Weight Management Coverage

All active U.S. employees and their family members and pre-Medicare retirees and their family members enrolled in either the MAP Plus Option 1 Low Deductible or MAP Plus Option 2 High Deductible benefit plans are eligible for weight management coverage. Eligible expenses are covered at 100% before deductible and have no annual limit.

What are eligible expenses for weight management?

Eligible expenses for weight management include:

  • Individual consultation with a registered dietitian
  • Group consultation with a registered dietitian
  • Support Group
  • Class or Workshop Membership (e.g., Weight Watchers, Jenny Craig)

The reimbursement program does NOT cover:

  • Experimental treatments
  • Diet products or food supplements of any kind
  • Self-help materials such as books or computer software
  • Vitamin, mineral or other supplements
  • Alternative therapies such as acupuncture or hypnosis
  • Cooking products
  • Surgical procedures and prescription weight loss drugs
  • Unproven weight management programs or products

What is the coverage amount for weight loss counseling?

100% of expenses for:

  • age 0-22, unlimited visits
  • age 22 and over, 26 visits per calendar year

of which 10 visits can be used for healthy diet counseling. Additional sessions are covered, if medically indicated.

How do I take advantage of the Weight Management Coverage benefit?

  1. Participate in an appropriate program/counseling service and get a copy of the bill (bill should include the facility name, facilitator credentials, if appropriate, and indicate that it is a weight management program/consultation). If you are submitting an invoice, e.g. Weight Watchers, submit a copy of your paid invoice or credit card statement.
  2. Attach copies of your receipt(s) with a completed Aetna Medical Claim Form and mail to:

    Aetna
    PO Box 981106
    El Paso, TX 79998-1106

How will I receive my reimbursement?

The weight management reimbursements are processed the same way as any other health care claim. After your claim is processed and approved, you will receive payment directly from Aetna.

What is the deadline to submit my reimbursement request?

Similar to other health care claims, you must submit your reimbursement request by the end of the year following the year of service/purchase. For example, a claim incurred in February, 2012 must be submitted by December 31, 2013.

Are there other coverage options for obesity?

Members may be eligible for prescription medication and/or obesity surgery coverage. It is recommended to contact AETNA at 800-7-DOW-DOW (800-736-9369) to fully understand this coverage and talk to your personal health care provider to determine if/how it applies to your personal situation.

  • Medications: All FDA-approved medications for treatment of obesity or weight loss are covered as part of the prescription drug plan, at standard coinsurance amounts. Coverage for medication is contingent on physician monitoring and participation in an individual or group counseling program.
  • Obesity Surgery: Obesity surgery is covered at standard plan coverage (e.g., For MAP Plus Option 1 Low Deductibe, In-Network is 85% coverage and Out-of-Network is 70% of the charge or 70% of the Plan Allowable Amount, whichever is less, after any required deductibles have been met) for morbidly obese individuals, when, as determined by the plan, a person’s weight is at least 100 pounds above the ideal weight specified for frame, age, height, and sex and other weight reduction methods have been tried and proven unsuccessful. This is subject to criteria for obesity surgery as outlined AETNA’s Clinical Policy Bulletin.
If you have questions, please contact Aetna Member Services toll free
Monday - Friday, 8:00 a.m. - 6:00 p.m. EST at 1-800-7-DOWDOW (736-9369)