Summary of Benefits and Coverage

Important information for individuals

It’s easy to know about your benefits and coverage

In March 2010, Congress passed a historic health care reform law called the Affordable Care Act (ACA).  Under it, health plans are required to provide consumers with a document giving them information about health plan benefits and coverage. This is a Summary of Benefits and Coverage (SBC) document.

The SBC gives you helpful information about what the plan covers. It also has examples of how much you might pay for certain health events or conditions. Remember, the SBC is only a summary. So, we’ve added other details about your plan here for you.

Be sure to visit these links for more information:

Find out what the bolded words in the SBC mean. Check out our glossary of coverage and medical terms. (Note:  Some of the terms may not have the same meaning when used in your policy or plan.  Your policy of plan governs)

Find out which doctors, hospitals and other providers are in our network
  • Already a member? Get information for your current plan in Aetna Navigator®.
  • Not a member yet? Go to Aetna DocFind®. Choose the plan name that matches the one in your SBC.

Learn more about prescription drug coverage

  • Already a member? Get information for your current plan in Aetna Navigator.
  • Not a member yet, or want information on a different Aetna plan? See our Preferred Drug List. Please note that these formularies are standard and may not reflect the formulary in your specific plan.

To obtain the terms of your policy or a copy of your plan document, please see below.  Which policy or plan document do you need?

Are you and/or your family the only people covered under this contract?

Explore an Individual Policy.

Does your employer have less than 100 employees?

Read more about our Small Group Policy certificate.

Does your employer have over 101 employees? 

Look up our Large Group policy.

Looking for more information about an International, Student Health or Aetna Voluntary plan?

Do you have an international plan? Visit Aetna International.

Do you have a student plan? Go to Aetna Student HealthSM .

Do you have an Aetna Voluntary Plan? Check out Aetna Voluntary Plans.

Contact us

Additional questions? If you’re already a member of the plan, simply call the Member Services number on your ID card. Or just call us at these numbers below.

Individual Members:
Aetna On Exchange: 855-586-6960
Aetna Off Exchange:  866-253-8885

Innovation Health On Exchange: 866-833-2957
Innovation Health Off Exchange: 855-330-4546

Leap Product Members:
SE PA, NC, SC and AZ:  844-241-0208

VA Innovation Health: 844-289-4503

Small Group Members:
Aetna On Exchange: 855-885-3289
Aetna Off Exchange (Non HMO): 1-888-802-3862
Aetna Off Exchange HMO Members: 866-529-2517

Innovation Health: 855-330-4545

Important information for employers

We’ll give employers the information they need.  But the law says employers have to give the SBCs to their employees. There are specific rules about what employers have to provide and when. Read more about the standards to create and provide an accurate SBC.