MANAGED CHOICE® POS PLAN Direct access to obstetricians and gynecologists DISCLOSURE FORM If you are a female member, you may go directly to a gynecologist in our network without a referral. You may Aetna Life Insurance Company do this for diagnosis or for treatment, or if you’ve been This disclosure is not your plan of benefits, but it does referred by another doctor for gynecologic problems. describe the main features of the Managed Choice® POS plan. We provide this disclosure in compliance with the Definitions laws of the state of Georgia. While this material is believed Preferred care is care provided by: to be accurate as of the date of publication, it is subject to • A primary care physician change without notice. • A preferred care provider on the referral of the primary Your plan of benefits will be determined by your employer care physician and underwritten by the Aetna Life Insurance Company, • A nonpreferred care provider on the referral of the of Hartford, Connecticut (called Aetna®). The benefits and primary care physician, if approved by Aetna main points of the Group Contract for persons covered under your employer’s plan or benefits is detailed in the • Any health care provider for an emergency condition Booklet-Certificate, which you’ll get at a later date. In case when you can’t travel to a preferred care provider or of conflict between the Group Contract and Booklet- when you can’t get a referral by your primary care Certificate and this disclosure, the Group Contract and physician prior to treatment Booklet-Certificate will govern. A preferred care provider is a provider that has The name and address of the managed care contracted with us to provide services or supplies for a organization is: negotiated charge but only if the provider is, with our Aetna Life Insurance Company consent, included in the directory of preferred care 151 Farmington Avenue providers for: Hartford, CT 06156 • The service or supply involved • The class of employee of which you are a member MANAGED CHOICE PLAN With the Managed Choice POS plan, you can access A primary care physician (PCP) is the preferred care benefits in one of two ways: provider you selected from the list of primary care physicians in the directory. A PCP is responsible for your • You can minimize your out-of-pocket costs by visiting ongoing health care. They’re on our records as your the primary care physician (PCP) you selected and primary care physician. by getting referrals, when necessary, from your PCP. Nonpreferred care is care furnished by a health care • You also have the option to access any provider provider that is not preferred care. (preferred care or nonpreferred care provider) without a referral, for covered medical expenses. But your A nonpreferred care provider is a provider that has not out-of-pocket costs will be higher — except for contracted with us to furnish services or supplies at a emergency treatment and direct-access benefits. negotiated charge. Or it can be a preferred care provider furnishing services or supplies without the referral of a This section describes benefits for expenses incurred for primary care physician. necessary care and treatment of disease and injury. Not Certification requirements all medical expenses are covered. And some covered You must obtain certification for certain types of medical expenses are not covered in full. nonpreferred care to avoid a reduction in benefits paid for All maximums included in this plan are combined that care. Read the Patient Management Program section between preferred care and nonpreferred care, where for more details of the types of care affected, how to get applicable, unless stated otherwise. certification and how not getting certification could affect your benefits.

02.28.318.1-GA-C (3/21)

1 Member deductibles and copays 30% difference in coinsurance between preferred and The plan may contain some or all of the following nonpreferred care expenses. features. Your employer will determine the applicability The payment percentage applies after you have paid any and amount of each copay and deductible. deductible or copay amounts. • Copays — these are fees that you must pay for some Payment limits for nonpreferred care covered medical expenses. These limits apply to covered medical expenses incurred • Calendar year deductible — the amount of covered for nonpreferred care except for expenses: medical expenses you pay each calendar year before • Applied against any deductible or copay amount benefits are paid. A calendar-year deductible applies • Incurred for the effective treatment of alcoholism and to each person. drug use disorders, and for the treatment of mental • Inpatient hospital deductible — this is the amount disorders, while not confined as a full-time inpatient for inpatient hospital charges you pay for each person’s hospital stay. Covered medical expenses To be covered, the medical expense must be necessary A hospital stay for a well newborn child, with coverage for the diagnosis, care or treatment of the disease or in force, starts on the day of birth. The inpatient hospital injury as determined by Aetna. deductible and the inpatient hospital copay will not exceed the hospital’s actual charge for board and room Covered expenses include: for the first day of confinement. • Room and board and other hospital services and This inpatient hospital deductible applies to inpatient supplies for inpatient hospital stays hospital expenses incurred for nonpreferred care. • Services and supplies for outpatient hospital treatment • Emergency room deductible — a separate deductible • Services and supplies for convalescent facilities applies to each person’s visit in a hospital emergency • Home health care room. This is true unless the person is admitted to the hospital within 24 hours after a visit to a hospital • Routine physical exam emergency room. • Routine eye exam • Routine obstetric and gynecologic exams Benefits payable • Routine hearing exam After you’ve paid any applicable deductible or copay amount, the benefits under this plan are paid in a calendar • Preventive health care services (including child year at the percentage that applies to the type of covered wellness services) medical expense incurred (this is known as coinsurance). • Mammogram There are exceptions for different benefits levels, as you • Lab exams for annual chlamydia screening may see later in this disclosure form. Your benefits may • Lab exams for routine prostate-specific antigen (PSA) test vary if you don’t use a preferred care provider. • Routine Pap test We will not cover any charge for a service or supply from a preferred care provider above the provider’s negotiated • Skilled nursing care charge. In no event will you or your eligible dependents • Hospice care have to pay any such excess charge. Aetna® and the • Short-term rehabilitation preferred care provider will resolve the amount deemed excess. If any expense is covered under one type of • Prescription drugs covered medical expense, it cannot be covered under • Physicians’ services any other type. • Diagnostic lab work and X-rays Payment percentage • X-ray, radium and radioactive isotope therapy Coinsurance percentages will range from 100% to 80% • Anesthetics and oxygen for preferred care expenses and from 80% to 60% for • Rental of durable medical and surgical equipment nonpreferred care expenses, depending on the plan your employer chose. Generally, you won’t see more than a • Artificial limbs and eyes

Health benefits and health insurance plans are offered by Aetna Health Inc. and/or Aetna Health Insurance Company (Aetna).

2 • Alcoholism or drug use disorders — inpatient and • Charges to the extent they are not reasonable charges, outpatient treatment as determined by Aetna • Mental disorders — inpatient and outpatient treatment • Reversal of a sterilization procedure Exclusions Pregnancy coverage We will not cover the following: We pay benefits for pregnancy-related expenses of • Services and supplies not necessary, as determined by female employees and dependents on the same basis as Aetna®, for the diagnosis, care or treatment of a disease for a disease. or an injury For inpatient hospital stays, we’ll pay benefits for care of the • Care, treatment, services, or supplies not prescribed, covered person and any newborn child for a minimum of: recommended, or approved by the attending physician • 48 hours following a vaginal delivery • Services or supplies, as determined by Aetna, that are • 96 hours following a cesarean delivery experimental or investigational If a woman is discharged earlier, benefits will be payable • Services, treatment, educational testing or training for two post-delivery home visits by a health care provider. related to learning disabilities or developmental delays Emergency care • Care furnished mainly to provide a surrounding free If you need emergency care, you’re covered, 24/7, from exposure that can worsen the person’s disease anywhere in the world. Call the local emergency hotline or injury (911). Or go to the nearest emergency facility. If a delay • Primal therapy, Rolfing, psychodrama, megavitamin would not be detrimental to your health, call your primary therapy, bioenergetic therapy, vision perception training care physician. or carbon dioxide therapy Notify your primary care physician as soon as possible • Treatment from covered health care providers, such after receiving treatment. An emergency medical as a resident physician or intern, who specialize in the condition is “one manifesting itself by acute symptoms mental health care field and receive treatment as part of sufficient severity such that a prudent layperson, who of their training possesses average knowledge of health and medicine, • Charges made for services only because there is could reasonably expect the absence of immediate health coverage medical attention to result in serious jeopardy to the • Services for which there is no legal obligation to pay person’s health, or with respect to a pregnant woman, the health of the woman and her unborn child.” • Custodial care • Services or supplies furnished, paid for, or for which Patient Management Program benefits are provided or required by reason of service in We evaluate and determine the appropriateness of the armed forces of a government medical care resources used by our members. To • Eye surgery mainly to correct refractive errors accomplish these goals, we’ve developed a • Education, special education or job training comprehensive Patient Management Program. We review the population demographics of the membership and the • Plastic surgery, reconstructive surgery or cosmetic program’s results to determine the need for changes. surgery, except as applied to certain injuries, diseases Regional medical directors, together with local market or birth defects medical directors, review this information to initiate • Sexual dysfunctions or inadequacies program development or enhancement. • Artificial insemination, in vitro fertilization or embryo The Patient Management Program is reviewed annually. transfer procedures Only medical directors make decisions denying coverage • Routine exams, immunizations or preventive care except for services for reasons of medical necessity. We as specifically provided for in your Booklet-Certificate communicate all patient management decisions both by • Marriage, family, child, career, social adjustment, telephone and in writing. We make timely decisions on pastoral or financial counseling appeals as the urgency of the situation dictates. • Acupuncture therapy • Speech therapy, except to restore lost existing speech function

3 Here are the time frames for making our decisions: For an emergency or urgent admission, you, your • Precertification decisions — within two business days physician or the hospital must get the days certified by calling the number on your ID card. This must be done • Emergent decisions — immediately before an urgent admission, or not later than 48 hours • Concurrent decisions — within one business day following an emergency admission. • Retrospective decisions — within 30 days of when If your physician thinks it’s necessary for you to stay for a we receive appropriate information longer time than already certified, you, the physician or the hospital may request certification for the additional days by The focused review process (if subspecialty review is calling the number on your ID card. This must be done no required) takes approximately 10 business days. Procedures later than on the last day that has already been certified. that must be performed within this time frame are excluded from the precertification requirement. Certification for convalescent facility admissions, home health care expenses, hospice care expenses Coverage denial letters specify any unmet criteria and skilled nursing care standards and guidelines, and they inform the provider Certification as necessary is required for: and member of the appeal process. • A stay in a convalescent or hospice facility The Patient Management Program includes the • Home health care or hospice care while not confined following components: as an inpatient Certification for certain prescription drugs Certification of necessity is required before certain • Skilled nursing care, if such care has not been ordered drugs are dispensed by a preferred pharmacy. or prescribed by your primary care physician or a preferred care provider upon referral by your primary We’ll cover these prescription drugs at the applicable care physician percentage if certification has been requested and the drug is necessary. Otherwise no benefit will be payable. Certification for convalescent and hospice It is your responsibility to have the prescriber of the drug facility stays request certification. They can do that by calling the If a stay is certified as necessary, convalescent and number on your ID card. They must call as soon as hospice facility expenses will be paid at the appropriate reasonably possible before the drug is dispensed. Written percentage. notice of the certification decision will be sent promptly If you have requested certification and it was denied, we to you. will not pay benefits for convalescent or hospice facility room and board expenses. Benefits for all other Certification for hospital admissions Certification that a hospital stay is necessary is required if convalescent or hospice facility expenses will be paid the stay has not been ordered and prescribed by: at the appropriate percentage. • Your primary care physician If certification has not been requested and the stay is not necessary, no benefits will be paid for convalescent • A preferred care provider upon referral by your primary or hospice facility room and board expenses. care physician Certification for home health care, hospice care and If a stay is certified as necessary, hospital expenses will skilled nursing care be payable at the appropriate percentage. If care is certified as necessary, home health care, If you have requested certification and it was denied, we hospice care and skilled nursing care expenses will be will not pay benefits for hospital room and board paid at the appropriate percentage. expenses. Benefits for all other hospital expenses will be If you have requested certification and it was denied, paid at the appropriate percentage. no benefits will be paid. Or, if certification has not been If certification has not been requested and the hospital requested and the care is not necessary, no benefits stay is not necessary, no benefits will be paid for hospital will be paid. room and board expenses. To get certification you must call the number on your If the hospital stay is for a nonurgent admission, you must ID card. You must obtain certification before you get the days certified by calling the number on your ID receive care. card. This must be done at least 14 days before the If your physician believes that you need more days of scheduled hospitalization. confinement or care beyond those which have already been certified, you must call to certify more days.

4 Certification for certain procedures and treatments Concurrent review Certification is required for certain procedures and The concurrent review process assesses the necessity treatments if they have not been ordered and prescribed for continued stay, level of care and quality of care for by your primary care physician or a preferred care members receiving inpatient services. All inpatient provider upon referral by your primary care physician. services extending beyond the initial certification period The procedures or treatments require certification before will require concurrent review. they are performed, whether on an inpatient or outpatient Discharge planning basis. You can view the procedures and treatments that Discharge planning may be initiated at any stage of the require certification at Aetna.com/ patient management process. It begins upon identification Health-Care-Professionals/Precertification/ of postdischarge needs during certification or concurrent Precertification-Lists.html. review. The discharge plan may include services or benefits If the procedure or treatment is certified as necessary, members can use when they are discharged from an expenses will be paid at the appropriate percentage. inpatient stay. If the procedure or treatment is not necessary, no Retrospective record review benefits will be payable whether or not certification has The purpose of these reviews is to retrospectively analyze been requested. potential quality and utilization issues, initiate appropriate If certification has been requested and the procedure or follow-up action based on quality or utilization issues, and treatment is necessary, benefits will be payable at the review all appeals of inpatient concurrent review appropriate percentage. decisions. Managing the services provided to members includes the retrospective review of claims submitted for You or the provider performing the procedure or payment and of medical records submitted for potential treatment must call the number on your ID card to quality and utilization concerns. request certification. The call must be made at least 14 days before the date of Appeal procedure the procedure or treatment unless it’s an emergency. An appeal is a written request for a review of a decision to Certification is required for hospital and treatment facility deny, in whole or in part, things like a claim payment, admissions or necessary confinement for alcoholism, a certification request, a referral or eligibility. drug use disorder or mental disorders. It’s required when • An appeal must be submitted within 180 days of the the confinement has not been ordered and prescribed by: date Aetna® provides notice of denial. • Your primary care physician • If your plan provides for a one-level appeal process, • A preferred care provider upon referral by your primary we will send you a response within 30 days of when care physician we receive the appeal if your request is regarding a preservice claim (or a service that requires prior If confinement is certified as necessary, expenses will be approval). The response will be based on the paid at the appropriate percentage. If certification has information provided with or subsequent to the appeal. been requested and denied, no benefits will be paid for hospital or treatment facility room and board expenses. • If your plan provides for two levels of appeal, you’ll get a Benefits for all other hospital or treatment facility response within 15 days of when we receive the request expenses will be paid at the appropriate percentage. at each level of appeal. If certification has not been requested and the • If your plan provides for a one-level appeal process, we’ll confinement is not necessary, no benefit will be paid for send you a response within 60 days after receipt of the hospital or treatment facility room and board expenses. appeal for a postservice issue. The response will be based on the information provided with or subsequent to the To get the days certified, you must call the number on appeal. If your plan provides for two levels of appeal, your ID card. Certification must be obtained before a stay. you’ll get a response within 30 days of our receipt of the Or in an emergency admission, within 48 hours after the request at each level of appeal. start of a confinement, or as soon as reasonably possible. • For urgent issues, if your plan provides a one-level If your physician believes that you need more days appeal process, you’ll get a response within 72 hours of confinement beyond those that have already been of the request. For a two-level process, you’ll get a certified, the additional days must be certified. response within 36 hours at each level of appeal. This must be done no later than on the last day that has already been certified.

5 Summary of grievances Limited utilization incentive plans A summary of the number, nature and outcome of This health plan does not contain any limited utilization grievances filed in the previous three years is available for incentive plans. inspection. Copies of the summary are available at a reasonable cost. Provider credentialing All prospective participating providers must meet our Specialty referral procedures standards before being accepted into our network. For Except for any applicable direct-access specialists, you example, prospective primary care physicians must comply can only access specialist benefits with prior approval with more than two dozen criteria before they are certified from your primary care provider. and accepted. These criteria include: • License and malpractice insurance Provider reimbursement • Hospital privileges Participating providers are reimbursed on a discounted fee-for-service basis. • Provision of continuous, comprehensive care Where the member is responsible for a coinsurance • Emergency coverage payment based on a percentage of the bill, the member’s • Office appearance, cleanliness and equipment obligation should be based on charges established • Organization of medical records by contract, if any, and not based on the provider’s billed charges. • Participation in continuing medical education programs We negotiate discounts from independent pharmacies, These physicians are evaluated regularly for continued chain pharmacies and mail vendors who accept our compliance with our criteria. Primary care physicians in reimbursement rates for dispensing and ingredient costs our networks are recredentialed about every two years. in return for volume business. Our negotiated discounts This process includes a review of: are passed in full to our plan sponsors. • Provider performance The reimbursement formula is based on average • Office environment wholesale price (AWP) less a negotiated discount, plus • Patient charts a dispensing fee. The dispensing fee is a contractual fee negotiated between Aetna® and the network pharmacy. • Member surveys and complaints The negotiated rate renews each year unless it is Results are submitted to a peer committee composed of changed contractually. physicians before participation is continued. Hospitals Where the member is responsible for a coinsurance and ancillary providers are also reviewed for quality and payment based on a percentage of the bill, the member’s appropriateness of care. obligation is determined on the basis of the charges set by contract, if any, rather than on the basis of the Need to find a health care professional in provider’s billed charges. our network? Claims payment for nonpreferred providers and Our online provider search tool at Aetna.com can help. use of claims software Click on Find a Doctor anytime, anywhere to find: If your plan covers services rendered by nonpreferred • Doctors providers, you should know that we determine the usual, • Dentists customary and reasonable fee for a provider by referring • Facilities to commercially available data. This data reflects the • Hospitals customary amount paid to most providers for a given ® service in that geographic area. If such data is not • EyeMed locations commercially available, our determination may be based • Pharmacies on our own data. We may also use computer software • Behavioral health professionals (including ClaimCheck®) and other tools to take into account factors such as the complexity of, amount of You can search by: time needed for, and manner of billing. You may be • Name responsible for any charges we determine are not • Specialty covered under the plan. • Gender • Hospital affiliation

6 We update the information six times a week. What is the Georgia consumer choice option The tool allows you to find additional information about (“option”)? your provider, including: Georgia law requires that an enrollee (“you” or “member”) • Their board certification of a managed care plan (HMO or PPO plan) must have the opportunity to nominate a provider (PCP, specialist, • Medical school attended dentist or hospital) not currently participating in the • Year of graduation managed care plan’s network. Under this option, and with • Languages spoken certain restrictions required by law, you may nominate a nonparticipating provider. • Other office locations The out-of-network provider you nominate must agree Need maps and driving directions? to both: When you find a doctor using our search tool, you’ll also • Provide services covered by the managed care plan at find a map and driving directions. the plan’s standard reimbursement rates • Follow the plan’s usual rules and procedures Need a paper copy of our provider directory? Although Aetna.com contains the most current We’ll cover the services you and your dependents receive information available about participating health care from this provider at the in-network level. This means providers, you can ask us for a paper copy of the listing. we’ll pay your provider as though they were “an accepted Just: provider” in the plan’s network. • Send us a message from your personal member When does this option go into effect? website at Aetna.com. Your coverage under the consumer choice option will • Call us anytime at Member Services using the toll-free take effect on whichever one of these two dates is later: number on your ID card. Our automated phone • The date your coverage under the plan takes effect attendant can help you with your search 24/7. • The date the nominated out-of-network provider becomes an accepted provider Use network providers To maximize benefits and reduce out-of-pocket This is called “the effective date.” expenses, you should select a preferred provider. Who can be nominated? You’ll see significant savings when you use preferred To be an accepted provider, a nominated provider must: providers because they’ve agreed to accept substantially • Be a health care provider as defined by O.C.G.A. lower rates as payment for their services. Nonpreferred §33-20A-3(3), or a hospital care is subject to reasonable and customary (R&C) charge allowance maximums. Any charges in excess of • Be located within and licensed by the state of Georgia the R&C allowance are not covered under the plan. • Agree to accept reimbursement by both the plan and Preferred providers are independent contractors and the enrollee at the rates for and on the terms and are neither employees nor agents of Aetna®. conditions applicable to similarly situated providers Summary of agreements between Aetna and • Agree to adhere to the plan’s requirements and meet preferred providers all other reasonable criteria that the plan may require of its participating providers You can get a summary of any agreement or contract between an Aetna managed care plan and any health How do I nominate a provider? care provider by calling 1-800-872-3862 (TTY: 711). Fill out the Nonparticipating Provider Nomination form. The summary will not include financial agreements as to It comes with instructions and conditions. You must fill actual rates, reimbursements, charges or fees negotiated out one form for each provider you wish to nominate, by the managed care plan and the provider. for yourself and eligible dependents. Give the form to The summary will include a category or type of the provider(s) you nominate, for their signature. Then compensation paid by the managed care plan to each return the form to our consumer choice option unit. There class of health care provider under contract with Aetna. are instructions on how to do that. If you nominate a provider, we won’t necessarily accept them. But we will let you and the provider know our decision, in writing. We’ll do that within three business days of getting your nomination.

7 We may cancel our acceptance of (or “deselect”) an accepted provider submits any claims that do not follow accepted provider at any time, if the provider fails to these procedures, it may result in an out-of-network claim comply with the plan’s generally accepted rules. If we being paid at the out-of-network reimbursement rate (or do cancel the acceptance, we’ll let you know in writing. denied). Any claims submitted through normal claims We’ll pay the deselected provider at the in-network level channels will be: for covered services. We’ll do that until you get our notice • Automatically treated as an out-of-network claim of their deselection. • Paid at the out-of-network level of reimbursement Will the provider’s credentials be reviewed? or denied Under the option, the plan will not credential or otherwise review the qualifications of any nonparticipating provider Consumer choice option claims are not automatically that you may nominate, beyond verifying that the electronically processed the way most in-network nominated provider is a health care provider as defined claims are. by O.C.G.A. § 33-20A-3(3), or a hospital. When you select Claims must be prepared for processing by the staff of a nonparticipating provider under this option, you will the consumer choice option unit. Otherwise, HMO claims not have the benefit of the plan’s usual credential may be denied outright. PPO claims will be processed at verification process. the out-of-network level, which means a higher out-of-pocket expense for the member. What are the plan benefits under the option? The benefits provided by your group benefits plan under When will the option terminate? which this option is exercised will remain in effect, and Coverage under the option is linked to the group benefits the benefits and all other requirements under the plan plan in which you are enrolled. This option will remain in (including precertification, notifications and referrals, effect from your date of acceptance through the end of when required) will not change because you your current plan year, or the end of the plan year under participated in the consumer choice option. any subsequent annual renewals you may exercise, whichever comes later. Payment for covered services provided by your accepted provider will be made at the in-network level for you and The plan will terminate the option coverage: any of your family members who may enroll in the option • When your coverage under the plan terminates with you. • If you don’t pay the premium for the option How will covered services by a nonparticipating • If the Georgia consumer choice option law provider be reimbursed under the option? (§ 33-20A-9.1, O.C.G.A.) is repealed An accepted provider will be eligible for reimbursement of covered services at the in-network benefits level. If you Call 1-800-470-2004 (TTY: 711) for exact pricing and receive covered services from a nonparticipating provider other information. Please have your Aetna® member ID before your option effective date, reimbursement will be card available when you call. at the same level (if at all) as for other nonparticipating providers under the plan. Accepted providers must follow claims procedures described in the Nonparticipating Provider Nomination form instructions and conditions to ensure that claims are paid correctly at the in-network reimbursement rate. If an

8 Aetna® complies with applicable federal civil rights laws and does not unlawfully discriminate, exclude or treat people differently based on their race, color, national origin, sex, age, or disability. We provide free aids/services to people with disabilities and to people who need language assistance. If you need a qualified interpreter, written information in other formats, translation or other services, call the number on your ID card. If you believe we have failed to provide these services or otherwise discriminated based on a protected class noted above, you can also file a grievance with the Civil Rights Coordinator by contacting: Civil Rights Coordinator, P.O. Box 14462, Lexington, KY 40512 (CA HMO customers: PO Box 24030 Fresno, CA 93779), 1-800-648-7817, TTY: 711, Fax: 859-425-3379 (CA HMO customers: 860-262-7705), [email protected]. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, or at 1-800-368-1019, 800-537-7697 (TDD).

9 TTY:711

English To access language services at no cost to you, call the number on your ID card. Para acceder a los servicios lingüísticos sin costo alguno, llame al número que figura Spanish en su tarjeta de identificación. Để sử dụng các dịch vụ ngôn ngữ miễn phí, vui lòng gọi số điện thoại ghi trên thẻ ID Vietnamese của quý vị. 무료 다국어 서비스를 이용하려면 보험 ID 카드에 수록된 번호로 전화해 Korean 주십시오. Chinese Traditional 如欲使用免費語言服務，請撥打您健康保險卡上所列的電話號碼

Gujarati

Pour accéder gratuitement aux services linguistiques, veuillez composer le numéro French indiqué sur votre carte d'assurance santé. Amharic የ ቋንቋ አ ገልግሎቶችን ያለክፍያ ለ ማግ ኘ ት ፣ በ መታወ ቂ ያ ዎ ት ላይ ያ ለ ውን ቁጥር ይ ደ ውሉ ፡ ፡

Hindi

French Creole Pou ou jwenn sèvis gratis nan lang ou, rele nimewo telefòn ki sou kat idantifikasyon (Haitian) asirans sante ou. Для того чтобы бесплатно получить помощь переводчика, позвоните по Russian телефону, приведенному на вашей идентификационной карте. ﻟﻠﺤﺼﻮل ﻋﻠﻰ اﻟﺨﺪﻣﺎت اﻟﻠﻐﻮﯾﺔ دون أي ﺗﻜﻠﻔﺔ، اﻟﺮﺟﺎء اﻻﺗﺼﺎل ﻋﻠﻰ اﻟﺮﻗﻢ اﻟﻤﻮﺟﻮد ﻋﻠﻰ ﺑﻄﺎﻗﺔ اﺷﺘﺮاﻛﻚ. Arabic Para aceder aos serviços linguísticos gratuitamente, ligue para o número indicado Portuguese no seu cartão de identificação. ﺑﺮای دﺳﺘﺮﺳﯽ ﺑﮫ ﺧﺪﻣﺎت زﺑﺎن ﺑﮫ طﻮر راﯾﮕﺎن، ﺑﺎ ﺷﻤﺎره ﻗﯿﺪ ﺷﺪه روی ﮐﺎرت ﺷﻨﺎﺳﺎﯾﯽ ﺧﻮد ﺗﻤﺎس ﺑﮕﯿﺮﯾﺪ. Persian Farsi Um auf den für Sie kostenlosen Sprachservice auf Deutsch zuzugreifen, rufen Sie die German Nummer auf Ihrer ID-Karte an. Japanese 無料の言語サービスは、IDカードにある番号にお電話ください。

©2021 Aetna Inc. 02.28.318.1-GA-C (3/21) 10