The Prescribed Medicines Expense Exclusions and Limitations section of the Policy has changed. The following has been added under Limitations: • Aetna retains the right to review all requests for reimbursement and, within its reasonable authority to, make reimbursement determinations subject to the Appeals Procedure, Exhaustion of Process, and External Review section of the Policy. • Aetna reserves the right to include only one manufacturer’s product on the preferred drug list when the same or similar drug (that is, a drug with the same active ingredient), supply or equipment is made by two or more different manufacturers. • Aetna reserves the right to include only one dosage or form of a drug on the preferred drug list when the same drug (that is, a drug with the same active ingredient) is available in different dosages or forms from the same or different manufacturers. The product in the dosage or form that is listed on our preferred drug list will be covered at the applicable benefit deductible, copay or coinsurance. This amendment makes no other changes to the Policy. Xxx Xxxxx President Aetna Life Insurance Company (A Stock Company) Amendment: 2 Issue Date: July 2, 2021 Aetna Life Insurance Company Hartford, Connecticut 06156 Student Accident Insurance Policy Amendment Policyholder: Central Connecticut State University - Accident Plan Policy No.: 890429 Effective Date: This Amendment is effective on the later of: August 1, 2021; or The date a person becomes a covered person under the Student Accident Policy. The Student Accident Insurance Policy (Policy) noted above has been changed. Except as modified or superseded by this Amendment, all other terms and conditions in the Policy remain unchanged and in full force and effect. The following is a summary of the changes in the Policy. This amendment is effective on the date(s) shown above.
