AetnaAdvantage plan choices
Our health insurance plans are designed to offer you quality coverage at an excellent value. Coverage can include prescription drugs, doctor visits, hospitalization and preventive care services.
Generally speaking, the lower your “premiums,” or monthly payments, the higher your “deductible,” which is the amount you pay out of pocket before the plan begins paying for expenses.
You’ll pay less by using “in-network” doctors, hospitals, pharmacies and other health care providers who participate in Aetna’s nationwide network than by using “out-of-network” doctors.
Abo ut HSAs
Many of our high-deductible plans are Health Savings Account (HSA) Compatible, offering you lower premiums and tax advantaged savings. An HSA is a personal account that lets you pay for qualified medical expenses with tax advantaged funds. You or an eligible family member make contributions to your HSA tax-free, and those dollars earn interest tax-free. Then, when you make withdrawals from your account to pay for qualified health care expenses, they’re tax-free, too.
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.
it’s easy to establish a health savings Account…
Simply enroll in an Aetna HSA Compatible High Deductible Health Plan and you will automatically have an HSA opened through Bank of America. You will also receive a debit card and a welcome package with additional information to get you started.
If you do not wish to set up an HSA, you can opt out by calling Bank of America – or the account will be automatically canceled after 90 days if the debit card is not activated or if you do not enroll online.
- Why choose an Aetna HealthFund HSA?
- No set-up fees
- No monthly administration fee
- No withdrawal forms required
- Convenient access to HSA funds via debit card or online
- Track HSA activity online
Is your doctor in the Aetna network?
Which local physicians, hospitals, pharmacies and eyewear providers participate in the nationwide Aetna Advantage Plan network? Visit www.aetna.com/docfind/custom/ advplans. Or call 1-800-694-3258 and ask for a directory of providers.
Get more from your Aetna plan
Cover just your children
Aetna Advantage Plans are also 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 a dental plan is selected).
Note: when an HSA Compatible plan is selected for child only enrollment, an HSA account is not available for the child.
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 have access to negotiated fees. Dental coverage is offered only if medical coverage is obtained.
Plan Details for Aetna in Virginia
1) First Dollar PPO plan options
robust coverage and lower out-of-pocket expenses with no deductibles when you choose a network provider featuring:
- Lower copay for in-network provider visits
- No deductible for generic prescription drugs
2) PPO plan options
robust coverage and lower monthly payments balanced with a deductible…where you don’t want to pay a lot for frequent doctor visits featuring:
Health insurance coverage with lower monthly premiums and varying deductible levels
3) PPO High Deductible plan options
lower premium costs…and an hsA-compatible plan that offers tax advantaged savings featuring:
- 0% coinsurance in network after your deductible is met
- Lower monthly premiums, higher annual deductibles (at least $3,000 for individuals and $6,000 for families)
- Can be paired with a tax-advantaged Health Savings Account (HSA)
Affordability — a balance of lower monthly premiums and quality coverage…where you want to cap the amount you’ll spend on total medical expenses each year
featuring:
- Lower monthly premiums (that’s the “Value” part)
- No deductible for generic prescription drugs
4) PPO Value plan options
Affordability — a balance of lower monthly premiums and quality coverage…where you want to cap the amount you’ll spend on total medical expenses each year
Featuring:
- Lower monthly premiums (that’s the “Value” part)
- No deductible for generic prescription drugs
Affordability is one of your top priorities and you use only basic health care services…and want to keep your monthly premiums lower
Featuring:
Health insurance coverage with lower monthly premiums and varying deductible levels
Medical and dental coverage; and vision discounts bundled together…at a reasonable cost
Featuring:
- One monthly premium for medical and dental coverage; and vision discounts
- Lower monthly premiums, higher annual deductibles (at least $7,500 for individuals and $15,000 for families)
- 100% coverage for diagnostic and preventive dental services from a preferred provider
Aetna special programs
Aetna Advantage plans include special programs1 to complement our standard health insurance coverage. these programs include health information programs and tools, and offer you access to substantial savings on products to help you stay healthy. these programs are offered in addition to your Aetna Advantage plan and are not insurance.
Aetna visionsm discount program
Aetna VisionSM discount program offers special savings on eye exams, contact lenses, frames, lenses, LASIK eye surgery, and eye care accessories.
Aetna natural products and servicessm discount 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 discount 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.
Aetna fitnesssm discount program
Eligible Aetna members and their families can access the GlobalFit™ national network of nearly 10,000 fitness clubs, in the United States and Canada, at preferred rates*. 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.
Aetna Weight managementsm discount program
The Weight ManagementSM discount 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.
Aetna hearingsm discount program
Aetna’s HearingSM discount program helps Aetna members and their families save on hearing exams, hearing services and hearing aids.
Aetna rx home delivery®
With this mail order prescription drug 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.
informed health® line
Our 24-hour toll-free number that puts you in touch with experienced registered nurses and an audio library for information on thousands of health topics.
Aetna’s secure member Website
Register and log on to Aetna’s secure member website to check claims status, contact Aetna Member Services, estimate the costs of health care services, and more. Aetna’s secure member website provides a starting point to find answers about health care, types of treatment, cost of services and more to help members make more informed decisions. Plus, members have access to their own Personal Health Record***, a single, secure place where they can view their medical history and add other health information.
The Vital Savings by Aetna® program (the “Program”) is not insurance. The Program provides Members with access to discounted fees pursuant to schedules negotiated by Aetna Life Insurance Company for the Vital Savings by Aetna® discount program. The Program does not make payments directly to the providers participating in the Program. Each Member is obligated to pay for all services or products but will receive a discount from the providers who have contracted with the Discount Medical Plan Organization to participate in the Program. Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, 1-877-698-4825, is the Discount Medical Plan Organization.
Things you need to know
To qualify for an Aetna Advantage Plan, you must be:
- Under age 64 3/4 (If applying as a couple, both you and your spouse must be under 64 3/4.)
- Under age 24 for unmarried dependent children n Legal residents in a state with products offered by the Aetna Advantage Plans
- 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:
- Non-payment of premiums
- Becoming a resident of a state or location in which Aetna Advantage Plans are not available
- Obtaining duplicate coverage
- For other reasons permissible by law 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 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.
Levels of coverage & enrollment
- You may be enrolled in your selected plan at the premium charge.
- You may be enrolled in your selected plan at a higher premium, based on medical underwriting.
- 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 a special guaranteed issue plan under Virginia/District of Columbia 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 enrollment form 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.
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
- 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
- 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
- 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
pre-existing Conditions
For Virginia only:
- Mental health services for PPO plans not covered except for severe biologically based mental or nervous disorders
- Chemical dependency and substance abuse not covered except for severe biologically based mental or nervous disorders
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
