Which surgeries are covered?
Aetna Public Employees Plan offers a limited benefit for obesity surgery. Because of the high-risk nature of obesity surgery, the plan covers just two surgeries and only in very specific circumstances.

In 2008, Aetna covers only the Roux-en-Y surgery for members ages 21 through 64 and laparoscopic adjustable gastric banding for members ages 18, 19, and 20. In 2009, coverage of laparoscopic adjustable gastric banding will be extended to members ages 21 through 64. The Criteria for coverage will not change in 2009. Which surgery a member has is a decision made by the surgeon at the Center of Excellence and the member after the member meets all criteria for coverage.

Members ages 65 or older who are interested in obesity surgery should check with Medicare for coverage. If Medicare approves obesity surgery, Aetna will pay second after Medicare.

Who will be considered for coverage of obesity surgery?
Because obesity surgery requires dramatic and permanent lifestyle changes, these surgeries are not for everyone. Members first must meet strict criteria to be considered.

The list of requirements includes but is not limited to having a body mass index of 40 or higher and having a chronic disease such as diabetes, high cholesterol, or high blood pressure. See Criteria for coverage for complete information.

If you are eligible for the presurgical program, you need to follow a diet and exercise regimen and lose 5 percent of your body weight. The final decision to approve surgery is made by an Aetna medical director after all presurgical requirements are met. Once approved, members must use providers and facilities designated as Centers of Excellence by the Health Care Authority.

Criteria for coverage
How to request coverage
Questionnaire to Request Coverage
FAQs about obesity surgery