Aetna Products for Individuals and Families on the Pennsylvania Exchange

Learn about what Aetna products are available on Pennsylvania’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.

As part of the health care reform law, the government created a new health 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 Pennsylvania.

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 Pennsylvania 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! To enroll, visit the Pennsylvania exchange website and complete the enrollment process. Exchanges will have an open enrollment period of October 1, 2013 through March 31, 2014. 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 Pennsylvania 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 Pennsylvania

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 Pennsylvania 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.
OAMC Open Access Managed Choice - this plan has both in and out-of-network coverage and does not require referrals.
HMO Health Maintenance Organization - this plan only includes coverage for in-network providers. You will also need referrals from your primary care physician.

ABOUT THE METALLIC LEVELS
Health benefits and 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: HMO This plan only includes coverage for in-network providers and requires a referral from your primary care physician (PCP) to a specialist.
Aetna Advantage 5750 PD: OAMC This plan has both in and out-of-network coverage and does not require referrals.
Native American (NA) Cost Sharing Reduction (CSR) plans:
Aetna Advantage 5750 PD: HMO NA CSR $0 This plan only includes coverage for in-network providers and you will need referrals from your primary care physician.
Aetna Advantage 5750 PD: HMO NA CSR LTD This plan only includes coverage for in-network providers and you will need referrals from your primary care physician.
Aetna Advantage 5750 PD: OAMC NA CSR $0 This plan has both in and out-of-network coverage and does not require referrals.
Aetna Advantage 5750 PD: OAMC NA CSR LTD This plan has both in and out-of-network coverage and does not require referrals.
Aetna Advantage 6350
Standard plans:
Aetna Advantage 6350: HMO This plan only includes coverage for in-network providers and requires a referral from your primary care physician (PCP) to a specialist.
Aetna Advantage 6350: OAMC This plan has both in and out-of-network coverage and does not require referrals.
Native American (NA) Cost Sharing Reduction (CSR) plans:
Aetna Advantage 6350: HMO NA CSR $0 This plan only includes coverage for in-network providers and you will need referrals from your primary care physician.
Aetna Advantage 6350: HMO NA CSR LTD This plan only includes coverage for in-network providers and you will need referrals from your primary care physician.
Aetna Advantage 6350: OAMC NA CSR $0 This plan has both in and out-of-network coverage and does not require referrals.
Aetna Advantage 6350: OAMC NA CSR LTD This plan has both in and out-of-network coverage and does not require referrals.
Aetna AdvantagePlus 5500 PD
Standard plans:
Aetna AdvantagePlus 5500 PD: HMO This plan only includes coverage for in-network providers and you will need referrals from your primary care physician.
Aetna AdvantagePlus 5500 PD: OAMC This plan has both in and out-of-network coverage and does not require referrals.
Native American (NA) Cost Sharing Reduction (CSR) plans:
Aetna AdvantagePlus 5500 PD: HMO NA CSR $0 This plan only includes coverage for in-network providers and you will need referrals from your primary care physician.
Aetna AdvantagePlus 5500 PD: HMO NA CSR LTD This plan only includes coverage for in-network providers and you will need referrals from your primary care physician.
Aetna AdvantagePlus 5500 PD: OAMC NA CSR $0 This plan has both in and out-of-network coverage and does not require referrals.
Aetna AdvantagePlus 5500 PD: OAMC NA CSR LTD This plan has both in and out-of-network coverage and does not require referrals.

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 5000
Standard plans:
Aetna Classic 5000: HMO This plan only includes coverage for in-network providers and you will need referrals from your primary care physician.
Aetna Classic 5000: OAMC This plan has both in and out-of-network coverage and does not require referrals.
Cost Sharing Reduction (CSR) plans:
Aetna Classic 5000: HMO CSR 73% This plan only includes coverage for in-network providers and you will need referrals from your primary care physician.
Aetna Classic 5000: HMO CSR 87% This plan only includes coverage for in-network providers and you will need referrals from your primary care physician.
Aetna Classic 5000: HMO CSR 94% This plan only includes coverage for in-network providers and you will need referrals from your primary care physician.
Aetna Classic 5000: OAMC CSR 73% This plan has both in and out-of-network coverage and does not require referrals.
Aetna Classic 5000: OAMC CSR 87% This plan has both in and out-of-network coverage and does not require referrals.
Aetna Classic 5000: OAMC CSR 94% This plan has both in and out-of-network coverage and does not require referrals.
Native American (NA) Cost Sharing Reduction (CSR) plans:
Aetna Classic 5000: HMO NA CSR $0 This plan only includes coverage for in-network providers and you will need referrals from your primary care physician.
Aetna Classic 5000: HMO NA CSR LTD This plan only includes coverage for in-network providers and you will need referrals from your primary care physician.
Aetna Classic 5000: OAMC NA CSR $0 This plan has both in and out-of-network coverage and does not require referrals.
Aetna Classic 5000: OAMC NA CSR LTD This plan has both in and out-of-network coverage and does not require referrals.

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: HMO This plan only includes coverage for in-network providers and you will need referrals from your primary care physician.
Aetna Premier 2000 PD: OAMC This plan has both in and out-of-network coverage and does not require referrals.
Native American (NA) Cost Sharing Reduction (CSR) plans:
Aetna Premier 2000 PD: HMO NA CSR $0 This plan only includes coverage for in-network providers and you will need referrals from your primary care physician.
Aetna Premier 2000 PD: OAMC NA CSR $0 This plan has both in and out-of-network coverage and does not require referrals.
Aetna Premier 2000 PD: HMO NA CSR LTD This plan only includes coverage for in-network providers and you will need referrals from your primary care physician.
Aetna Premier 2000 PD: OAMC NA CSR LTD This plan has both in and out-of-network coverage and does not require referrals.

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: HMO This plan only includes coverage for in-network providers and you will need referrals from your primary care physician.
Aetna Basic: OAMC This plan has both in and out-of-network coverage and does not require referrals.

These managed care plans may not cover all of your health care expenses.  Read your contract carefully to determine which health care services are covered. To contact the plan if you are a member, call the number on your ID card; all others call 1-888-98-AETNA (1-888-982-3862).

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 a 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 Health Plans (HMO) are underwritten by Aetna Health Inc. (“Aetna” refers to Aetna Life Insurance Company and/or Aetna Health Inc.). 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 benefits and 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. If you are in a plan that requires the selection of a primary care physician and your primary care physician is part of an integrated delivery system or physician group, your primary care physician will generally refer to you specialists and hospitals that are affiliated with the delivery system or physician group. 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 1-855-632-6273 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 1-855-632-6273

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

Once you've purchased an Aetna health benefits or insurance plan on the exchange, here's what you can expect:

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.

News
Feedback

aetna.com

JavaScript is required.

In order to have the best experience on Aetna.com, Javascript needs to be enabled.
Learn how to change your browser settings to enable Javascript.

You are now leaving the Aetna website.

Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.

Continue >