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Aetna Fixed Benefitsâ„  Plan

What is the Aetna Fixed Benefits Plan?
It's affordable supplemental insurance that pays fixed-dollar benefits for costs associated with health care - like doctor's office visits, prescriptions and hospital stays.

It's a great option for those who want coverage that supplements their health insurance, especially a high-deductible plan. The product is offered on a guarantee issue basis with no individual medical underwriting and no pre-existing condition exclusions.

Members will receive:
        • Cash benefits paid directly to them to use as they wish when they receive covered medical care
        • Benefits that pay even if they have other health coverage
        • Access to discounted rates if they use an in-network provider



What is covered*:


        • Inpatient benefits pay a fixed-dollar benefit for:

                - A covered inpatient hospital stay

                - Each day in the hospital for a covered stay

                - 
Each day a covered inpatient surgery is performed

        • Outpatient benefits pay a fixed-dollar benefit per day for:
                - Covered outpatient surgeries, tests, procedures and doctor office visits
                - Covered prescription drugs, medical equipment or supplies

        • Accident benefits pay a fixed-dollar benefit for:
               - Injuries from a covered off-the-job accident



*Please refer to the Benefits Summary for the dollar amount and service limits of the specific plan.       


The Aetna Fixed Benefits Plan is underwritten by Aetna Life Insurance Company (Aetna).

The Aetna Fixed Benefits Plan does not count as "Minimum Essential Coverage" under the Affordable Care Act.

 
This material is for information only. Health insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is 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.

The Aetna Fixed Benefits Plan does not cover all health care expenses and has exclusions and limitations. Members should refer to the plan documents to determine what benefits are paid for which health care services. The following is a partial list of services and supplies that are generally not covered. Your plan may contain exceptions to this list based on state mandates or the plan design purchased.

  • All medical or hospital services not specifically covered in, or which are limited or excluded in, the plan documents
  • Cosmetic surgery, including breast reduction
  • Custodial care
  • Experimental and investigational procedures
  • Infertility services, including, but not limited to, artificial insemination, advanced reproductive technologies donor egg retrieval or reversal of sterilization
  • Non-medically necessary services or supplies

 

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.

Policy forms include GR-96841, GR-96842.

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