Summary of Benefits and Coverage

Important information for individuals

What you need to know

In March 2010, Congress passed a historic health care reform law called the Affordable Care Act (ACA).  The law is meant to help an estimated 32 million Americans get health coverage.

Many changes under the law won’t go into effect until 2014. For example, in 2014 all Americans must obtain health care coverage to avoid a tax penalty. Subsidies to buy coverage will be available to many of the nation’s poorest citizens. Other changes, however, are already in place. For example, health plans that provide coverage to children on their parents’ plan now must make that coverage available at least until the adult child reaches age 26.

With the debate continuing about health care reform, no one knows exactly how the new law will play out. But we want to help you understand the law. We have combed through 2,300 pages of the law and have developed summary information and Questions and Answers focused on how the law impacts you.

Of course, this is only a quick view of the most important points.

You have a lot of questions when you choose a health plan. Now health plans have a Summary of Benefits and Coverage, or SBC, to help answer your questions. The SBC is required by the Affordable Care Act, the Federal health care reform law adopted in 2010.

The SBC gives you helpful information about what the plan covers. It also has examples of how much you might pay for a few health events or conditions.

Some information was too detailed to put in the SBC itself. Instead, we've put it here for you. Additional information can be found at the links below.

  • What do all of the bolded terms in the SBC mean? Uniform 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 or plan governs.)
  • What doctors, hospitals and other providers are in Aetna's network?
    • Already an Aetna member? Get information for your current plan in Aetna Navigator®.
    • Not a member yet? Go to Aetna DocFind®. Choose the plan that matches the plan name on your SBC.
  • Learn more about prescription drug coverage
    • Already an Aetna 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 the formularies provided are Aetna's standard formularies and may not reflect your plan's specific formulary.

Remember, the SBC is only a summary. If you would like additional information on Aetna’s individual plans, you may visit http://www.aetna.com/individuals-families-health-insurance/index.html.

If you are enrolling through a group plan, you should contact your employer for additional plan information.

If you are already a member of the plan today, you can also call the Member Services number on your ID card.

Aetna also gives you great tools and resources to help you make decisions about your health care. You can find out how much a doctor visit or drug will cost before you go. You can find a doctor or check a claim on your computer or smartphone. You can even create and use your own Personal Health Record. Check out our member tools.

Do you have an international plan? Go to the Aetna International page for more information.

Do you have a student plan? Go to the Aetna Student HealthSM page for more information.

Do you have an Aetna Voluntary Plan (administered by SRC, an Aetna company)? Go to the Aetna Voluntary Plans page for more information.

Questions?

  • Already an Aetna member? Call Member Services at the toll-free number on your member ID card.
  • Not a member yet? Call the toll-free number on your SBC if you have any questions.

Important information for employers

Aetna will give employers the information they need, but the law says employers have to give the SBCs to their employees. There are very specific rules about what employers have to provide and when. We have more information for employers here.