Here are some quick answers to common questions you might have. If you need additional information, please call us at 1-800-822-4346.
First, choose a primary care doctor to lead your care team. Your doctor and other health care providers in the network should generally refer you to specialists and hospitals that are affiliated with the Texas Health Aetna network. Then, electronic health records help keep you and your care team on the same page. That’s because they can keep track of your prescriptions, lab results, health history and more. Having this big-picture view of your health also helps them spot any gaps in your care. And if they find that you’re at risk for certain conditions, they can build a personalized care plan to treat you.
The primary care doctor you pick will lead your care team. That’s important because you should see your doctor not only when you’re sick, but also for your annual wellness exam, including preventive screenings. Your doctor can also help you find care programs tailored to your needs. He or she can guide you on important health decisions. And coordinate your care across other specialties and facilities in your network. It’s important to select a PCP* at enrollment. If you don’t choose one, a PCP will be assigned to you.
*In Texas, PCP is known as physician (primary care)
First, you'll receive your member welcome package along with your ID card. The package is full of tips on how to get the most from your Texas Health Aetna benefit plan.
When asked to pick a plan, select HMO from the drop-down menu under Employer Plans - Care Plus.
You can work with your current doctor and request transition-of-care coverage. If we approve your request, you can stay with your current out-of-network doctor for a limited time at the highest benefit level. And before your grace period ends, we can help transfer you to a new doctor within the Texas Health Aetna network.
Transition-of-care coverage is for your current doctor only. It doesn’t cover health care facilities, durable medical equipment (DME) or prescription drugs. So you’ll need to use Texas He alth Aetna network facilities, DME vendors and pharmacies while you’re in treatment with your current doctor if you want to avoid out-of-network costs.
Whether you’re at risk, were just diagnosed or are trying to get a condition under control, your care team can help. They want you to get the right treatment and the right level of care, at the right time. So, they may:
- Build a personalized care plan for you
- Educate you about your condition
- Monitor your progress and adjust your treatment plan
- Check in with you to be sure you’re taking your medicine, refilling prescriptions and following your plan
- Encourage you to be actively involved in your care and call if you’re having any trouble
- Offer you resources to help you throughout your health care journey
Your employer offers an HMO Plan (health maintenance organization), so your primary care doctor can make a referral and suggest an in-network specialist for you.
We have over 200 urgent care and walk-in clinics included in the Texas Health Aetna network, including:
- TakeCareHealth at Walgreens
- City Doc Urgent Care
- Code 3 Urgent Care
- CommunityMed Urgent Care
- Concentra Urgent Care
- Cook Children’s Urgent Care
- Expedian Care
- Integra Urgent Care
- MedPost Urgent Care
- Methodist Urgent Care
- PediatricUrgent Care
- PrimaCare Medical Center
- Plus, many more.
For a complete listing, visit texashealthaetna.com.
If you’re ill and out of town, you still have in-network coverage: use the Anytime-MD app 24/7 to speak with a doctor, or for in-person care visit any CVS MinuteClinic for non-emergencies anywhere in the United States.
Members can enroll their dependents in a Texas Health Aetna Out-of-Area Dependent PPO plan. They’ll also have access to the Anytime-MD app as well as any MinuteClinic nationwide.