Health Management Programs
Additional integrated programs are available to you and your family members to help you manage your health and to assist you in obtaining good health care when care is needed. These programs reflect a commitment by you and the company to good health and quality care. The Health Management tools and resources available to Aetna Select participants include a 24-Hour Nurse Line, Medical and Behavioral Health Advocates, Condition Management Programs, Cancer Care Program, Expert Medical Opinion Services, and Centers of Excellence.
Health Management tools and resources are available to you at no additional cost. However, health care claims (e.g., doctor's fees or facilities charges) are processed according to the Plan's provisions.
24-Hour nurse line
Trained, licensed nurses are available by telephone at 1-800-556-1555, 24 hours a day, 7 days a week to answer routine questions about your health, or questions about a specific medical situation, condition or concern. However, these nurses cannot diagnose medical conditions, prescribe medication or give specific medical instruction. Topics discussed during your call may include services and expenses not covered under the Plan.
The nurse may refer you to a Health Advocate for a more detailed conversation if you face a health risk or serious medical condition.
Health Advocacy Program
The Health Advocate Program provides direct support to you, your family, and your treating physician(s) in the management of specific health care needs. The Health Advocate staff consists of registered nurses, supported by a medical director. Once you begin working with a Health Advocate, the nurse will work personally with you as long as you need support.
Health Advocates will assist you to coordinate a wide array of health care-related support and educational services. As situations require, your Health Advocate will assist you with admission, counseling, inpatient advocacy, discharge planning and home counseling. The nurse will also act as your proactive partner, working directly with you to help you navigate the health care delivery system by assisting with the coordination and management of your health care needs and collaborating with others involved in your treatment.
Some of the condition management programs available include but not limited to Coronary artery disease (CAD), Heart failure, diabetes –adult and pediatric, Asthma –adult and pediatric, Chronic obstructive pulmonary disease (COPD), Chronic lower back pain, Osteoporosis / Osteoarthritis and Peripheral Artery Disease. Contact Aetna to check if your chronic condition can be managed through the Health Advocate program.
Aetna Maternity Program
The AETNA Maternity Program provides free support and resources to help you have a healthy pregnancy. The program provides useful information about early labor symptoms, genetic counselling and screening, preeclampsia prevention and education and resources on caring for a newborn.
If your pregnancy is considered at-risk, nurse managers will be available to help you manage the risk, identify symptoms and understand treatment options.
Contact aetna.com for additional information.
Cancer Management Program
As a part of your coverage under this plan, Health Advocacy nurses are available to assist with newly diagnosed cancer, undergoing active treatment for cancer, or a recurrence, at no cost to you. The Health Advocacy team will support you in your cancer journey with case management and provide you with information on the many resources available to you including a personal navigator with experience in cancer diagnosis and treatments, who will provide you with personalized support whenever you need it, genetic counseling to help guide your treatment and assess your risk of developing other forms of cancer, and an extensive online cancer support center. If you would like to receive support from a Health Advocate, call 800-255-2386.
Musculoskeletal Conditions Support
As a part of your coverage under this plan, Hinge Health offers musculoskeletal conditions support at no cost to you, with programs relating to care for different joint and muscle pain needs, for example:
- Prevention (at risk): specific exercises and education
- Acute (recent injury): physical therapy video visits for every body part
- Chronic (high risk): exercise, education and behavioral change
- Surgery (pre & post rehab): pre and post rehabilitation continuity of care
Learn more about this program at www.hingehealth.com/exxonmobil or call 855-902-2777
Expert Medical Opinion Services
If you or a family member receive a diagnosis or treatment plan requiring complex medical care, you have access to expert medical opinion services through 2ndMD. Specialists who are recognized experts in their field will review medical records related to the diagnosis and provide an opinion on the recommended treatment, including a detailed report you can share with your physician or Health Advocate nurse. Expert opinion consults are available at no additional cost to you and can be accessed through a mobile application, web portal, or phone. Call 866-410-8649 or www.2ndMD.com/Aetna to initiate services.
Pharmacy Diabetes Management
Insulin and diabetic supplies are covered under the prescription drug plan through Express Scripts. They can be obtained through a retail pharmacy or through home delivery by paying your required coinsurance. In those rare instance where insulin or diabetic supplies are received in a doctor’s office, outpatient facility or hospital setting, they are covered as a medical expense.
Centers of Excellence and Institutes of Excellence
Centers of Excellence (COE) and Institutes of Excellence (IOE) are nationally recognized facilities for the treatment of certain conditions or the delivery of certain procedures where high-level knowledge and expertise provide better care and more likely positive outcomes.
COEs/IOEs are not available for all diseases and all conditions or procedures relevant to a disease state. For instance, at this time there are COEs/IOEs for pancreatic cancer, but there is insufficient information available to select COEs/IOEs for lung cancer. Changes to identified COEs/IOEs may occur in the future. If you would like to learn more about different COE/IOE options you will need to contact the 24-hour nurse line and ask to be put in contact with a Health Advocate who will be able to discuss different options with you.
Participation in a COE/IOE program is voluntary, and designed to direct participants to nationally recognized facilities with more positive outcomes. A COE/IOE recommended treatment plan, however, must meet the Plan provisions for medically necessary care in order for claims to be eligible for reimbursement.
Whenever clinically appropriate, you will be referred to a local COE/IOE. If access to a clinically appropriate COE/IOE requires the patient to travel 100 or more miles, the Plan will reimburse reasonable transportation costs for you and a caregiver. The Plan will also provide a per diem for you and a caregiver to cover lodging and other expenses. If you become hospitalized, only your caregiver will receive the per diem, because food and lodging are already provided as part of the hospital charge. The per diem amounts are established by the Administrator-Benefits.
If you decide not to use a COE/IOE, you will not incur additional out-of-pocket costs for choosing another hospital in the Plan's network.