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151 Farmington Avenue, F265 Hartford, CT 06156 MTA New York City Transit Aetna Medicare Advantage PPO Extend Service Area (ESA) As a participant in the MTA NYCTA/Aetna Medicare Advantage PPO ESA the following information will help you and your medical care providers understand the plan. You can help your doctor understand your plan It’s easy to receive covered care from your doctor under your Medicare Advantage PPO ESA plan. Just show your Aetna Medicare ID card. You can get care even from doctors that are not part of our network. Some of the language in the “For your providers” section of this letter may seem unclear to you. Your provider’s billing staff will understand it. It has to do with billing between your provider, Medicare and Aetna. How MTA NYCT Aetna Medicare Advantage plan works for you and your doctor You can see any doctor who participates with Original Medicare, even if they are not in our network. With MTA NYCT customized benefits, you will pay the same amount, in- or out-of network. We’re here to help you Call us at 1-888-267-2637 (TTY: 711), Monday to Friday, 8 a.m. to 6 p.m. EST. Cut out the handy cards at the end of this letter to show your doctors Show your doctors the cards before getting care. This will help them learn more about working with Aetna.

MTA New York City Transit Aetna Medicare Advantage …mtanyct.aetnamedicare.com/docs/MTA NYCT provider_member_letter.… · 151 Farmington Avenue, F265 Hartford, CT 06156 MTA New

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151 Farmington Avenue, F265 Hartford, CT 06156

MTA New York City Transit Aetna Medicare Advantage PPO Extend Service Area (ESA)

As a participant in the MTA NYCTA/Aetna Medicare Advantage PPO ESA the following information will help you and your medical care providers understand the plan.

You can help your doctor understand your plan It’s easy to receive covered care from your doctor under your Medicare Advantage PPO ESA plan. Just show your Aetna Medicare ID card. You can get care even from doctors that are not part of our network.

Some of the language in the “For your providers” section of this letter may seem unclear to you. Your provider’s billing staff will understand it. It has to do with billing between your provider, Medicare and Aetna.

How MTA NYCT Aetna Medicare Advantage plan works for you and your doctor You can see any doctor who participates with Original Medicare, even if they are not in our network. With MTA NYCT customized benefits, you will pay the same amount, in- or out-of network.

We’re here to help you Call us at 1-888-267-2637 (TTY: 711), Monday to Friday, 8 a.m. to 6 p.m. EST.

Cut out the handy cards at the end of this letter to show your doctors Show your doctors the cards before getting care. This will help them learn more about working with Aetna.

For your providers

MTA New York City Transit and Aetna Medicare Advantage MTA NYCT Aetna Medicare Advantage plan is a customized group Medicare Advantage PPO (ESA) plan. Benefits have been customized so that the members will pay the same amount, in- or out-of network. Our Medicare Advantage PPO ESA members can get covered medical service from either nonparticipating or participating providers. If your provider participates, there is nothing further for you to verify. For nonparticipating providers, services will be covered if the provider is:

Eligible to receive payment from Medicare

Willing to accept the plan

Aetna’s Medicare PPO ESA plan provides all the benefits of Original Medicare — and more. Benefits include unlimited hospitalization and coverage for certain preventive services. Other key features:

No contract

Medicare rates to doctors who do not participate for good order claims (less the member copayment, coinsurance or deductible, as required under Medicare Advantage regulations and the member’s plan)

One bill and one payment

No referrals

Precertification recommended, but not required

ID card says ‘Medicare ESA PPO’ below the Aetna logo

Reimbursement and claims processing information Doctors who do not participate in Aetna’s Medicare Advantage PPO should:

Collect the member’s copayment, coinsurance and deductible for covered expenses.

Submit all good order claims for covered services for payment.

Submit the patient-paid amount on claims.

Aetna will process claims using:

Original Medicare billing rules

Medicare fee schedule

Prospective payment system requirements

Local Coverage Determinations (LCDs)

The member’s plan documents, including Evidence of Coverage

Medicare-limiting charges apply. Aetna uses the Correct Coding Initiative (CCI) for bundling/unbundling logic. The link to CCI on the CMS website is http://www.cms.gov/nationalcorrectcodinited/.

Additional online tools and resources Go to http://www.aetna.com for more information. Click on the “Eligibility” tab on the “Plan Central” page.

Select “Aetna Health Plan” and then “Aetna Support Menu.”

Next, select “Doing Business with Aetna Benefit Products.”

Next, select “Aetna Medicare.” Go to http://www.aetnaeducation.com for Medicare Advantage training and resources. Aetna Medicare is a PPO plan with a Medicare contract. Enrollment in Aetna Medicare depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. 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. Plans are offered by Aetna Health Inc., Aetna Health of California Inc., and/or Aetna Life Insurance Company (Aetna). Not all health services are covered. See Evidence of Coverage for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location. You must be entitled to Medicare Part A and continue to pay your Part B premium and Part A, if applicable.

Cut the cards below to show your doctor Medicare Providers: MTA New York City Transit/Aetna Medicare Advantage ESA PPO plan is a customized group Medicare Advantage plan. We reimburse non-network doctors by Medicare rules. We’re here to help MTA NYCT retirees Call Aetna Medicare Advantage member services, 1-888-267-2637 (TTY: 711), Monday to Friday, 8 a.m. to 6 p.m.

Medicare Providers: MTA New York City Transit/Aetna Medicare Advantage ESA PPO plan is a customized group Medicare Advantage plan. We reimburse non-network doctors by Medicare rules. We’re here to help MTA NYCT retirees Call Aetna Medicare Advantage member services, 1-888-267-2637 (TTY: 711), Monday to Friday, 8 a.m. to 6 p.m.

©2013 Aetna Inc. GRP_13_466 ZS-191-13 QR