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Additional Information E\t l'I'/l.:1I I~C\ ie\\ While we already offer a comprehensive grievance and appeal system to review coverage decisions, our external review process gives you the added comfort of knowing that further recourse is avail- able. With the external review process, you can request an objective and timely external review of certain coverage decisions by an independent physician expert. You can request a review if the decision involves more than $500* and is based on lack of medical necessity or on the experimental or investigational nature of the proposed service or treatment. Certain states mandate external review of additional benefits or service issues, or mandate the use of their own external review process. For further details, refer to your specific plan documents, call the Member Services toll-free number on your 10 card or visit our website at www.aetnaushc.com. \ fl' n!l \(' i ((j II Ii d (' I! ti ell i l \ Aetna U.S. Healthcare protects the privacy of confidential member medical information. We require that participating providers keep member information confidential in accordance with applic- able laws. Furthermore, you have the right to access your medical records from participating providers at any time. Aetna U.S. Healthcare (including its affiliates and authorized agents, collectively "Aetna U.S. Healthcare") and participating providers require access to member medical information for a number of important and appropriate purposes, including claims payment, fraud prevention, coordination of care, data collection, performance measurement, fulfilling state and federal requirements, Quality management, utilization review, research and accreditation activities, preventive health, early detection and disease management programs. Accordingly, for these purposes, members authorize the sharing of member medical information about themselves and their dependents between Aetna U.S. Healthcare, participating providers and health delivery systems. We do not share identifiable medical information with your employer, unless allowed by applicable law or with your permission. \\Iwt's \ot CO\CI'Ccl This plan does not cover all health care expenses and includes exclusions and limitations. Read your plan documents carefully to determine which health care services are covered and to what extent. Services and supplies that are generally not covered** include, but are not limited to: · Cosmetic surgery, including breast reduction. · Special duty nursing unless medically necessary and preauthorized by Aetna U.S. Healthcare. · Custodial care. · Blood and blood byproducts (varies by state). · Dental care and dental X-rays. · Experimental and investigational procedures. · Special equipment, including crutches and braces. · Immunizations for travel or work. · Hearing aids. · Orthotics. · Long-term rehabilitation therapy. · Orthoptic therapy (vision exercises). · Prescription drugs (unless covered by a prescription plan) and over-the-counter medications (except as provided in a hospital). · Oral or topical drugs used for sexual dysfunction or performance. · Lifestyle-enhancing drugs. · In certain prescription plans, prescription drugs on the "Formulary Exclusions" list (formulary information is available at our website, WINW.aetnaushc.com). · Substance abuse rehabilitation. · All medical and hospital services not speCifically covered in, or which are limited or excluded by, your plan documents. 'The $500 requirement does not apply in all states. ,. LJependmg on the speCific benefits mandated in your state or offered by your employer. See your plan documents for details.