeforCivilRightsComplaintPortal,availableat https://ocrportal.hhs.gov/ocr/portal/lobby.jsf,orbymailorphoneat:
U.S.DepartmentofHealthandHumanServices
200IndependenceAvenue,SW Room509F,HHHBuilding Washington,D.C.20201 1-800-368-1019,1-800-537-7697(TDD)
Complaintformsareavailableathttp://www.hhs.gov/ocr/office/file/index.html. ThisnoticeisavailableatAetnaInc.’swebsite:https://www.aetna.com/
5356157-01-01(07/25)
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