 Aetna individual plans in Illinois are not always the most affordable but they are indeed the most reliable in terms of coverage and trust. What do I mean by trust? Well you can trust Aetna not to rescind your policy and to pay your claims without even a murmur of discontent, which sadly is not the case for all health insurance companies.
To see Aetna’s Illinois health insurance plans get an Illinois Aetna Quote here. All Managed Choice Open Access and PPO Plans, MC* and PPO Value Plans, MC* and PPO High Deductible Plans and MC* and PPO First Dollar Plans include:
MC* and PPO Value Plans
MC* and PPO First Dollar Plans
MC* and PPO High Deductible Plans (HSA Compatible)
Here are Aetna’s* plans for individuals in your state. Just click on “more” to learn more about any of them. |
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| Managed Choice Open Access & PPO High-Deductible 3000 (HSA Compatible) |
Managed Choice Open Access & PPO High-Deductible 5000 (HSA Compatible) |
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| Lower contributions. Moderately high deductible, then pay 0% of fee for most visits and services. Allows you to open a tax-advantaged HSA.** | Lower contributions. High deductible, then no charge for most visits and services. Allows you to open a tax-advantaged HSA.** | ||
| First Dollar 30 | PPO 7500 with Unlimited Primary Care Visits plus Dental | ||
| Moderate premiums, moderate out-of-pocket maximum and quality prescription drug coverage. | Lower premiums, moderately higher copays, deductible and out-of-pocket maximum . | ||
| Managed Choice Open Access & PPO 2500 | Managed Choice Open Access & PPO 5000 | ||
| Lower deductibles, copays and expenses, moderately higher premiums. Quality prescription coverage. | Lower deductibles, copays and expenses, moderately higher premiums. Quality prescription coverage. | ||
| Managed Choice Open Access Value 1500 | Managed Choice Open Access Value 2500 | ||
| Moderate balance of plan features and affordable monthly premiums. | Moderate balance of plan features and affordable monthly premiums. | ||
| Managed Choice Open Access Value 5000 | Preventive and Hospital Care 1250 | ||
| Moderately high copays and out-of-pocket expenses, balanced by lower monthly premiums. | Low premiums, low annual deductible and moderately high out-of-pocket maximum. | ||
| Preventive and Hospital Care 3000 (HSA Compatible) |
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| Low premiums, moderate annual deductible and high out-of-pocket maximum. | |||
Aetna Advantage Plans for individuals, families and the self-employed are underwritten by Aetna Life Insurance Company (Aetna) directly and/or through an out-of-state blanket trust.
In some states, individuals may qualify as a business group of one and may be eligible for guaranteed issue, small group health plans.
These plans are medically underwritten and you may be declined coverage in accordance with your health condition.
Looking for a lower cost plan?
Our Preventive and Hospital Care plan include:
n Preventive care n Annual GYN exams (annual Pap/Mammogram) n Well-child care (includes immunizations) n Routine physical exams n Coverage for: inpatient hospital care, outpatient
surgery, skilled nursing or home health care in lieu of a hospital stay
Add Dental PPO Max
With the Aetna Advantage Dental PPO Max insurance plan, you can obtain services from either a participating or non-participating dentist. Participating dentists have agreed to provide services at a negotiated rate for both covered services, as well as non-covered services such as cosmetic tooth whitening and orthodontic care, so you generally pay less out-of-pocket. You also have the flexibility to visit a dentist who does not participate in Aetna’s network, though you will not benefit from negotiated fees. Dental is offered only if medical coverage is obtained.
Want to cover your children only?
All Aetna Advantage plans are available for children only, which means you can enroll your child even if no other family member enrolls. Coverage includes immunizations, well-child visits, emergency room and dental preventive services (if dental is selected). Note: when an HSA Compatible plan is selected for child only enrollment, an HSA account is not available for the child.
Aetna Advantage Plans include special programs1 with a wealth of features to complement our standard health insurance coverage. These programs include substantial savings on products and educational materials geared toward your special health needs. These programs are value added and are NOT insurance. Here are a few of the ways we can help you be well.
Fitness Program
With our Fitness program, eligible Aetna members and their families can enjoy preferred rates* on fitness club memberships at over 2,000 fitness clubs within the GlobalFit™ network. In addition, members can access other programs such as at-home weight loss programs, home fitness options and even one-on-one health coaching** services.
Availability varies by plan. Talk with your Aetna representative for details.
* At some clubs, participation in this program may be restricted to new
club members. ** Provided by WellCall, Inc. through GlobalFit.
Aetna Weight ManagementSM Program
The Weight Management Program can help you achieve your weight loss goals by providing you with a sensible weight loss plan and balanced nutrition guide to fit your lifestyle. This program provides Aetna members and their eligible family members access to discounts on Jenny Craig® weight loss programs and products. Start with a FREE 30-day trial membership2; then choose either a 6-month2 or 12-month2 program3 that’s right for you. You also receive individual weight loss consultations, personalized menu planning, tailored activity planning, motivational materials and much more.
Aetna Natural Products and ServicesSM program
Eligible Aetna members and their families can access complementary health care products and services at reduced rates through the Aetna Natural Products and Services program. Members can save on acupuncture, chiropractic care, massage therapy and dietetic counseling as well as on over-the-counter vitamins, herbal and nutritional supplements and other health-related products.
eyecare Savings
Aetna VisionSM Discounts program offers special savings on eye exams, contact lenses, frames, lenses, LASIK eye surgery, and eye care accessories.
Aetna Natural Products and ServicesSM program, Eyecare Savings, Fitness and similar discount programs are rate-access programs and may be in addition to any plan benefits. Discount and other similar health programs offered hereunder are NOT insurance, and program features are not guaranteed under the plan contract and may be discontinued at any time. Program providers are solely responsible for the products and services provided hereunder. Aetna does not endorse any vendor, product or service associated with these programs. It is not necessary to be a member of an Aetna plan to access the program participating providers.
2 Offers good at participating centers and through Jenny Direct at
home only. Additional cost for all food purchases. 3
Additional weekly food discounts will grow throughout the year, based on active participation.
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Want to save on dental expenses?
Vital Savings by Aetna® is a discount program that provides you with dental savings. This is not insurance. Enrolling in the program will give you access to a network of providers who have agreed to accept discounted rates for services. To sign up today, visit www.vitalsavings.com or call 1-877-698-4825.
Informed Health® Line
Get answers 24/7 to your health questions via a toll-free hotline staffed by a team of registered nurses.
Hearing Discount Program
Aetna’s HearingSM Discounts help Aetna members and their families save on hearing exams, hearing services and hearing aids.
Aetna rx Home Delivery®
With this optional program, order prescription medications through our convenient and easy-to-use mail order pharmacy. To learn more or obtain order forms, visit www.AetnaRxHomeDelivery.com.
Aetna Navigator®
It’s easy and convenient for Aetna members to manage their health benefits. Anytime – day or night
– wherever they have Internet access, members can log in to Aetna Navigator, Aetna’s secure member website. Members who register on the site can check the status of their claims, contact Aetna Member Services, estimate the costs of health care services, and much more!
Our new Aetna Navigator Health Information Guide provides you with a starting point to find answers about health care, types of treatment, cost of services and more. It provides links to some of the tools, programs and health content on Aetna Navigator that can help you make more informed decisions – before, during and after you receive medical care.
Members will also have access to their own Personal Health Record***, a single, secure place where they can view their medical history and add other health information that’s important to them.
For more information on any of these programs, please visit us online at www.aetna.com.
*** The Aetna Personal Health Record should not be used as the
sole source of information about your health conditions or medical
treatment.
Things you need to know to enroll
To qualify for an Aetna Advantage Plan, you must be:
n Under age 64 3/4 (If applying as a couple, both you and your spouse must be under 64 3/4.)
n Under age 24 for dependent children
n Legal residents in a state with products offered by the Aetna Advantage Plans
n Legal U.S. residents for at least six (6) continuous months.
Your premium payments
Your premium payments are guaranteed not to increase for 12 months from your effective date once you’ve been accepted for coverage. After that, your premiums may change. Final rates are subject to underwriting review.
Your coverage
Your coverage remains in effect as long as you pay the required premium charges on time, and as long as you maintain membership eligibility. Coverage will be terminated if you become ineligible due to any of the following circumstances:
n Non-payment of premiums n Becoming a resident of a state or location in which
Aetna Advantage plans are not available.
n Obtaining duplicate coverage
n For other reasons permissible by law
Medical underwriting requirements
The Aetna Advantage Plans are generally not guaranteed issue plans and require medical underwriting. Some individuals may be federally eligible under the Health Insurance Portability Accountability ACT (HIPAA),
for special guaranteed issue plans under Illinois laws and regulations.
All applicants, enrolling spouses and dependents are subject to medical underwriting to determine eligibility and appropriate premium rate level.
We offer various premium rate levels based on the known and predicted medical risk factors of each applicant.
Levels of coverage and enrollment
n You may be enrolled in your selected plan at the
standard premium charge. n You may be enrolled in your selected plan at a
higher rate, based on medical findings.
n You may be declined coverage based on significant medical risk factors.
Duplicate coverage
If you are currently covered by another carrier, you must agree to discontinue the other coverage before or on the effective date of the Aetna Advantage Plan. Do not cancel your current insurance until you are notified that you have been accepted for coverage.
Pre-existing conditions
During the first 12 months following your effective date of coverage, no coverage will be provided for the treatment of a pre-existing condition unless you have creditable prior coverage.
A pre-existing condition is an illness or injury for which medical advice or treatment was recommended or received within six (6) months preceding the effective date of coverage.
All You Need to Know About easy-Pay
Simple Automatic Payments via Electronic Funds Transfer (EFT)
registration: Complete the payment section of the Aetna Advantage Plans enrollment form. Select the EFT option to approve the automatic withdrawal of your initial premium and all subsequent premium payments.
Invoices: You will not receive a paper invoice when you are enrolled in EFT. Payments will appear on your bank statement as “Aetna Autodebit Coverage.”
Terminating: To terminate EFT, you will need to provide Aetna with 10 days written notice prior to the date your next EFT payment will be deducted. Without this written notice, your bank account may be debited for the next month’s premium. You will then need to contact Aetna to have funds placed back in the checking account.
refunds: To process an EFT refund (placing money back in member’s checking account), Aetna will require at least five (5) days after the withdrawal was made to ensure valid payment.
rejected transactions: If the EFT payment rejects for any reason, Aetna will automatically terminate the EFT and send you a letter saying you will receive paper invoices. Processing time to reinstate EFT will be 30–60 days. If an EFT payment is rejected, you will need to pay that payment by paper check or credit card.
Timing: Payments for Cycle 1 accounts (1st of the month effective date) will be taken from your bank account between the 3rd and the 10th of the month the premium is due. Payments for Cycle 2 accounts (15th of the month effective date) will be taken from your bank account between the 18th and 23rd of the month the premium is due.
Limitations and exclusions Medical
These medical plans do not cover all health care expenses and include exclusions and limitations. You should refer to your plan documents to determine which health care services are covered and to what extent.
The following is a partial list of services and supplies that are generally not covered. However, your plan documents may contain exceptions to this list based on state mandates or the plan design or rider(s). Services and supplies that are generally not covered include, but are not limited to:
- All medical and hospital services not specifically covered in, or which are limited or excluded by your plan documents, including costs of services before coverage begins and after coverage terminates
- Cosmetic surgery
- Custodial care
- Donor egg retrieval
- Weight control services including surgical procedures, for the treatment of obesity, medical treatment, and weight control/loss programs
- Experimental and investigational procedures, (except for coverage for medically necessary routine patient care costs for Members participating in a cancer clinical trial)
- Charges in connection with pregnancy care other than for pregnancy complications n Immunizations for travel or work n Implantable drugs and certain injectable drugsincluding injectable infertility drugs
- Infertility services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI and other related services unless specifically listed as covered in your plan documents
- Medical expenses for a pre-existing condition are not covered for the first 12 months after the member’s effective date. Look back period for determining a pre-existing condition (conditions for which diagnosis, care or treatment was recommended or received) is six (6) months prior to the effective date of coverage. If the applicant had prior creditable coverage within 63 days immediately before the signature on the enrollment, then the pre-existing conditions exclusion of the plan will be waived.
- Non-medically necessary services or supplies n Orthotics
- Over-the-counter medications and supplies n Radial keratotomy or related procedures
- Reversal of sterilization n Services for the treatment of sexual dysfunction or
- inadequacies including therapy, supplies or counseling n Special or private duty nursing n Therapy or rehabilitation other than those listed as covered in the plan documents
- Mental Health services for Managed Choice Open Access and PPO plans not covered, except for severe biologically based mental or nervous disorder.
- Chemical dependency and substance abuse not covered except for severe, biologically based mental or nervous disorders associated with treatment of drug and alcohol dependencies.
