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Qualified Health Plans (QHPs) - including public exchange/marketplace plans
Effective January 1, 2014, we offer Qualified Health Plans (QHPs), sold on and off the public health insurance exchanges and marketplaces. These federal or state exchanges are part of the Affordable Care Act (ACA).

Where we offer QHPs in 2015
We will offer QHP benefits for individuals in the following states:
Arizona
Delaware
District of Columbia
Florida
Ohio
Pennsylvania
Texas
Virginia

To find network providers in one of our QHPs visit our QHP DocFind site.

We offer small group employer plans on the SHOP (Small Business Health Options Program) in Delaware, District of Columbia 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 a "QHP" logo on their member ID card. Continue to look on the right-hand side of the ID card for the product name, as you do on any of the Aetna ID Cards. The member's plan name will be listed on the left side, below the Aetna logo.

Identifying network providers
To identify network providers participating in a QHP:
  • For Individual plans choose the applicable state from the "Qualified Health Plans (QHPs)" from the "Select a Plan Category" drop down box. Then, pick the applicable "Qualified Health Plan 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, DE 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