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Vision Insurance Plans for Individuals & Families | Aetna

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href="https://www.aetna.com/about-us/contact-aetna.html#tab_content_section_responsivegrid_202619046_responsivegrid_tabs_link_tabs_1" data-linklocation="Navigation" data-linktype="Regular" data-modal="Please Select">Contact us </a> </li> <li class="megamenumobile__tertiary--item"> <a class="megamenumobile__tertiary--link" href="/faqs-health-insurance.html" data-linklocation="Navigation" data-linktype="Regular" data-modal="Please Select">Frequently asked questions </a> </li> <li class="megamenumobile__tertiary--item"> <a class="megamenumobile__tertiary--link" href="/individuals-families/prior-authorization-guidelines.html" data-linklocation="Navigation" data-linktype="Regular" data-modal="Please Select">Prior authorization guidelines </a> </li> </ul> </nav> </div> </li> <li class="megamenumobile__secondary--item"> </li> </ul> </nav> </div> </section> <section class="megamenumobile__panel--tertiary" id="idMegamenumobile__panel--tertiary"> </section> </div> </div> </div> </div> </div> <main> <div class="content_section" id="content__main"> <div class="pageherobanner"> <div class="hero_banner_ps_wrapper hero_banner_primary "> <div class="hb_image "> <img class=" lazyload" data-src="/content/dam/aetna/asset-libraries/redesign/hero/GettyImages-1398048506_B2_Af6363_1800x520.jpg" alt width="1800" height="520"/> </div> <div class="hb_content"> <div class="container"> <div class="row"> <div class="col-sm-12 col-md-11 col-lg-5 hb_content--wrapper"> <div class="hb_white_box "> <h1 class="hb_white_box_title page__title__hero">Vision plans made for you</h1> <div class="hb_white_box_subcopy rte-component-wraper mb-0"><p>Get the insurance coverage you need to keep your eyes healthy and get the eyewear you want, where you want. The choice is yours with an Aetna Vision Preferred Direct™ plan.<br /> </p> <p><a data-analytics-name="Find a vision plan" href="http://www.visiondirect.aetna.com/#/" class="btn--primary" target="_self">Find a vision plan</a></p> </div> <!-- CTA 3, 6 --> <!-- Form Container 1, 2, 4, 5 --> <!--Parsys--> <div> </div> </div> </div> </div> <div class="row"> <div class="col-sm-12 col-md-11 col-lg-5 offset-md-1"> <div class="hb_callout_gray "> <h2 class="hb_callout_gray_title">Looking for dental and vision?</h2> <!-- callOutBoxSubCopy 1, 2 --> <p class="hb_callout_gray_text">You can save by choosing our dental plan that includes vision coverage.</p> <!-- Parsys 1, 2 --> <div class="hb_callout_gray_parsys"> </div> <!-- CTA 1, 2, 4 --> <div> <div class="component__cta"> <div data-cmp-is="cta"> <div class="cta__linkswrapper "> <a class="link__text type__link__text " href="https://dentaldirect.aetna.com/" data-modal="Please Select" data-linktype="Regular" target="_self" role="link" data-analytics-name="Explore plan options" data-linklocation="primary" data-ctahrefholder="https://dentaldirect.aetna.com/" aria-label="Explore dental plan with vision included">Explore plan options</a> </div> </div> </div> </div> <!-- Form Container 3 --> </div> </div> </div> </div> </div> </div> </div> <div class="textwithmedia"><div class="textmedia " data-cmp-is-async="textwithmedia/one" data-content-well="yes" data-disablereadmore="true"> <div class="container textmedia__componentwrapper textmedia--one component--left textmedia--one--small"> <div class="row"> <div class="col-md-4 col-lg-4 mediawrapper__small__xsmall mediawrapper--left"> <div class="mediacontainer__slot1 "> <div data-src="/content/dam/aetna/asset-libraries/photos/20161215_02_Lobby-0179_696x928.jpg" class="media__one__image media--hide"></div> <div class="media__one media__image--vertical" data-slot1-image-loaded="false"> <div class="media__content media__image--animate"> <img class=" lazyload" data-src="/content/dam/aetna/asset-libraries/photos/20161215_02_Lobby-0179_696x928.jpg" alt width="696" height="928"/> </div> </div> </div> </div> <div class="col-md-6 col-lg-6 mediawrapper--right"> <div class="textmedia__wrapper"> <div class="textmedia__wrapper--inner"> <div class="textmedia__text textmedia__text--top body__copy"><div class="textdescription text"><div class="rte-component-wraper component--default "> <p><span class="title--secondary">Choice and convenience</span></p> <h2><span class="title__block">More providers to fit your needs</span></h2> <p> </p> <p>In-store and online, you can <a data-analytics-name="choose from thousands of vision providers" href="https://eyedoclocator.aetnavision.com/aetna/en" class="link__text--inline">choose from thousands of vision providers</a> across the country. Our large nationwide network includes convenient vision offices and retailers. More choices, more ways to be healthy.</p> </div> </div> </div> </div> <div> <div class="component__cta"> <div data-cmp-is="cta"> <div class="cta__additionallinkswrapper count--2 "> <div class="link__column"> <h3 class="column__heading textUpper">National retailers</h3> <ul> <li class="link__row"> LensCrafters® </li> <li class="link__row"> Pearle Vision </li> <li class="link__row"> Target Optical® </li> <li class="link__row"> Independent Provider Network </li> </ul> </div> <div class="link__column"> <h3 class="column__heading textUpper">Online retailers</h3> <ul> <li class="link__row"> CVS Optical™ </li> <li class="link__row"> LensCrafters® </li> <li class="link__row"> Target Optical® </li> <li class="link__row"> Glasses.com </li> <li class="link__row"> Contacts Direct </li> <li class="link__row"> Ray-Ban </li> </ul> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="responsivegrid"> <div> <div class="container "> <div class="row"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 aem-Grid--md--12 aem-Grid--xs--12 "> <div class="text aem-GridColumn--md--10 aem-GridColumn--default--none aem-GridColumn--offset--xs--0 aem-GridColumn aem-GridColumn--offset--md--1 aem-GridColumn--xs--none aem-GridColumn--default--6 aem-GridColumn--offset--default--0 aem-GridColumn--xs--12 aem-GridColumn--md--none"><div class="rte-component-wraper component--default "> <p><span class="title--secondary">Vision plans at a glance</span></p> <h2><span class="title__block">Looking for a plan that fits your life and budget? Let’s explore.</span></h2> <p> </p> <p>With our vision insurance for individuals and families, we can help you find the right plan for you. Use this chart to compare coverage and costs for Aetna Vision Preferred Direct plans. This chart shows in-network benefits.</p> </div> </div> </div> </div> </div> </div> </div> <div class="tablecomparison"><div class="comparisontable" data-cmp-is-async="comparisontable"> <div class="container d-none d-lg-block"> <table class="table--dekstop"> <thead> <tr class="row comparisontable__row "> <td class="comparisontable__labelcolumn count--3"></td> <th scope="col" class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow column__parentcontainer--header "> <div class="column__container column--header "> <div class="column--title title__block" data-label="Value Plan"> <p>Value Plan</p> </div> </div> </div> </th> <th scope="col" class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow column__parentcontainer--header "> <div class="column__container column--header "> <div class="column--title title__block" data-label="Select Plan"> <p>Select Plan</p> </div> </div> </div> </th> <th scope="col" class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow column__parentcontainer--header "> <div class="column__container column--header "> <div class="column--title title__block" data-label="Elite Plan"> <p>Elite Plan</p> </div> </div> </div> </th> </tr> </thead> <tr class="row comparisontable__row comparisontable__row--normal"> <th scope="row" class="comparisontable__labelcolumn count--3"> <div class="column__container"> <div class="row__label"><p><a data-analytics-name="Deductible*" href="#" class="link__text--inline" data-footnote-modal="Deductible">Deductible*</a></p> </div> </div> </th> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>None</p> </div> </div> </div> </td> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>None</p> </div> </div> </div> </td> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>None</p> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row comparisontable__row--normal"> <th scope="row" class="comparisontable__labelcolumn count--3"> <div class="column__container"> <div class="row__label"><p><a data-analytics-name="Eye exam copay*" data-footnote-modal="Eye-exam-copay" href="#" class="link__text--inline">Eye exam copay*</a></p> </div> </div> </th> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>$20</p> </div> </div> </div> </td> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>$15</p> </div> </div> </div> </td> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>$10</p> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row comparisontable__row--normal"> <th scope="row" class="comparisontable__labelcolumn count--3"> <div class="column__container"> <div class="row__label"><p><a data-analytics-name="Standard lens copay*" data-footnote-modal="Standard-lens-copay " href="#" class="link__text--inline">Standard lens copay*</a></p> </div> </div> </th> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>$25</p> </div> </div> </div> </td> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>$20</p> </div> </div> </div> </td> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>$10</p> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row comparisontable__row--normal"> <th scope="row" class="comparisontable__labelcolumn count--3"> <div class="column__container"> <div class="row__label"><p><a data-analytics-name="Frame allowance*" data-footnote-modal="Frame-allowance" href="#" class="link__text--inline">Frame allowance*</a></p> </div> </div> </th> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>$130</p> </div> </div> </div> </td> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>$160</p> </div> </div> </div> </td> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>$200</p> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row comparisontable__row--normal"> <th scope="row" class="comparisontable__labelcolumn count--3"> <div class="column__container"> <div class="row__label"><p><a data-analytics-name="Contact lens allowance*" data-footnote-modal="Contact-lens-allowance" href="#" class="link__text--inline">Contact lens allowance*</a></p> </div> </div> </th> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>$130</p> </div> </div> </div> </td> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>$160</p> </div> </div> </div> </td> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>$200</p> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row comparisontable__row--normal"> <th scope="row" class="comparisontable__labelcolumn count--3"> <div class="column__container"> <div class="row__label"><p><a data-analytics-name="Progressive lens copay*" data-footnote-modal="Progressive-lens" href="#" class="link__text--inline">Progressive lens copay*</a></p> </div> </div> </th> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p style="text-align: left;">Standard: $90</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Premium tiers 1-3: $110-$135</p> </div> </div> </div> </td> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p style="text-align: left;">Standard: $85</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Premium tiers 1-3: $105-$130</p> </div> </div> </div> </td> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p style="text-align: left;">Standard: $10</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Premium tiers 1-3: $95-$120</p> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row comparisontable__row--normal"> <th scope="row" class="comparisontable__labelcolumn count--3"> <div class="column__container"> <div class="row__label"><p><a data-analytics-name="Standard lens options*" data-footnote-modal="Standard-lens-options" href="#" class="link__text--inline">Standard lens options*</a></p> </div> </div> </th> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p style="text-align: left;">Polycarbonate: $40</p> <p style="text-align: left;"><br /> Scratch resistant: $15</p> <p style="text-align: left;"><br /> Anti-glare: $45</p> <p style="text-align: left;"> </p> <p style="text-align: left;">UV protection: $15</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Tinted lenses: $15</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Photochromic light-to-dark tinting: $75<br /> </p> </div> </div> </div> </td> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p style="text-align: left;">Polycarbonate under age 19: $0<br /> </p> <p style="text-align: left;"> </p> <p style="text-align: left;">Polycarbonate over age 19: $40</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Scratch resistant: $15</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Anti-glare: $45</p> <p style="text-align: left;"> </p> <p style="text-align: left;">UV protection: $15</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Tinted lenses: $15</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Photochromic light-to-dark tinting: $75<br />  </p> </div> </div> </div> </td> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p style="text-align: left;">Polycarbonate: $0</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Scratch resistant: $0</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Anti-glare: $45</p> <p style="text-align: left;"> </p> <p style="text-align: left;">UV protection: $15</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Tinted lenses: $15</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Photochromic light-to-dark tinting: $75</p> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row comparisontable__row--normal"> <th scope="row" class="comparisontable__labelcolumn count--3"> <div class="column__container"> <div class="row__label"><p><a data-analytics-name="Out-of-network coverage*" data-footnote-modal="Out-of-network-coverage" href="#" class="link__text--inline">Out-of-network coverage*</a></p> </div> </div> </th> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>Included</p> </div> </div> </div> </td> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>Included</p> </div> </div> </div> </td> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>Included</p> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row comparisontable__row--normal"> <th scope="row" class="comparisontable__labelcolumn count--3"> <div class="column__container"> <div class="row__label"><p><a data-analytics-name="Monthly cost*" data-footnote-modal="Monthly-cost" href="#" class="link__text--inline">Monthly cost*</a></p> </div> </div> </th> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>Starting at $10.40 a month</p> </div> </div> </div> </td> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>Starting at $13.13 a month</p> </div> </div> </div> </td> <td class="comparisontable__column count--3"> <div class="column__parentcontainer column__parentcontainer--shadow "> <div class="column__container "> <div class="column--description"> <p>Starting at $18.33 a month</p> </div> </div> </div> </td> </tr> </table> </div> <div class="container d-lg-none"> <table> <thead class="mobiletable__caption"> <tr class="row comparisontable__row "> <th colspan="2"> <div class="column__parentcontainer column__parentcontainer--shadow column__parentcontainer--header "> <div class="column__container column--header "> <div class="column--title title__block" data-label="Value Plan"> <p>Value Plan</p> </div> </div> </div> </th> </tr> </thead> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Deductible*" href="#" class="link__text--inline" data-footnote-modal="Deductible">Deductible*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>None</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Eye exam copay*" data-footnote-modal="Eye-exam-copay" href="#" class="link__text--inline">Eye exam copay*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>$20</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Standard lens copay*" data-footnote-modal="Standard-lens-copay " href="#" class="link__text--inline">Standard lens copay*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>$25</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Frame allowance*" data-footnote-modal="Frame-allowance" href="#" class="link__text--inline">Frame allowance*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>$130</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Contact lens allowance*" data-footnote-modal="Contact-lens-allowance" href="#" class="link__text--inline">Contact lens allowance*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>$130</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Progressive lens copay*" data-footnote-modal="Progressive-lens" href="#" class="link__text--inline">Progressive lens copay*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p style="text-align: left;">Standard: $90</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Premium tiers 1-3: $110-$135</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Standard lens options*" data-footnote-modal="Standard-lens-options" href="#" class="link__text--inline">Standard lens options*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p style="text-align: left;">Polycarbonate: $40</p> <p style="text-align: left;"><br /> Scratch resistant: $15</p> <p style="text-align: left;"><br /> Anti-glare: $45</p> <p style="text-align: left;"> </p> <p style="text-align: left;">UV protection: $15</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Tinted lenses: $15</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Photochromic light-to-dark tinting: $75<br /> </p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Out-of-network coverage*" data-footnote-modal="Out-of-network-coverage" href="#" class="link__text--inline">Out-of-network coverage*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>Included</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Monthly cost*" data-footnote-modal="Monthly-cost" href="#" class="link__text--inline">Monthly cost*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>Starting at $10.40 a month</p> </div> </div> </div> </div> </td> </tr> </table> <table> <thead class="mobiletable__caption"> <tr class="row comparisontable__row "> <th colspan="2"> <div class="column__parentcontainer column__parentcontainer--shadow column__parentcontainer--header "> <div class="column__container column--header "> <div class="column--title title__block" data-label="Select Plan"> <p>Select Plan</p> </div> </div> </div> </th> </tr> </thead> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Deductible*" href="#" class="link__text--inline" data-footnote-modal="Deductible">Deductible*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>None</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Eye exam copay*" data-footnote-modal="Eye-exam-copay" href="#" class="link__text--inline">Eye exam copay*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>$15</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Standard lens copay*" data-footnote-modal="Standard-lens-copay " href="#" class="link__text--inline">Standard lens copay*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>$20</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Frame allowance*" data-footnote-modal="Frame-allowance" href="#" class="link__text--inline">Frame allowance*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>$160</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Contact lens allowance*" data-footnote-modal="Contact-lens-allowance" href="#" class="link__text--inline">Contact lens allowance*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>$160</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Progressive lens copay*" data-footnote-modal="Progressive-lens" href="#" class="link__text--inline">Progressive lens copay*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p style="text-align: left;">Standard: $85</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Premium tiers 1-3: $105-$130</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Standard lens options*" data-footnote-modal="Standard-lens-options" href="#" class="link__text--inline">Standard lens options*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p style="text-align: left;">Polycarbonate under age 19: $0<br /> </p> <p style="text-align: left;"> </p> <p style="text-align: left;">Polycarbonate over age 19: $40</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Scratch resistant: $15</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Anti-glare: $45</p> <p style="text-align: left;"> </p> <p style="text-align: left;">UV protection: $15</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Tinted lenses: $15</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Photochromic light-to-dark tinting: $75<br />  </p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Out-of-network coverage*" data-footnote-modal="Out-of-network-coverage" href="#" class="link__text--inline">Out-of-network coverage*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>Included</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Monthly cost*" data-footnote-modal="Monthly-cost" href="#" class="link__text--inline">Monthly cost*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>Starting at $13.13 a month</p> </div> </div> </div> </div> </td> </tr> </table> <table> <thead class="mobiletable__caption"> <tr class="row comparisontable__row "> <th colspan="2"> <div class="column__parentcontainer column__parentcontainer--shadow column__parentcontainer--header "> <div class="column__container column--header "> <div class="column--title title__block" data-label="Elite Plan"> <p>Elite Plan</p> </div> </div> </div> </th> </tr> </thead> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Deductible*" href="#" class="link__text--inline" data-footnote-modal="Deductible">Deductible*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>None</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Eye exam copay*" data-footnote-modal="Eye-exam-copay" href="#" class="link__text--inline">Eye exam copay*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>$10</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Standard lens copay*" data-footnote-modal="Standard-lens-copay " href="#" class="link__text--inline">Standard lens copay*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>$10</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Frame allowance*" data-footnote-modal="Frame-allowance" href="#" class="link__text--inline">Frame allowance*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>$200</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Contact lens allowance*" data-footnote-modal="Contact-lens-allowance" href="#" class="link__text--inline">Contact lens allowance*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>$200</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Progressive lens copay*" data-footnote-modal="Progressive-lens" href="#" class="link__text--inline">Progressive lens copay*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p style="text-align: left;">Standard: $10</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Premium tiers 1-3: $95-$120</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Standard lens options*" data-footnote-modal="Standard-lens-options" href="#" class="link__text--inline">Standard lens options*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p style="text-align: left;">Polycarbonate: $0</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Scratch resistant: $0</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Anti-glare: $45</p> <p style="text-align: left;"> </p> <p style="text-align: left;">UV protection: $15</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Tinted lenses: $15</p> <p style="text-align: left;"> </p> <p style="text-align: left;">Photochromic light-to-dark tinting: $75</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Out-of-network coverage*" data-footnote-modal="Out-of-network-coverage" href="#" class="link__text--inline">Out-of-network coverage*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>Included</p> </div> </div> </div> </div> </td> </tr> <tr class="row comparisontable__row "> <th scope="row" class="comparisontable__labelcolumn column__parentcontainer--shadow"> <div class="column__container"><div class="row__label"><p><a data-analytics-name="Monthly cost*" data-footnote-modal="Monthly-cost" href="#" class="link__text--inline">Monthly cost*</a></p> </div></div> </th> <td class="comparisontable__column column__parentcontainer--shadow"> <div class="column__container"> <div class="column__parentcontainer "> <div class="column__container "> <div class="column--description"> <p>Starting at $18.33 a month</p> </div> </div> </div> </div> </td> </tr> </table> </div> </div> </div> <div class="responsivegrid"> <div data-dynamicbehaviourflag="false"> <div class="container "> <div class="row"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 aem-Grid--md--12 aem-Grid--xs--12 "> <div class="icontext aem-GridColumn--md--10 aem-GridColumn--default--none aem-GridColumn--offset--xs--0 aem-GridColumn aem-GridColumn--offset--md--1 aem-GridColumn--xs--none aem-GridColumn--default--8 aem-GridColumn--offset--default--2 aem-GridColumn--xs--12 aem-GridColumn--md--none"> <div class="texticon texticon__inherited "> <div class="texticon__container texticon__container--withbackground texticon__container--withbackground-dropshadow"> <div class="texticon__wrapper texticon__iconwrapper align-items-start"> <div class="texticon__icon icon__medium"> <img class=" lazyload" data-src="/content/dam/aetna/asset-libraries/pictograms_2021/Pictogram_onWhite_Advice_and_counseling.svg" alt/> </div> <div class="texticon__text rte-component-wraper inherited justified--left"> <h2><span class="title--secondary">Looking for more details? Check out our brochure.</span></h2> <p> </p> <p>You'll find vision care services, costs, network retailers, special offers and more. </p> <p> </p> <p><a data-analytics-name="Aetna Vision Preferred Direct plan brochure (PDF)" href="/content/dam/aetna/pdfs/aetnacom/individuals-families/document-library/individual-standalone-vision-brochure.pdf" class="link__digitaldownload" target="_blank">Aetna Vision Preferred Direct plan brochure (PDF)</a></p> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="footnote"><div class="aetna-modal footnote-modal" data-cmp-is="modal"> <div class="modal__box " id="Deductible" role="dialog" tabindex="-1" aria-labelledby="modal-heading-438957953"> <div class="modal__inner"> <div class="modal__content"> <h2 id="modal-heading-438957953" class="title--secondary__big"> Deductible</h2> <div class="component__main"> <div class="text"><div class="rte-component-wraper component--default "> <p>The amount you pay before your plan begins to pay for eligible vision services. Great news! With Aetna Vision Preferred Direct plans, you have no deductible.</p> </div> </div> </div> </div> <button type="button" aria-label="Close" class="modal__close"></button> </div> </div> </div> </div> <div class="footnote"><div class="aetna-modal footnote-modal" data-cmp-is="modal"> <div class="modal__box " id="Eye-exam-copay" role="dialog" tabindex="-1" aria-labelledby="modal-heading-1534966269"> <div class="modal__inner"> <div class="modal__content"> <h2 id="modal-heading-1534966269" class="title--secondary__big"> Eye exam copay</h2> <div class="component__main"> <div class="text"><div class="rte-component-wraper component--default "> <p>The amount you pay to the network provider for your routine eye exam. You can get 1 eye exam every 12 months.</p> </div> </div> </div> </div> <button type="button" aria-label="Close" class="modal__close"></button> </div> </div> </div> </div> <div class="footnote"><div class="aetna-modal footnote-modal" data-cmp-is="modal"> <div class="modal__box " id="Standard-lens-copay" role="dialog" tabindex="-1" aria-labelledby="modal-heading-422100186"> <div class="modal__inner"> <div class="modal__content"> <h2 id="modal-heading-422100186" class="title--secondary__big"> Standard lens copay</h2> <div class="component__main"> <div class="text"><div class="rte-component-wraper component--default "> <p>The amount you pay to a network provider for your base eyeglass lens. Base eyeglass lenses include standard plastic single vision, bifocal, trifocal or lenticular lenses. You can use your lens benefit towards the purchase of eyeglass lenses or contact lenses every 12 months.</p> </div> </div> </div> </div> <button type="button" aria-label="Close" class="modal__close"></button> </div> </div> </div> </div> <div class="footnote"><div class="aetna-modal footnote-modal" data-cmp-is="modal"> <div class="modal__box " id="Frame-allowance" role="dialog" tabindex="-1" aria-labelledby="modal-heading-194219633"> <div class="modal__inner"> <div class="modal__content"> <h2 id="modal-heading-194219633" class="title--secondary__big"> Frame allowance</h2> <div class="component__main"> <div class="text"><div class="rte-component-wraper component--default "> <p>The amount of your frame cost your plan covers when you visit a network provider. If your frame cost is more than your frame allowance, you get 20% off the balance. You’re responsible for the balance up to the total cost of the frame.</p> </div> </div> </div> </div> <button type="button" aria-label="Close" class="modal__close"></button> </div> </div> </div> </div> <div class="footnote"><div class="aetna-modal footnote-modal" data-cmp-is="modal"> <div class="modal__box " id="Contact-lens-allowance" role="dialog" tabindex="-1" aria-labelledby="modal-heading-232596453"> <div class="modal__inner"> <div class="modal__content"> <h2 id="modal-heading-232596453" class="title--secondary__big"> Contact lens allowance</h2> <div class="component__main"> <div class="text"><div class="rte-component-wraper component--default "> <p>The amount of your contact lens cost your plan covers when you purchase from a network provider. If your purchase of conventional contact lens goes over your plan's allowance, you get 15% off the balance. You can use your lens benefit towards the purchase of eyeglass lenses or contact lenses every 12 months.</p> </div> </div> </div> </div> <button type="button" aria-label="Close" class="modal__close"></button> </div> </div> </div> </div> <div class="footnote"><div class="aetna-modal footnote-modal" data-cmp-is="modal"> <div class="modal__box " id="Progressive-lens" role="dialog" tabindex="-1" aria-labelledby="modal-heading-1900272983"> <div class="modal__inner"> <div class="modal__content"> <h2 id="modal-heading-1900272983" class="title--secondary__big"> Progressive lens copay</h2> <div class="component__main"> <div class="text"><div class="rte-component-wraper component--default "> <p>The amount you pay to the network provider for upgrading to a progressive lens. This copay includes the cost of the bifocal lens plus the progressive upgrade. If the progressive lens you choose is outside of tiers 1 through 3, you get a 20% discount off the retail cost plus a $120 plan allowance.</p> </div> </div> </div> </div> <button type="button" aria-label="Close" class="modal__close"></button> </div> </div> </div> </div> <div class="footnote"><div class="aetna-modal footnote-modal" data-cmp-is="modal"> <div class="modal__box " id="Standard-lens-options" role="dialog" tabindex="-1" aria-labelledby="modal-heading-801231859"> <div class="modal__inner"> <div class="modal__content"> <h2 id="modal-heading-801231859" class="title--secondary__big"> Standard lens options</h2> <div class="component__main"> <div class="text"><div class="rte-component-wraper component--default "> <p>Lens options are available at a discount when you visit a network provider. You don’t pay more than the amount listed. Some options are covered in full based on the plan you choose. Other non-covered lens options are available for 20% off the retail cost.</p> </div> </div> </div> </div> <button type="button" aria-label="Close" class="modal__close"></button> </div> </div> </div> </div> <div class="footnote"><div class="aetna-modal footnote-modal" data-cmp-is="modal"> <div class="modal__box " id="Out-of-network-coverage" role="dialog" tabindex="-1" aria-labelledby="modal-heading-2041430308"> <div class="modal__inner"> <div class="modal__content"> <h2 id="modal-heading-2041430308" class="title--secondary__big"> Out-of-network coverage</h2> <div class="component__main"> <div class="text"><div class="rte-component-wraper component--default "> <p>You have the option to visit an out-of-network provider. If you do, you pay the provider in full and submit a claim to get reimbursed (up to the maximum out-of-network plan limit). </p> </div> </div> </div> </div> <button type="button" aria-label="Close" class="modal__close"></button> </div> </div> </div> </div> <div class="footnote"><div class="aetna-modal footnote-modal" data-cmp-is="modal"> <div class="modal__box " id="Monthly-cost" role="dialog" tabindex="-1" aria-labelledby="modal-heading-2134161133"> <div class="modal__inner"> <div class="modal__content"> <h2 id="modal-heading-2134161133" class="title--secondary__big"> Monthly cost</h2> <div class="component__main"> <div class="text"><div class="rte-component-wraper component--default "> <p>The monthly costs shown are examples of our lowest monthly rates. Your cost may vary based on the individual vision plan you choose and the number of people you insure. Once you choose a plan, check your plan documents for your covered services and benefit levels.</p> </div> </div> </div> </div> <button type="button" aria-label="Close" class="modal__close"></button> </div> </div> </div> </div> <div class="disclaimer"><div class="cmp-disclaimer component--left" data-cmp-is-async="disclaimer"> <div class="container"> <div class="row"> <div class="col-md-10 disclaimer__parentContainer"> <div class="disclaimer__wrapper option-b"> <div class="row--inner"> <div class="disclaimer__contentwrapper disclaimer__contentwrapper--wide"> <h2 class="title__section">Legal notices</h2> <div class="disclaimer__description"> <div class="rte-component-wraper component--default " data-linklocationGeneral="discoverable"> <p>Dental plans and vision benefits are insured by Aetna Life Insurance Company (Aetna). Certain vision claims administration services are provided by First American Administrators, Inc. and certain network administration services are provided through EyeMed Vision Care (&quot;EyeMed&quot;), LLC.</p> <p>This material is for information only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Insurance plans contain exclusions and limitations. See brochure and policy for a complete description of benefits, exclusions, limitations, and conditions of coverage. Providers are independent contractors and are not agents of Aetna®. Provider participation may change without notice. Plan features and availability may vary by location and are subject to change. Refer to <a data-analytics-name="DentalDirect.Aetna.com" href="https://dentaldirect.aetna.com/#/" class="link__text--inline" target="_self">DentalDirect.Aetna.com</a> for more information about Aetna Dental® plans.<br /> </p> <p>Dental service areas in Massachusetts include Barnstable, Berkshire, Bristol, Essex, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, and Worcester counties. Members residing outside of the service area seeking in-network level of care would need to seek services within the approved service area.<br /> </p> <p><strong>Policy forms issued in Idaho include: </strong>AL IVL HPol-PPODental_WP 01 and AL IVL HPol-PPODental_NWP 01<br /> </p> <p><strong>Policy forms issued in Missouri, Oklahoma, Washington and Wyoming include:</strong> AL IVL HPol-PPODental 01</p> <p>Vision insurance plans contain exclusions and limitations. Not all vision services are covered. Exclusions and limitations for vision include: any charges in excess of the benefits, dollar or supply limits listed above; special vision procedures, such as orthoptics, vision therapy or vision training; vision services or supplies that do not meet professionally accepted standards; plano (non-prescription) lenses; non-prescription sunglasses; two pair of glasses in lieu of bifocals; medical and/or surgical treatment of the eyes; cosmetic services; lost or broken lenses, frames, glasses or contact lenses. Other exclusions and limitations may also apply.</p> <p>See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Providers in the Aetna Vision network are contracted and credentialed through EyeMed Vision Care, LLC according to EyeMed's requirements. EyeMed and Aetna are independent contractors and not agents of each other. Provider participation may change without notice.<br /> </p> <p><strong>Policy form issued in all approved states</strong> is AL IVL HPol-VisionPPO. Refer to <a href="http://www.visiondirect.aetna.com/#/" style="background-color: rgb(255,255,255);" target="_self" class="link__text--inline" data-analytics-name="VisionDirect.Aetna.com">VisionDirect.Aetna.com</a> <span style="">for more information about Aetna® vision plans.</span></p> <p>DISCOUNT OFFERS ARE NOT INSURANCE. They are not benefits under your insurance plan. You get access to discounts off the regular charge on products and services offered by third party vendors and providers. Aetna makes no payment to the third parties — you are responsible for the full cost. Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts.<br /> </p> <p>This public website is available broadly and is not plan or state specific. If you are an Aetna member, you can log in to access the exact list of available providers, benefits and/or offers based on your specific plan, network or state. If you are not yet enrolled in an Aetna plan, please keep in mind that your actual network, benefits and/or offers may vary from what appears on this website. Not all providers participate in every plan or offer all services. 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The ABA Medical Necessity Guide does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.</p> <p>Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.</p> <p>The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.</p> <p>Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change.</p> <p>Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law.</p> </div> </div> </div> <div class="component__cta "> <a href="#" class="modalContinueBtn btn--primary type__btn--primary ">I Accept</a> </div> </div> </div> </div> </div> </div> <div class="interstitial section"><div class="aetna-modal" data-cmp-is="modal"> <div class="modal__box " id="exit-cvs-caremark" role="dialog" title="Aetna® is proud to be part of the CVS® family." tabindex="-1" aria-labelledby="modal-heading-28807244"> <div class="modal__inner"> <button type="button" aria-label="Close" class="modal__close"></button> <div class="modal__content"> <!-- Modal's Title --> <h2 id="modal-heading-28807244" class="title__block ">Aetna® is proud to be part of the CVS® family.</h2> <div class="component__main"> <div class="text"><div class="rte-component-wraper component--default "> <p>You are now being directed to CVS Caremark<sup>®</sup> site.</p> </div> </div> </div> <div class="component__cta "> <a href="#" class="modalContinueBtn btn--primary type__btn--primary ">Continue</a> </div> </div> </div> </div> </div> </div> <div class="interstitial section"><div class="aetna-modal" data-cmp-is="modal"> <div class="modal__box modal--blocked " id="asam-modal" role="dialog" title="ASAM Terms and conditions" tabindex="-1" aria-labelledby="modal-heading-1817940071"> <div class="modal__inner"> <button type="button" aria-label="Close" class="modal__close"></button> <div class="modal__content"> <!-- Modal's Title --> <h2 id="modal-heading-1817940071" class="title__block ">ASAM Terms and conditions</h2> <div class="component__main"> <div class="text"><div class="rte-component-wraper component--default "> <p>By clicking on “I accept”, I acknowledge and accept that:</p> <p> </p> </div> </div> <div class="text"><div class="rte-component-wraper component--default "> <p>Licensee's use and interpretation of the American Society of Addiction Medicine’s ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits.</p> <p> </p> <p>This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose.</p> <p> </p> <p>Copyright 2015 by the American Society of Addiction Medicine. Reprinted with permission. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM.</p> </div> </div> </div> <div class="component__cta "> <a href="#" class="modalContinueBtn btn--primary type__btn--primary ">I accept</a> </div> </div> </div> </div> </div> </div> <div class="interstitial section"><div class="aetna-modal" data-cmp-is="modal"> <div class="modal__box modal--blocked " id="cpt-modal" role="dialog" title="Precertification lists" tabindex="-1" aria-labelledby="modal-heading-1737369633"> <div class="modal__inner"> <button type="button" aria-label="Close" class="modal__close"></button> <div class="modal__content"> <!-- Modal's Title --> <h2 id="modal-heading-1737369633" class="title__block ">Precertification lists</h2> <div class="component__main"> <div class="text"><div class="rte-component-wraper component--default "> <p>By clicking on “I accept”, I acknowledge and accept that:</p> <p> </p> </div> </div> <div class="text"><div class="rte-component-wraper component--default "> <p>Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled &quot;I Accept&quot;.</p> <p> </p> <ul> <li>The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members.</li> <li>Applies to: Aetna Choice<sup>®</sup> POS, Aetna Choice POS II, Aetna Medicare<sup>℠</sup> Plan (PPO), Aetna Medicare Plan (HMO), all Aetna HealthFund<sup>®</sup> products, Aetna Health Network Only<sup>℠</sup>, Aetna Health Network Option<sup>℠</sup>, Aetna Open Access<sup>®</sup> Elect Choice<sup>®</sup>, Aetna Open Access HMO, Aetna Open Access Managed Choice<sup>®</sup>, Open Access Aetna Select<sup>℠</sup>, Elect Choice, HMO, Managed Choice POS, Open Choice<sup>®</sup>, Quality Point-of-Service<sup>®</sup> (QPOS<sup>®</sup>), and Aetna Select<sup>℠</sup> benefits plans and all products that may include the Aexcel<sup>®</sup>, Choose and Save<sup>℠</sup>, Aetna Performance Network or Savings Plus networks. Not all plans are offered in all service areas.</li> <li>All services deemed &quot;never effective&quot; are excluded from coverage. Aetna defines a service as &quot;never effective&quot; when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Visit the secure website, available through www.aetna.com, for more information. Click on &quot;Claims,&quot; &quot;CPT/HCPCS Coding Tool,&quot; &quot;Clinical Policy Code Search.&quot;</li> <li>The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT<sup>®</sup>), copyright 2023 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians.</li> <li>The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Applicable FARS/DFARS apply.</li> </ul> <p> </p> <h3><strong>LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION (&quot;CPT<sup>®</sup>&quot;)</strong></h3> <p> </p> <ul> <li>CPT only Copyright 2023 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt.</li> </ul> <p> </p> <h3><strong>U.S. Government Rights</strong></h3> <p> </p> <ul> <li>This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.</li> </ul> <p> </p> <h3><strong>Disclaimer of Warranties and Liabilities.</strong></h3> <p> </p> <ul> <li>CPT is provided &quot;as is&quot; without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.</li> <li>This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.</li> <li>Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled &quot;I Accept&quot;.</li> <li>The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services.</li> <li>This information is neither an offer of coverage nor medical advice. It is only a partial, general description of plan or program benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.</li> </ul> </div> </div> </div> <div class="component__cta "> <a href="#" class="modalContinueBtn btn--primary type__btn--primary ">I accept</a> </div> </div> </div> </div> </div> </div> <div class="interstitial section"><div class="aetna-modal" data-cmp-is="modal"> <div class="modal__box modal--blocked " id="dcpb-modal" role="dialog" title="Dental clinical policy bulletins" tabindex="-1" aria-labelledby="modal-heading-1767983030"> <div class="modal__inner"> <button type="button" aria-label="Close" class="modal__close"></button> <div class="modal__content"> <!-- Modal's Title --> <h2 id="modal-heading-1767983030" class="title__block ">Dental clinical policy bulletins</h2> <div class="component__main"> <div class="text"><div class="rte-component-wraper component--default "> <p>By clicking on “I accept”, I acknowledge and accept that:</p> <p> </p> </div> </div> <div class="text"><div class="rte-component-wraper component--default "> <ul> <li>Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Treating providers are solely responsible for dental advice and treatment of members. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider.</li> <li>While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). Your benefits plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government.</li> <li>Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change.</li> <li>Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies.</li> <li>Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met.</li> </ul> </div> </div> </div> <div class="component__cta "> <a href="#" class="modalContinueBtn btn--primary type__btn--primary ">I accept</a> </div> </div> </div> </div> </div> </div> <div class="interstitial section"><div class="aetna-modal" data-cmp-is="modal"> <div class="modal__box modal--blocked " id="mcpbs-modal" role="dialog" title="Medical clinical policy bulletins" tabindex="-1" aria-labelledby="modal-heading-1142802819"> <div class="modal__inner"> <button type="button" aria-label="Close" class="modal__close"></button> <div class="modal__content"> <!-- Modal's Title --> <h2 id="modal-heading-1142802819" class="title__block ">Medical clinical policy bulletins</h2> <div class="component__main"> <div class="text"><div class="rte-component-wraper component--default "> <p>By clicking on “I accept”, I acknowledge and accept that:</p> <p> </p> </div> </div> <div class="text"><div class="rte-component-wraper component--default " data-linklocationGeneral="discoverable"> <p>Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled &quot;I Accept&quot;.</p> <p> </p> <ul> <li>Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider.</li> <li>While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental, investigational, unproven, or cosmetic. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors).</li> <li>Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error.</li> <li>CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. New and revised codes are added to the CPBs as they are updated. When billing, you must use the most appropriate code as of the effective date of the submission. Unlisted, unspecified and nonspecific codes should be avoided.</li> <li>Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern.</li> <li>In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. </li> </ul> <p><a href="https://www.cms.gov/Center/special-topic/medicare-coverage-center.html" target="_blank" class="link__text" data-analytics-name="See CMS's Medicare Coverage Center" data-modal="exit" data-linktype="Regular">See CMS's Medicare Coverage Center</a></p> <p> </p> <ul> <li>Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change.</li> <li>Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Under certain circumstances, your physician may request a peer to peer review if they have a question or wish to discuss a medical necessity precertification determination made by our medical director in accordance with Aetna’s Clinical Policy Bulletin.</li> <li>While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans.</li> </ul> <p><a href="/individuals-families/member-rights-resources/claims-coverage/aetna-external-review-program.html" target="_self" class="link__text" data-analytics-name="See Aetna's External Review Program" data-modal="Please Select" data-linktype="Regular">See Aetna's External Review Program</a></p> <p> </p> <ul> <li>The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT®), copyright 2015 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians.</li> <li>The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. 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License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt.</p> <p> </p> <p><a href="http://www.ama-assn.org/go/cpt" target="_blank" class="link__text" data-analytics-name="Go to the American Medical Association Web site" data-modal="exit" data-linktype="Regular">Go to the American Medical Association Web site</a></p> <p> </p> <h3><strong>U.S. Government Rights</strong></h3> <p> </p> <p>This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. 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