Aetna Health Insurance Limitations and Exclusions

The health insurance plans indicated here do not cover all health care expenses and include exclusions and limitations. You should refer to plan documents to determine which health care services are covered and to what extent.

Medical Limitations and Exclusions
Services and supplies that are generally notcovered include, but are not limited to:

Surgery or related services for cosmeticpurposes to improve appearance, but not torestore bodily function or correct deformityresulting from disease, trauma or congenitalor developmental anomalies
Private duty nursing
Personal care services and home care servicesnot stated in the plan description
Non-replacement fees for blood and blood products
The operation or treatment for fitting or wearing of dentures
Orthodontic care
Dental implants: Dental work or treatment, unless otherwise specified in covered services, including hospital or professional care in connection with:
- The operation or treatment for fitting or wearing of dentures
- Orthodontic care
- Dental implants Experimental services
Immunizations related to foreign travel
The purchase, examination, or fitting ofhearing aids and supplies, and tinnitusmaskers, unless included as a covered benefit.
Arch support, orthotic devices, in-shoesupports, orthopedic shoes, elastic supports,or exams for their prescription or fitting,unless these services are determined to bemedically necessary.
Inpatient admissions primarily for physicaltherapy unless authorized by the plan.
Charges in connection with pregnancy care,other than for pregnancy complications
Treatment of sexual dysfunction not related to organic disease
Services to reverse a voluntary sterilization
In vitro fertilization, ovum transplants andgamete intrafallopian tube transfer, orcryogenic or other preservation techniquesused in these or similar procedures
Practitioner, hospital or clinical servicesrelated to the procedure commonly referredto as “Lasik Eye Surgery” including radialkeratomy, myopi keratomileusis, and surgerythat involved corneal tissue for the purpose of altering, modifying or correcting myopia,hyperopia or stigmatic error
Nonmedical ancillary services such asvocational rehabilitation, employmentcounseling, or educational therapy
Services that are not medically necessary
Medical expenses for a pre-existing conditionare not covered for the first 12 months after themember’s effective date. Look-back period fordetermining a pre-existing condition(conditions for which diagnosis, care ortreatment was recommended or received) is 6months prior to the effective date of coverage. If the applicant had prior creditable coveragewithin 63 days immediately before the signatureon the application, then the pre-existingconditions exclusion of the plan will be waived.
Weight control services including surgicalprocedures, medical treatments, weightcontrol/loss programs, dietary regiments andsupplements, appetite suppressants and othermedication; food or food supplements, exerciseprograms, exercise or other equipment; andother services and supplies that are primarilyintended to control weight or treat obesity,including Morbid Obesity, or for the purpose of weight reduction, regardless of the existenceof comorbid conditions.

10-day right to review

Do not cancel your current insurance until you’re notified you’ve been accepted for coverage.
Aetna will review your application to determine if you meet underwriting requirements. If you’re denied, you will be notified by mail. If approved, you’ll be sent an AARP Essential Premier Health Insurance contract and ID card.
If, after reviewing the contract, you are not satisfied for any reason, simply return the contract to us within 10 days of your receipt. We will refund any premium you have paid, less the cost of any services paid on behalf of you or any covered dependent.

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