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:
Once you're enrolled, we'll send you a copy of the SBC. The SBC will also include the date your plan takes effect.
For details and features about these plans, check out our plan brochure.
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:
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 Oklahoma 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 Oklahoma 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.
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:
For most consumers, the "Standard" category is where you will find the plans available to you.
However, the Oklahoma 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.
|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.
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.
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.
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.
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.
We offer several options to make your monthly premium payment.
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, limitations, exclusions 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. Policy forms issued in OK include: Comprehensive PPO-GR-11741 (5/04); Limited-GR-11741-LME (5/04) and Dental-11826 Ed 9/04.
Once you've enrolled, you can reach us by calling the number on your Aetna ID card.
Or, call 1-855-632-6271 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.
We offer these services at no cost to you.
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.
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.
Now that you're officially enrolled, you'll get information to help you understand your plan and the many features it offers you, including:
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!
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.