Schedule of Cost Sharing Sample Contracts

Aetna Medicare
Schedule of Cost Sharing • December 9th, 2022

This Schedule of Cost Sharing is part of the Evidence of Coverage for Aetna Medicare Plan (PPO). When the Evidence of Coverage refers to the document with information on health care benefits covered under our plan, it is referring to this Medical Benefits Chart. (See Chapter 4, Medical Benefits Chart (What is covered and what you pay).) If you have questions, please call our Member Services at the telephone number printed on your member ID card or call our Member Services at 1‑866‑241‑0262. (TTY users should call 711.) Hours are 8 AM to 8 PM ET, Monday through Friday.

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Aetna Medicare
Schedule of Cost Sharing • November 14th, 2023

This Schedule of Cost Sharing is part of the Evidence of Coverage for The Federal Employees Health Benefits Program. When the Evidence of Coverage refers to the document with information on health care benefits covered under our plan, it is referring to this Medical Benefits Chart. (See Chapter 4, Medical Benefits Chart (what is covered and what you pay).) If you have questions, please call our Member Services at the telephone number printed on your member ID card or call our Member Services at 1‑866‑241‑0262. (TTY users should call 711.) Hours are 8 AM to 8 PM ET, Monday through Friday.

Aetna Medicare
Schedule of Cost Sharing • September 30th, 2021

This Schedule of Cost Sharing is part of the Evidence of Coverage for Aetna Medicare Plan (PPO). When the Evidence of Coverage refers to the document with information on health care benefits covered under our plan, it is referring to this Medical Benefits Chart. (See Chapter 4, Medical Benefits Chart (what is covered and what you pay).) If you have questions, please call our Member Services at the telephone number printed on your member ID card or call our general Member

Aetna Medicare
Schedule of Cost Sharing • October 14th, 2022

This Schedule of Cost Sharing is part of the Evidence of Coverage for Aetna Medicare Plan (PPO). When the Evidence of Coverage refers to the document with information on health care benefits covered under our plan, it is referring to this Medical Benefits Chart. (See Chapter 4, Medical Benefits Chart (What is covered and what you pay).) If you have questions, please call our Member Services at the telephone number printed on your member ID card or call our Member Services at 1‑866‑539‑6750. (TTY users should call 711.) Hours are 8 AM to 9 PM ET, Monday through Friday.

Aetna Medicare
Schedule of Cost Sharing • September 22nd, 2021

This Schedule of Cost Sharing is part of the Evidence of Coverage for Aetna Medicare Plan (PPO). When the Evidence of Coverage refers to the document with information on health care benefits covered under our plan, it is referring to this Medical Benefits Chart. (See Chapter 4, Medical Benefits Chart (what is covered and what you pay).) If you have questions, please call our Member Services at the telephone number printed on your member ID card or call our Member Services at 1-

Aetna Life Insurance Company
Schedule of Cost Sharing • September 21st, 2020

This Schedule of Cost Sharing is part of the Evidence of Coverage for Aetna Medicare Plan (PPO). When the Evidence of Coverage refers to the attachment for information on health care benefits covered under our plan, it is referring to this Medical Benefits Chart. (See Chapter 4, Medical Benefits Chart (what is covered and what you pay).) If you have questions, please call Member Services at the telephone number listed on your member ID card.

Aetna Life Insurance Company
Schedule of Cost Sharing • June 20th, 2017

This Schedule of Cost Sharing is part of the Evidence of Coverage for Aetna Medicare Plan (PPO). When the Evidence of Coverage refers to the attachment for information on health care benefits covered under our plan, it is referring to this Medical Benefits Chart. (See Chapter 4, Medical Benefits Chart (what is covered and what you pay).) If you have questions, please call Member Services at the telephone number listed on your member ID card.

Aetna Medicare
Schedule of Cost Sharing • October 7th, 2022

This Schedule of Cost Sharing is part of the Evidence of Coverage for Aetna Medicare Plan (PPO). When the Evidence of Coverage refers to the document with information on health care benefits covered under our plan, it is referring to this Medical Benefits Chart. (See Chapter 4, Medical Benefits Chart (What is covered and what you pay).) If you have questions, please call our Member Services at the telephone number printed on your member ID card or call our Member Services at 1‑888‑272‑5651. (TTY users should call 711.) Hours are 8 AM to 6 PM ET, Monday through Friday.

Aetna Medicare‌
Schedule of Cost Sharing • February 9th, 2023

This Schedule of Cost Sharing is part of the Evidence of Coverage for Aetna Medicare Plan (PPO). When the Evidence of Coverage refers to the document with information on health care benefits covered under our plan, it is referring to this Medical Benefits Chart. (See Chapter 4, Medical Benefits Chart (What is covered and what you pay).) If you have questions, please call our Member Services at the telephone number printed on your member ID card or call our general Member Services at 1‑855‑648‑0389. (TTY users should call 711.) Hours are 8 AM to 9 PM ET, Monday through Friday.

Aetna Medicare
Schedule of Cost Sharing • October 5th, 2021

This Schedule of Cost Sharing is part of the Evidence of Coverage for Aetna Medicare Plan (PPO). When the Evidence of Coverage refers to the document with information on health care benefits covered under our plan, it is referring to this Medical Benefits Chart. (See Chapter 4, Medical Benefits Chart (what is covered and what you pay).) If you have questions, please call our Member Services at the telephone number printed on your member ID card or call our general Member

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