Aetna Products for Individuals and Families on the Illinois Exchange

Learn about what Aetna products are available on Illinois’s exchange (also called “marketplace”) and what sets Aetna apart

See overviews of plans you can choose from
To help you understand your choices, you can view a consumer-friendly overview of each health insurance plan and what it covers.

The health care reform law requires a health insurance plan information document called the Summary of Benefits and Coverage (SBC). The SBC will help you understand and compare different medical plan options. It provides an overview of each medical plan in a standard format. The SBC is also written in easy-to-understand language.

The Summary of Benefits and Coverage includes three parts:

  • Benefits and coverage information
  • Coverage examples
  • A link to a Uniform Glossary

Once you're enrolled, we'll send you a copy of the SBC. The SBC will also include the date your plan takes effect.

Click here to view Summary of Benefits and Coverage (SBC) documents for plans available in Illinois.

For details and features about these plans, check out our plan brochure.

What else you need to know

  • Are my doctor and pharmacy in network? Check our online directory to see who's in our network in your area.
  • Are my medications covered? Our pharmacy search tool and formulary guide tell you about covered medications as well as our programs and guidelines.
  • What happens if I use a provider who isn’t in my network? Check out the Cost of Out-of-Network Doctors and Hospitals page to understand how much more you may need to pay for care (including emergency care) from a provider who is not in your network.
  • Am I eligible for financial help? The Illinois exchange will help you understand if you qualify for financial help that will make insurance more affordable.

Making it easy to work with us

We know you're busy, so we make it easy to work with us. This way you can focus on the rest of your life.

Check out our online resources to find out more about:

  • One place for checking claims, balances and more. Visit your Aetna Navigator® secure member website.
  • Aetna's mobile solutions - when you're on the go, your health plan is right there with you.
  • Online tools that give you instant access to health care costs, your personal health information and more.

Ready to enroll?

Great! The next open enrollment period is scheduled to begin November 15, 2014 through February 15, 2015. If you have had a life changing event, you may qualify for enrollment outside of the open enrollment period. To learn more about what qualifies as a life changing event, please visit the Illinois exchange website. If you have questions or need help with enrolling, call 1-800-318-2596.

Need financial help? To find out if you’re eligible, visit the Illinois exchange website. If you qualify, you need to buy your plan through that website to get financial help.

Don't forget -- you can also buy a plan by shopping with Aetna. However, you won’t be able to apply for financial help when you buy directly from us.

Summary of Benefits and Coverage (SBC) documents for exchange plans available in Illinois

The Summary of Benefits and Coverage (SBC) is designed to help you understand and compare different medical plan options. It provides an overview of each medical plan in a standard format and is written in easy-to-understand language.

How to use this page:

Categories:
For most consumers, the "Standard" category is where you will find the plans available to you.

However, the Illinois exchange may have indicated you are eligible for a Cost Sharing Reduction (CSR) plan or a Native American (NA) plan. This is based on the information you shared when you applied for insurance. If so, refer to those sections when looking at the plans below.

Here are some quick definitions:
Abbreviation What it means
Number shown in plan name Deductible amount for the standard plan (for example, Aetna Classic 5000 has a $5,000 deductible). Based on eligibility, the deductible for a CSR or NA plan may vary from the standard plan deductible. For most plan benefits, you must meet the deductible before you will begin to split the cost of care with your health plan.
PD Includes coverage for pediatric dental (covered to age 19).
CSR 73% With cost sharing reduction, the percentage of average costs the plan will pay increases to 73%.
CSR 87% With cost sharing reduction, the percentage of average costs the plan will pay increases to 87%.
CSR 94% With cost sharing reduction, the percentage of average costs the plan will pay increases to 94%.
NA CSR $0 For this Native American plan, there is no cost sharing in network for the member; you pay nothing out of pocket.
NA CSR LTD For this Native American plan, you pay nothing for covered expenses or supplies furnished directly to you by the Indian Health Service, an Indian Tribe, Tribal Organization, Urban Indian Organization or through referral under contract health services. This includes deductibles, coinsurance, and copayments.

ABOUT THE METALLIC LEVELS
Health insurance plans sold on an exchange are assigned a metallic level (Bronze, Silver, Gold, or Catastrophic). The metallic level is based on how much of the total health care cost the plan pays, versus what a member will pay out of pocket.

Bronze plans

For Bronze level plans, the plan will pay about 60 percent of covered health care costs. Bronze plans tend to have lower monthly premiums, but have higher out-of-pocket costs for deductibles, copayments and coinsurance for covered health care services..

Aetna Advantage 5750 PD
Standard plans:
Aetna Advantage 5750 PD
Native American (NA) Cost Sharing Reduction (CSR) plans:
Aetna Advantage 5750 PD: NA CSR $0
Aetna Advantage 5750 PD: NA CSR LTD
Aetna Advantage 6350
Standard plans:
Aetna Advantage 6350
Native American (NA) Cost Sharing Reduction (CSR) plans:
Aetna Advantage 6350: NA CSR $0
Aetna Advantage 6350: NA CSR LTD
Aetna AdvantagePlus 5500 PD
Standard plans:
Aetna AdvantagePlus 5500 PD
Native American (NA) Cost Sharing Reduction (CSR) plans:
Aetna AdvantagePlus 5500 PD: NA CSR $0
Aetna AdvantagePlus 5500 PD: NA CSR LTD

Silver plans

For Silver level plans, the plan will pay about 70 percent of covered health care costs. Silver level plans tend to have higher monthly premiums compared to Bronze plans, but out-of-pocket costs for health care services are lower compared to Bronze plans.

Aetna Classic 3500 PD
Aetna Classic 5000
Standard plans:
Aetna Classic 5000
Cost Sharing Reduction (CSR) plans:
Aetna Classic 5000: CSR 73%
Aetna Classic 5000: CSR 87%
Aetna Classic 5000: CSR 94%
Native American (NA) Cost Sharing Reduction (CSR) plans:
Aetna Classic 5000: NA CSR $0
Aetna Classic 5000: NA CSR LTD

Gold plans

For Gold level plans, the plan will pay about 80 percent of covered health care costs. Gold level plans tend to have lower out-of-pocket costs for deductibles, copayments and coinsurance for health care services, but have higher monthly premiums.

Aetna Premier 2000 PD
Standard plans:
Aetna Premier 2000 PD
Native American (NA) Cost Sharing Reduction (CSR) plans:
Aetna Premier 2000 PD: NA CSR $0
Aetna Premier 2000 PD: NA CSR LTD

Catastrophic plans

Catastrophic plans generally have lower monthly payments and recommended preventive services are covered at 100 percent. Catastrophic plans are only available to individuals not yet age 30, or individuals for whom insurance is determined to be unaffordable as evidenced by a hardship exemption.

Aetna Basic
Standard plans:
Aetna Basic

Premium Payment FAQs

What forms of payment does Aetna accept?

We accept: 

  • Electronic funds transfer (payment made to us directly from your bank)
  • Credit cards (American Express, Visa and MasterCard)
  • Pre-paid debit cards
  • Check 
  • Money orders

How can I make my monthly payment?

We offer several options to make your monthly premium payment.  

  • Once you enroll with us, you’ll have access to your Aetna Navigator® secure member website. You can pay your monthly premium online, quickly and easily.
  • You can save time and money and never miss a payment. EasyPay from Aetna automatically withdraws your plan premium payment from your checking account on the date it is due. You save money on checks, envelopes and postage. Plus, you don’t have to worry about your payment being late or getting lost in the mail. And if you like to “go green” (by not getting a bill in the mail), you can feel good about how much paper and gas you’re saving.
  • You can also call our member services department to make your payment through our automated call system.  
  • If you’d rather pay by mail you can do that, too. Make sure to include key information from your billing invoice. 

When is my premium due each month?

Premium payments are due the first of the month.

Aetna Health Plans for Individuals, Families and the Self-Employed are underwritten by Aetna Life Insurance Company (Aetna). In some states, individuals may qualify as a business group of one and may be eligible for guaranteed issue, small group health plans.

This material is for information only.  Health insurance plans contain exclusions and limitations.  Not all services are covered.  See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage.  Plan features and availability may vary by location and are subject to change.  Providers are independent contractors and are not agents of Aetna.  Provider participation may change without notice.  Aetna does not provide care or guarantee access to health services.  Information is believed to be accurate as of the production date; however, it is subject to change.

We're here to support you

On the phone:

Once you've enrolled, you can reach us by calling the number on your Aetna ID card.

Or, call 1-855-586-6962 8 a.m.-6 p.m. local time, Monday through Friday. 

Do you have a certified speech or hearing disability?
Call 711 and we'll help you.

Do you need help in another language?
Our Customer Service representatives can connect you to a special line where you can talk to someone in your own language, receive oral interpretation and request written translations of documents into another language.

  • Para obtener asistencia en Español, por favor llame al 1-855-586-6962

We offer these services at no cost to you.

Online:

You can use our e-mail form if you're not a member or if you prefer not to log in. We'll need your personal and contact information so we can get back to you. We respond to messages from 8 a.m.-6 p.m. (ET), Monday-Friday.

E-mail Form

Once you've enrolled

You’ve purchased an Aetna plan through your state’s public exchange/marketplace. Welcome to the Aetna family! Below are a few tips to get started.

Still have questions? Click here for answers.

Getting started

Activate your coverage

You'll receive a "What Comes Next" letter from us, along with your first month's premium invoice. Pick the payment method that works for you.

Get a quick overview

Now that you're officially enrolled, you'll get information to help you understand your plan and the many features it offers you, including:

  • A "quick start" guide that walks you through three easy steps to begin getting the most from your plan.
  • Your ID card with the phone number to your Member Services team, in case you have any questions.

Get connected

Register for our online and mobile self-serve resources. They give you access to the information you need, when you need it. Quick, convenient, and hassle-free!

Personal information

When you are enrolled with us and need to change any personal information, contact the exchange/marketplace. This includes changing your address or phone number.

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