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State Specific Information

Here you will find state specific information about your insurance plan


California

California HMO Transition of Care Coverage Policy:

California Rate Filing Information

California Insurance Code 10181.7(d); Health & Safety Code 1385.07(d))

Health insurance premiums are a direct reflection of the growing cost of health care services. These types of premium increases – which have a greater impact on rates for individual and small group health plans, as opposed to plans for our larger customers - are being propelled by the increasing prices of hospital care, prescription drugs, doctor’s visits, and other health care services. Other underlying cost pressures—from the underpayments for government insurance to the rising rates of obesity—also drive up premiums

In addition to certain groups of customers being impacted by the increased costs of health care services, certain geographic areas are also experiencing more significant difficulties with the increasing cost of health care services.

These rate changes apply to Small Group HMO Plans/ Small Group Insurance Policies renewing from 07/01/2011 through September 30, 2011 and are guaranteed for 12 months.  These rates also apply to new business after 07/01/2011.  For Individual and Family Insurance Policies, these rate changes apply to policies renewing from 07/01/2011 to 12/31/2011, and to new business effective 07/01/2011.

New Hampshire 

New Jersey

  • Extension of Benefits - A subscriber or dependent may be eligible for continued coverage under the Aetna benefits plan if the subscriber's plan would otherwise terminate but the plan includes a provision for continued coverage for total disability and the subscriber or dependent initiates a request for continued coverage by contacting Aetna Member Services.

    The individual who is totally disabled must meet the extension eligibility requirements on the date that coverage would otherwise end.

    If the request for continued coverage is approved, the continued coverage applies only to the individual who is disabled and not to other family members. In addition, the terms of coverage at the time of the approved extension remain in effect and the continued coverage would be subject to all plan provisions and limitations.

    The following forms must be completed and submitted to Aetna Member Services for consideration. Contact Aetna Member Services using the phone number listed on back of the Aetna Member ID card to obtain the mailing address.

  • Present on Admission Indicator Code
    Effective 10/1/2008, Present on Admission (POA) indicator codes will be required for determining appropriate DRG (Diagnosis Related Grouping) assignment and thus pricing. The code is required for both Commercial and Medicare lines of business. A POA code is a code used to indicate if the corresponding diagnosis was present at the time of admission. A POA code is required for all primary and secondary diagnosis codes; however a POA code is not needed for the admitting diagnosis code. Refer to the below for a list of POA indicator codes.

    Value in the POA - Field Meaning
    Y - Diagnosis was present at the time of inpatient admission.

    N - Diagnosis was not present at the time of the inpatient admission.

    U - Documentation insufficient to determine if condition was present at the time of inpatient admission.

    W - Clinically undetermined. Provider unable to clinically determine whether the condition was present at the time of the inpatient admission.

    1 or Spaces Unreported/not used - Exempt from POA reporting.

New York 

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