AARP – North Carolina

AARP®Essential Premier Health Insurance

Welcome to AARP Essential Premier Health Insurance, insured by Aetna

This Premier-level, major medical health insurance plan is similar to plans offered by many companies to their employees. It offers many advantages to you, including:

Family coverage

The plan offers you and your family quality coverage at an excellent value. You can apply for coverage for yourself, your spouse or domestic partner, and children and grandchildren. Coverage can include prescription drugs, doctor visits, hospitalization and upfront preventive care.

Choice

Choose from a wide range of health insurance plans, with different price and coverage levels. You can select from three (3) options: robust Premier PPO plans; High Deductible plans with tax-advantaged health savings accounts; or more affordable Preventive and Hospital Care plans.

Have questions or want a quote?

Call East Coast Health Insurance now at 888 803 5917 or get an online AARP health insurance quote and compare it to other North Carolina health insurance companies.

Tax advantages

Our High Deductible plans are compatible with tax-advantaged Health Savings Accounts (HSAs). You can contribute money to your HSA tax free. That money earns interest tax free. And qualified withdrawals for medical expenses are tax free, too.

Coverage when you travel

Like to travel? You’re covered by a nationwide network of doctors and hospitals that accept Aetna’s negotiated fees. There is even reimbursable coverage for health care services when you travel internationally.

Help with health information

Need health information fast? We offer secure Internet access to reliable health tools and resources through Aetna Navigator®, Aetna’s award-winning website for understanding and managing your health benefits. You can also call a registered nurse toll-free 24/7 through Aetna’s Informed Health® Line.

Why Aetna?

Why did AARP select Aetna to make available health insurance for its members? Because Aetna is focused on addressing the needs of people aged 50 to 64, when insurance coverage is often unavailable or unaffordable. In addition to receiving quality, affordable coverage, eligible AARP members gain access to Aetna’s innovative and personalized tools and services to help make better health care decisions.

Want to cover your children or grandchildren?

You can enroll dependent children or grandchildren even if no other family member enrolls. All AARP® Essential Premier Health Insurance plans in your state offer ‘Child Only’ coverage.

In your state, there are three (3) types of AARP® Essential Premier Health Insurance plans to choose from. One of these is probably right for your situation:

A. Premier PPO Plans: B. High Deductible (HSA Compatible) Plans: C. Preventive and Hospital Care Plans:

Tax advantages, lower premiums

  • Lower monthly premiums, with a higher annual deductible.
  • Covers preventive care, prescription drugs, doctor visits and hospitalization.
  • Should be paired with a Health Savings Account (HSA), which lets you pay for qualified medical expenses with tax-advantaged funds.
  • See “HSA advantages” on page 5 for details.
  • Two (2) plan options, based on an annual deductible of $3000 or $5000.

Robust coverage, competitive premiums

  • An excellent combination of quality coverage and competitively priced premiums.
  • The freedom to see doctors whenever you need to, with no referrals needed.
  • Covers preventive care, prescription drugs, doctor visits and hospitalization.
  • No claim forms to fill out when you use a network provider.
  • Three (3) plan options, based on an annual deductible of $1500, $2500 or $5000.

Basic coverage, lower premiums

  • The most affordable premiums available.
  • Covers preventive care, including annual GYN exam, well-child care and physical exam.
  • Covers inpatient hospital stays, plus benefits for outpatient surgery, skilled nursing or home health care.
  • Two plan options, based on an annual deductible of $1250 or $3000.

Note: This plan provides limited benefits only and does not constitute a major medical health insurance plan. It may not cover all expenses associated with your health care needs.

AARP Essential Premier Health Insurance plans are medically underwritten by Aetna and you may be declined coverage in accordance with your health condition.

AARP does not make health plan recommendations for individuals. You are strongly encouraged to evaluate your needs before choosing a health plan.

AARP Health is a collection of health related products, services and insurance programs made available by AARP. Neither AARP nor its affiliate is the insurer. AARP contracts with insurers to make coverage available to AARP members. Insurers and providers pay a fee to AARP and its affiliate for use of the AARP trademark and other services. Amounts paid are used for the general purposes of AARP and its members.

Special Aetna programs to help you manage your health

AARP® Essential Premier Health Insurance plans come with Aetna programs* offering special savings and services.

Aetna Rx Home Delivery®

With this optional program, you can order prescription drugs through Aetna’s convenient and easy mail-order pharmacy. To learn more, visit www.AetnaRxHomeDelivery.com.

Aetna Weight ManagementSM program

You and eligible family members can save on weight-loss programs and products from Jenny Craig®. Start with a FREE 30-day trial membership. Then choose the 6-month or 12-month program that’s right for you. You also receive one-on-one weight loss consultations, personalized menu planning, tailored activity planning, and much more.

Aetna Navigator® website

It’s easy and convenient to look up health information and manage your health benefits. Any time day or night, log on to the secure Aetna Navigator website. Check the status of claims, estimate the costs of health care services, and much more.

Informed Health® Line

Get answers to your health questions, 24 hours a day, 7 days a week, by calling a toll-free hotline staffed by Aetna’s team of registered nurses.

Aetna Natural Products and ServicesSM program

You and eligible family members can get reduced rates on acupuncture, chiropractic care, massage therapy and diet counseling. This program also offers discounts on over-the-counter vitamins, herbal and nutritional supplements and other health-related products.

* Discount and other similar health programs offered above 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. Availability varies by plan. Call 1-866-660-4081 for details.

Neither AARP nor Aetna endorses any vendor, product or service associated with these programs. It is not necessary to be a member of an AARP plan to access the program participating providers.

† Offers good at participating centers and through Jenny Direct at home only. Additional cost for all food purchases. Additional weekly food discounts will grow throughout the year, based on active participation.

Things to know before you apply

To qualify for an AARP® Essential Premier Health Insurance plan, you must be:

  • Between the ages of 50 and 64-3/4 (if you are applying as a couple, both you and your spouse or domestic partner must be under 64-3/4), and
  • Under age 19 for eligible dependent* children; between ages 19 and 25 for unmarried eligible dependent children with proof of full-time student status, and
  • A legal resident in a state with products offered by these plans, and
  • A legal U.S. resident for at least 6 continuous months, and
  • An AARP member. However, you do not need to be a member to get a quote.

Your premium payments

Your premium payments are guaranteed not to increase for 6 months from your effective date. After that, your premiums may change. Final rates are subject to a review of your health history (also known as an “underwriting review”).

Your coverage

Your coverage will remain in effect as long as you pay the required premiums on time, and as long as you maintain AARP membership eligibility. Your coverage will end, for example, if you:

  • Do not pay premiums on time, or
  • Do not meet residency requirements, or any other eligibility requirements noted above, or
  • Have or obtain similar coverage (duplicate coverage) from another insurance company, or
  • Become ineligible for other reasons permitted by law. For more information, see the Disclosure Document included with this brochure.

Medical underwriting

  • AARP Essential Premier Health Insurance plans are medically underwritten by Aetna, and you may be declined coverage depending on your health condition.
  • AARP Essential Premier Health Insurance plans are not guaranteed issue plans and require a review of your health history (called “medical underwriting”).
  • Some people may be federally eligible under the Health Insurance Portability and Accountability Act (HIPAA) for a special guaranteed issue plan under North Carolina laws and regulations.
  • All applicants, enrolling spouses or domestic partners and dependents are subject to medical underwriting to determine eligibility and appropriate rate levels.
  • Aetna offers various rate levels based on the known health and medical risk factors of each applicant.

Rate levels and enrollment

After processing of your application, you may be:

  • Enrolled in your selected plan at the standard premium charge (lowest rate available), or
  • Enrolled in your selected plan at a higher rate, based on medical findings, or
  • Declined coverage, based on significant medical risk factors.

Duplicate coverage

If you currently have major medical coverage through another insurer, you must agree to discontinue that coverage before or on the effective date of your AARP Essential Premier Health Insurance Plan. Do not cancel your current insurance until you are notified you have been accepted for coverage.

Pre-existing conditions

  • During the first 12 months after your effective date of coverage, no coverage will be provided for treatment of a pre-existing condition unless you have prior creditable coverage. A “pre-existing condition” is any physical or mental condition you’ve been diagnosed or treated for before the date your coverage begins. “Prior creditable coverage” is a person’s prior medical coverage as defined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). See the Words To Know section of this booklet for more information on creditable coverage.
  • You are considered to have prior creditable coverage if the difference between the prior coverage termination date and signature date on your application is NOT greater than 63 days.
  • Prior creditable coverage does not guarantee acceptance into the AARP Essential Premier Health Insurance plan, insured by Aetna.
  • Plans are medically underwritten, and you must submit a completed application.
  • If you have prior creditable coverage within 63 days immediately before the signature date on your application, then the pre-existing conditions exclusion of the plan will be waived.

* An eligible dependent is defined as an unmarried person age 0 through age 18, and through age 24 (subject to state mandates) if a full time student and is primarily dependent upon an AARP member for support and maintenance and is one of the following: natural child, stepchild, legally adopted child, child placed for adoption, child for whom legal guardianship has been awarded to the AARP member, or relative of the AARP member by blood or marriage.

Limitations and exclusions

The health insurance plans in this booklet do not cover all health care expenses, and they include exclusions and limitations. Refer to plan documents 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:

  • Surgery or related services for cosmetic purposes to improve appearance, but not to restore bodily function or correct deformity resulting from disease, trauma or congenital or developmental anomalies.
  • Private duty nursing.
  • Personal care services and home care services not stated in the plan description.
  • Non-replacement fees for blood and blood products.
    • Dental work or treatment, unless otherwise specified in covered services, including hospital or professional care in connection with:
- The operation or treatment for fitting or wearing of dentures
- Orthodontic care
- Dental implants
- Experimental services
  • Immunizations related to foreign travel.
  • The purchase, examination or fitting of hearing aids and supplies, and tinnitus maskers, unless included as a covered benefit.
  • Arch support, orthotic devices, in-shoe supports, orthopedic shoes, elastic supports, or exams for their prescription or fitting, unless these services are determined to be medically necessary.
  • Inpatient admissions primarily for physical therapy unless authorized by the plan.
  • Charges in connection with pregnancy care, other than for pregnancy complications.
  • Treatment of sexual dysfunction not related to organic disease.
  • Services to reverse a voluntary sterilization.
  • In vitro fertilization, ovum transplants and gamete intrafallopian tube transfer, or cryogenic or other preservation techniques used in these or similar procedures.
  • Practitioner, hospital or clinical services related to the procedure commonly referred to as “Lasik Eye Surgery,” including radial keratomy, myopi keratomileusis, and surgery that involved corneal tissue for the purpose of altering, modifying or correcting myopia, hyperopia or stigmatic error.
  • Nonmedical ancillary services such as vocational rehabilitation, employment, counseling, or educational therapy.
  • Services that are not medically necessary.
  • Medical expenses for a pre-existing condition, 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 6 months prior to the effective date of coverage. If the applicant had prior creditable coverage within 63 days immediately before the signature of the application, then the pre-existing conditions exclusion of the plan will be waived. See the “Words To Know” section of this booklet for more information on pre-existing conditions and prior creditable coverage.

• Weight control services including surgical procedures, medical treatments, weight control/loss programs, dietary regiments and supplements, appetite suppressants and other medication: food or food supplements, exercise programs, exercise or other equipment; and other services and supplies that are primarily intended to control weight or treat obesity, including Morbid Obesity, or for the purpose of weight reduction, regardless of the existence of comorbid conditions.

10-day right to review

  • Do not cancel your current insurance until you’re notified you’ve been accepted for coverage.
  • Aetna will review your application to determine if you meet underwriting requirements. If you’re denied, you will be notified by mail. If approved, you’ll be sent an AARP Essential Premier Health Insurance contract and ID card.
  • If, after reviewing the contract, you are not satisfied for any reason, simply return the contract to us within 10 days of your receipt. We will refund any premium you have paid, less the cost of any services paid on behalf of you or any covered dependent.