Choose the disclosure that applies to your plan.
These disclosure documents describe Texas Health Aetna health benefits and health insurance plans. Find your plan type.
Medical
How Texas Health Aetna Pays Out-of-Network Benefits
Note about employer-funded plans: State mandates do not apply to most self-funded plans governed by ERISA. If you are unsure if your plan is self-funded and/or governed by ERISA, please confer with your benefits administrator. Plan documents may supersede the information on this website.
HMO based plans - Texas Health | Aetna
Traditional PPO based plans - Texas Health | Aetna
Dental
Texas Health Aetna members receive dental benefits from Aetna. Aetna provides certain management services to Texas Health Aetna. Please refer to aetna.com for more information.
Important benefits for women
Women’s Health and Cancer Rights Act of 1998
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:
- All stages of reconstruction of the breast on which the mastectomy was performed;
- Surgery and reconstruction of the other breast to produce a symmetrical appearance;
- Prostheses; and
- Treatment of physical complications of the mastectomy, including lymphedema.
Benefits will be provided to a person who has already undergone a mastectomy as a result of breast cancer while covered under a different health plan. Coverage is provided in accordance with your plan design and is subject to plan limitations, copays, deductibles, coinsurance and referral requirements, if any, as outlined in your plan documents. For more information, please contact Member Services at the number on your ID card, or the links below.
Centers for Medicare & Medicaid Services fact sheet
U.S. Department of Labor website