Qualified Health Plans (QHPs) - including public exchange/marketplace plans
Effective January 1, 2014, we will offer Qualified Health Plans (QHPs), including plans sold on public health insurance exchanges and marketplaces. These federal or state exchanges are part of the Affordable Care Act (ACA). If you are in a state where we offer QHPs, you may begin to see these members starting January 1, 2014.
Where we offer QHPs
We will offer QHP benefits for individuals in the following states:
District of Columbia
To find network providers in one of our QHPs visit our QHP DocFind site.
We will also offer small group plans on the SHOP (Small Business Health Options Program) in Washington, DC and Maryland.
To find network providers in our SHOP plans visit our DocFind site.
Caring for QHP members
Members enrolled in our Qualified Health Plans will have "QHP" on their member ID card. Continue to look on the right-hand side of the ID card for the product name, just as you do today. The plan name will be listed on the left side, below the Aetna logo. It may include an indicator like Basic, Classic, Advantage, AdvantagePlus or Premier for individual plans. Or, it may have a metallic level, like Bronze, Silver, Gold or Platinum for small group plans.
Identifying network providers
To identify network providers participating in a QHP:
To help these members access care from other health care professionals in their QHP network, please choose "QHP" from the Select a Plan Category drop down box. Then, choose the appropriate indicator from the Select a Plan Name drop down box. These members may pay more when they visit a provider outside their QHP network.
- For Individual plans choose "Qualified Health Plans (QHPs)" from the "Select a Plan Category" drop down box. Then, pick "Qualified Health Plans (for AZ, DC, FL, IL, PA, OK, TX and VA)" from the "Select a Plan Name" drop down box that corresponds to the plan name on the ID card.
- For SHOP plans choose "State Based Plans" from the "Select a Plan Category" drop down box. Then, pick the appropriate DC or MD metallic level plan name from the "Select a Plan Name" drop down box that corresponds to the plan name on the ID Card.
You can keep using the same processes you do today for checking eligibility and benefits, as well as submitting claims for these members.