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Summary of Benefits Aetna Medicare Prime Plan (HMO) H3931, Plan 087 This is a summary of services covered by Aetna Medicare Prime Plan (HMO) January 1,2017 - December 31,2017 Aetna Medicare Prime Plan (HMO) is a Medicare Advantage HMO plan with a Medicare contract. Enrollment in the Plan depends on contract renewal. The benefit information provided is a summary of what we cover and what you pay. It does not list every service that we cover or list every limitation or exclusion. The plan's "Evidence of Coverage" provides a complete list of services we cover. The "Evidence of Coverage" is available on our website or you may call us to request a copy. Tojoin Aetna Medicare Prime Plan (HMO),you must be entitled to Medicare Part A, be enrolled in Medicare Part B, and live in our service area. Our service area includes the following counties in North Carolina: Durham, Orange, Person and Wake. Y0001 2017 H3931 087 SB Accepted 9/2016 " " 45

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Page 1: Summary of - ARC Agent Tools · 2016. 11. 16. · This is a summaryofservices covered byAetna Medicare Prime Plan (HMO) January 1,2017-December31,2017 Aetna Medicare Prime Plan (HMO)

Summary ofBenefitsAetna Medicare Prime Plan (HMO)

H3931, Plan 087

This is a summary of services covered by Aetna Medicare Prime Plan (HMO)January 1,2017 - December 31,2017

Aetna Medicare Prime Plan (HMO) is a Medicare Advantage HMO plan with a Medicare contract.Enrollment in the Plan depends on contract renewal.

The benefit information provided is a summary of what we cover and what you pay. It does not listevery service that we cover or list every limitation or exclusion. The plan's "Evidence of Coverage"provides a complete list of services we cover. The "Evidence of Coverage" is available on our websiteor you may call us to request a copy.

Tojoin Aetna Medicare Prime Plan (HMO), you must be entitled to Medicare Part A, be enrolled inMedicare Part B, and live in our service area. Our service area includes the following counties inNorth Carolina: Durham, Orange, Person and Wake.

Y0001 2017 H3931 087 SB Accepted 9/2016" " 45

Page 2: Summary of - ARC Agent Tools · 2016. 11. 16. · This is a summaryofservices covered byAetna Medicare Prime Plan (HMO) January 1,2017-December31,2017 Aetna Medicare Prime Plan (HMO)
Page 3: Summary of - ARC Agent Tools · 2016. 11. 16. · This is a summaryofservices covered byAetna Medicare Prime Plan (HMO) January 1,2017-December31,2017 Aetna Medicare Prime Plan (HMO)
Page 4: Summary of - ARC Agent Tools · 2016. 11. 16. · This is a summaryofservices covered byAetna Medicare Prime Plan (HMO) January 1,2017-December31,2017 Aetna Medicare Prime Plan (HMO)
Page 5: Summary of - ARC Agent Tools · 2016. 11. 16. · This is a summaryofservices covered byAetna Medicare Prime Plan (HMO) January 1,2017-December31,2017 Aetna Medicare Prime Plan (HMO)
Page 6: Summary of - ARC Agent Tools · 2016. 11. 16. · This is a summaryofservices covered byAetna Medicare Prime Plan (HMO) January 1,2017-December31,2017 Aetna Medicare Prime Plan (HMO)
Page 7: Summary of - ARC Agent Tools · 2016. 11. 16. · This is a summaryofservices covered byAetna Medicare Prime Plan (HMO) January 1,2017-December31,2017 Aetna Medicare Prime Plan (HMO)
Page 8: Summary of - ARC Agent Tools · 2016. 11. 16. · This is a summaryofservices covered byAetna Medicare Prime Plan (HMO) January 1,2017-December31,2017 Aetna Medicare Prime Plan (HMO)
Page 9: Summary of - ARC Agent Tools · 2016. 11. 16. · This is a summaryofservices covered byAetna Medicare Prime Plan (HMO) January 1,2017-December31,2017 Aetna Medicare Prime Plan (HMO)
Page 10: Summary of - ARC Agent Tools · 2016. 11. 16. · This is a summaryofservices covered byAetna Medicare Prime Plan (HMO) January 1,2017-December31,2017 Aetna Medicare Prime Plan (HMO)
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