Apply for coverage for yourself, your spouse, and children, or even just your children. Coverage can include prescription drugs, doctor visits, hospitalization and preventive care services.

Tax advantages

We also offer High Deductible plans that 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.

Help with health information

Need health information fast? We offer secure Internet access to reliable health tools and resources. Learn more about Aetna Navigator^® and the Informed Health^® Line in Section 3 -More Value with Aetna Special Programs

Coverage when you travel

Like to travel? You’re covered by a nationwide network of doctors and hospitals that accept Aetna’s negotiated fees.

Apply Online or Call 888 803 5917

use this guide to narrow down your plan choices. then, get a free quote and apply for a policy either online or by mail.

online:

1. Choose your state.
2. Choose the best plan for you.
3. Click “get A quote.”
4. Apply online and submit an electronic form of payment. (or mail the enclosed application with one form of payment selected.)
5. track the status of your application by clicking the site’s Apps tab.

EASY-PAY

simple Automatic payments via electronic funds transfer (eft)

Registration: Complete the payment section of the Aetna Advantage Plans application. 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 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.

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 19 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 continuous months

Your premium payments

Your rates 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 eligibility in the plan. 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

Levels of coverage & enrollment

n You may be enrolled in your selected plan at the premium charge.

n You may be enrolled in your selected plan at a higher premium, based on medical underwriting.

n You may be declined coverage based on medical underwriting.

Medical underwriting requirements

The Aetna Advantage Plans are not guaranteed issue plans and require medical underwriting. Some individuals may qualify as federally eligible under the Health Insurance Portability Accountability Act (HIPAA) for special guaranteed issue plans under North Carolina 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 medical underwriting of each applicant.

10-day right to review

Do not cancel your current insurance until you are notified that you have been accepted for coverage. We’ll review your application to determine if you meet underwriting requirements. If you’re denied, you’ll be notified by mail. If you’re approved, you’ll be sent an Aetna Advantage Plan contract and ID card.

If, after reviewing the contract, you find that you’re not satisfied for any reason, simply return the contract to us within 10 days. We will refund any premium you’ve paid (including any contract fees or other charges) less the cost of any services paid on behalf of you or any covered dependent.

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 and are certain that you are keeping your Aetna Advantage Plan coverage.

North Carolina Aetna Limitations & 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

• Ambulance coverage is limited to $1,000 per trip.
• 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

Pre-existing Conditions

• 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
• Implantable drugs and certain injectable drugs including 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
• Non-medically necessary services or supplies
• Orthotics
• Over-the-counter medications and supplies n Radial keratotomy or related procedures
• Reversal of sterilization
• Services for the treatment of sexual dysfunction or inadequacies including therapy, supplies or counseling
• Special or private duty nursing
• Therapy or rehabilitation other than those listed as covered in the plan documents
• Mental health services not covered

Dental

Listed below are some of the charges and services for which these dental plans do not provide coverage. For a complete list of exclusions and limitations, refer to plan documents.

• Dental Services or supplies that are primarily used to alter, improve or enhance appearance. Negotiated rates for cosmetic procedures available when a participating dentist is accessed.
• Experimental services, supplies or procedures
• Treatment of any jaw joint disorder, such as temporomandibular joint disorder
• Replacement of lost or stolen appliances and certain damaged appliances
• Services that Aetna defines as not necessary for the diagnosis, care or treatment of a condition involved
• All other limitations and exclusions in your plan documents