Aetna International – Expats – Benefits Made Right

Aenta International

comprehensive coverage while on assignment

The Mondelēz Global LLC Group Benefits Plan (the Plan) offers medical (including prescription drug), dental, and vision coverage through Aetna International. This coverage is available if you need care anywhere in the world while on assignment, including the U.S. and your host country. Here are a few highlights:

Eligibility: Regular full-time employees on an international assignment, along with their eligible dependents (spouse/domestic partner and children to age 26, regardless of student status), are eligible for this coverage.
Automatic Enrollment: You and your eligible dependents are automatically enrolled in medical (including prescription drug) and dental coverage when first eligible. However, you must elect vision coverage.
Waiving Coverage: If you waive medical, dental, or vision coverage when you’re first eligible, you can actively enroll if you experience a qualified life event or during the Annual Enrollment period.
Coverage Details: See the chart for covered medical, prescription drug, dental, and vision services, or visit www.aetnainternational.com.
Coverage Caveats: See the caveats related to your medical and dental coverage.

Log in to your MyBenefits Online account to see your current coverage elections and for additional coverage and carrier-related details.

KEY FEATURES

Annual deductible: This is the dollar amount you pay for covered services each year before the Plan starts paying benefits.
Coinsurance: Once you meet your deductible, the Plan pays a percentage of eligible expenses. The percentage you pay is called your coinsurance.
Wellness services: A deductible requirement doesn’t apply to services such as annual physicals, PAP smears, vaccines, mammograms, and colonoscopies.
Prescription drug services: A copay applies for in-network generic and formulary brand name drugs. The Plan then pays the full cost of in-network covered services. When you go outside the network, the Plan pays a percentage of eligible expenses (no deductible is required).
Vision services: The Plan covers routine eye exams and provides allowances for eyewear—such as glasses or contacts. You can opt to receive care from either in-network or out-of-network providers, regardless of whether you’re in or outside the U.S.
Dental services: The Plan covers a broad range of dental services, including diagnostic and preventative care, basic and major restorative care, and orthodontia treatments (covered dependent children only).

Meeting the family deductible and out-of-pocket maximum

The annual family deductible and out-of-pocket maximum are cumulative, which means:

All covered family members’ combined eligible expenses apply toward the deductible/out-of-pocket maximum
No one covered person in a family has to meet more than the individual deductible/out-of-pocket maximum

ABOUT THE NETWORK

The network consists of doctors, hospitals, clinics, and other providers that contract to provide services at a lower negotiated price. You can go to any doctor in the network at any time, or you can see a doctor outside the network—it’s your choice. But remember, network providers agree to charge lower negotiated rates for covered services. As a result, the Plan pays a higher level of benefit for covered in-network services, and you pay less in out-of-pocket expenses.

Is your provider in the network?

To take advantage of in-network benefit levels, make sure your provider participates in the Aetna International network each and every time you need care (you don’t need specialist referrals). To do so, go to the Aetna International website and verify your providers’ network participation status before you receive services.

To access your Aetna International ID card(s), you’ll need to register first, here’s how:

Go to the Aetna International website
Select Log in/Register
Under Don’t have an account?, select Register
Fill in the required information and select Aetna International Plan Member as your plan type

You can also contact the Aetna International support team at 1-800-231-7729 (or collect from anywhere in the world at 1-813-775-0190). If you’re having trouble logging in or registering, visit the Aetna International website’s dedicated help pages.

Once you’re registered, here’s how to access your ID card online:

Go to the Aetna International website
Select Member Log in/Register
Enter your Username and Password
Go to Want to Make or Check a Claim
Go to the Aetna Navigator link
Go to View/Print ID Card

Present your ID card when you receive care.

CONTACT INFO & APPS

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Looking for more details?

You can access more detailed coverage information on MyBenefits Online.

Features	Outside the U.S.	In the U.S.
Features	Outside the U.S.	Preferred Benefits (In-Network)	Non-Preferred Benefits (Out-of-Network)
Individual Deductible	$0 per calendar year	$700 per calendar year	$1,350 per calendar year
Family Deductible	$0 per calendar year	$1,400 per calendar year	$2,700 per calendar year
Prior Plan Credit	Does not apply
Individual Coinsurance Limit	$0 per calendar year	$3,000 per calendar year	$6,000 per calendar year
Does not include deductibles, copays, benefit penalties, 50% items, and Outpatient Prescription Drugs; includes Outpatient Prescription Drugs when outside the U.S.
Family Coinsurance Limit	$0 per calendar year	$6,000 per calendar year	$12,000 per calendar year
Does not include deductibles, copays, benefit penalties, 50% items, and Outpatient Prescription Drugs; includes Outpatient Prescription Drugs when outside the U.S.
Lifetime Maximum	Unlimited
Member Payment Percentages
Hospital Services
Inpatient	No charge	20% after deductible	40% after deductible
Outpatient	No charge	20% after deductible	40% after deductible
Private Room Limit	The institution’s semiprivate rate
Pre-certification Penalty	No penalty	No penalty	$400
To avoid penalties and/or benefit reductions for non-preferred benefits received in the U.S., contact the service center to determine if precertification is needed for a procedure.
Non-Emergency Use of the Emergency Room	No penalty	50% after deductible	50% after deductible
Emergency Room	No charge	20% after deductible	20% after deductible
Non-Urgent Use of Urgent Care Provider	No charge	20% after deductible	40% after deductible
Urgent Care	No charge	20% after deductible	40% after deductible
Ambulance	No charge	20% after deductible	40% after deductible
Physician Services
Physician Office Visit	No charge	20% after deductible	40% after deductible
Specialist Office Visit	No charge	20% after deductible	40% after deductible
Virtual Care and Virtual Primary Care	Not covered	No charge	Not covered
Walk-in Clinics	No charge	20% after deductible	40% after deductible
Designated Walk-in Clinics, no charge when outside the U.S. Walk-in Clinics are free-standing health care facilities that (a) may be located in or with a pharmacy, drug store, supermarket, or other retail store, and (b) provide limited medical care and services on a scheduled or unscheduled basis. Urgent care centers, emergency rooms, the outpatient department of a hospital, ambulatory surgical centers, and physician offices are not considered to be a Walk-in Clinic.
Mental Health Services*
Mental Health Inpatient Coverage (Unlimited days per calendar year)	No charge	20% after deductible	40% after deductible
Mental Health Outpatient Coverage (Unlimited visits per calendar year)	No charge	20% after deductible	40% after deductible
Alcohol/Drug Abuse Services*
Substance Abuse Inpatient Coverage (Unlimited days per calendar year)	No charge	20% after deductible	40% after deductible
Substance Abuse Outpatient Coverage (Unlimited visits per calendar year)	No charge	20% after deductible	40% after deductible
Other Services
Skilled Nursing Facility (120 days per calendar year)	No charge	20% after deductible	40% after deductible
Hospice Care Facility Inpatient (60 days lifetime maximum)	No charge	20% after deductible	40% after deductible
Hospice Care Facility Outpatient (Unlimited lifetime maximum)	No charge	20% after deductible	40% after deductible
Home Health Care (120 visits per calendar year)	No charge	20% after deductible	40% after deductible
Private Duty Nursing (70 shifts per calendar year)	No charge	20% after deductible	40% after deductible
Spinal Disorder Treatment (Unlimited visits per calendar year)	No charge	20% after deductible	25% after deductible
Short-Term Rehabilitation	No charge	20% after deductible	25% after deductible
Includes coverage for Occupational and Physical Therapies; unlimited visits per calendar year.
Speech Therapy	No charge	20% after deductible	40% after deductible
Includes coverage for Speech Therapies; 60 visits per calendar year.
Diagnostic Outpatient X-ray	No charge	20% after deductible	40% after deductible
Diagnostic Outpatient Lab	No charge	20% after deductible	40% after deductible
Bariatric Surgery (Unlimited per lifetime)	No charge	20% after deductible	40% after deductible
Base Infertility Services	No charge	20% after deductible	40% after deductible
Base plan coverage is limited to the testing and treatment of an underlying condition.
Other Services
Comprehensive Infertility Services	No charge	20% after deductible	40% after deductible
Six cycles of Comprehensive plan coverage include coverage of Artificial Insemination and Ovulation Induction.
ART Infertility Services	No charge	20% after deductible	40% after deductible
Six cycles per lifetime for Advanced Reproductive Technology (ART) coverage with cryopreservation, storage, and unlimited embryo transfers.
Autism	Autism covered same as any other expense Member cost sharing is based on the type of service performed and the place of service where it is rendered.
Payment for Non-Preferred Providers**	Not applicable	Not applicable	Professional: 105% of Medicare Facility: 140% of Medicare
Routine Hearing Exam (Includes one routine exam every 12 months.)	No charge	No charge	40% after deductible
Hearing Aids	No charge	20% after deductible	40% after deductible
One hearing aid per ear, up to $1,000 maximum per ear every three years, for child to age 24.
Aetna Assistance Program (Unlimited calendar year maximum)	No charge	No charge	No charge
Employee Assistance Program (EAP)	Included	Included	Included
Includes up to five counseling sessions per issue, per year, per enrolled member. Access benefits by calling the member service number on ID card: 1-800-231-7729 or collect 1-813-775-0190. Services include: cultural adjustment assistance, marital/family stress, child care and behavioral concerns, social adaptation needs, alcohol/substance abuse, work/life balance, and depression.
Wellness Benefits
Routine Children Physical Exams	No charge	No charge	No charge
Seven exams in the first 12 months of life, three exams in the second 12 months of life, three exams in the third 12 months of life, one exam per 12 months thereafter to age 22 (includes immunizations).
Routine Adult Physical Exams	No charge	No charge	No charge up to a $1,000 calendar-year maximum (includes immunizations, X-rays, and labs)
Adults age 22+ & -65: one exam/12 months; Adults age 65+: one exam/12 months (includes immunizations).
Routine Gynecological Exams	No charge	No charge	No charge
Includes one exam and pap smear per calendar year.
Mammograms (Unlimited visits per calendar year)	No charge	No charge	No charge
Prostate Specific Antigen (PSA) (Unlimited visits per calendar year)	No charge	No charge	No charge
Digital Rectal Exam (DRE) (Unlimited visits per calendar year)	No charge	No charge	No charge
Cancer Screening	No charge	No charge	No charge
Recommended: Members age 45 and older.
Prescription Drug Coverage
Generic Drugs (365-day maximum supply)	No charge	$10 copay per month supply (includes Mail Order Drugs)	40% no deductible
Brand Name Drugs (365-day maximum supply)	No charge	$20 copay per month supply (includes Mail Order Drugs)	40% no deductible
Vision Expenses
Routine Eye Exam	No charge	No charge	No charge up to a maximum of $35 after $10 per-visit deductible
Covered under medical. Includes one routine exam per calendar year.
Single, Bifocal, Trifocal & Lenticular Vision Lenses (Two lenses, once every calendar year)	No charge	No charge	No charge
Frames-Retail (Once every other calendar year)	No charge up to $100	No charge up to $100	No charge up to $100
Contact Lenses (In place of lens and frame allowances, once every calendar year)	No charge up to $110	No charge up to $110	No charge up to $110
Comprehensive Dental
Calendar Year Deductible	$50 per calendar year
Family Deductible	$150 per calendar year
Type A Expense (Diagnostic & Preventative)	No charge
Type B Expense (Basic Restorative)	20% after deductible
Type C Expense (Major Restorative)	50% after deductible
Type D Expense (Major Restorative)	50% after deductible
Orthodontic Treatment (Dependent children only)	50% after deductible
Calendar Year Maximum	$2,000
Orthodontic Lifetime Maximum	$2,000
TMJ Lifetime Maximum	$1,200
Implants Calendar Year Maximum	$2,000
Services and Programs Included in Quote
Informed Health Line (24-hour nurse line)		International Maternity Management Program
International Case Management		Well-Being Assessment
This Plan includes coverage under the extent required in accordance with the Federal Mental Health Parity and Addiction Equity Act (MHPAEA), beginning with plan years starting on or after January 1, 2018. * Payment for Non-Preferred Providers: We cover the cost of care differently based on whether health care providers, such as doctors and hospitals, are “in-network” or “out-of-network.”

Aenta International

comprehensive coverage while on assignment

Meeting the family deductible and out-of-pocket maximum

Is your provider in the network?

Looking for more details?

What's Covered - ppo

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Caveats related to your coverage

Medical coverage caveats

Dental coverage caveats

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