Buy insurance: Individual health coverage FAQs

How long are these rates valid?
Rates for the Aetna Advantage Plan can be modified if such modification is approved by the regulators and we give at least 30 days notice before a rate modification. You will receive notice of the rate change before its application.

Do the Aetna Advantage Plans offer dental coverage?
Yes, dental coverage is offered in certain states. Dental coverage is available only in combination with an applicable medical plan and is never offered as a stand alone product.

What health care services are covered under the Aetna Advantage Plans?
For specific plan benefits, please use the "Request a Quote" function on the navigation bar.

Are maternity benefits covered under the Aetna Advantage Plans?
Maternity benefits are not currently available in most states. Complications of pregnancy are normally covered in most states. A newborn is automatically covered under the policy for 31 days and can be added to the policy during this time.

What is a Non-Specialist (Primary Care Physician)?
A primary care physician (PCP) is trained to manage your entire health care program. Your PCP plays many roles - primary caregiver, health care advisor and consultant, coordinator of specialty care and patient advocate. PCPs can be:

• Family/General Practitioners (Doctors who treat patients of all ages)
• Internists (Doctors who treat adults and may have a subspecialty)
• Pediatricians (Doctors who treat children)
  

What Is a formulary?
A formulary is a list of preferred medications put together by Aetna to help you to access quality, cost-effective medications. Some of Aetna's prescription drug benefit plans use a formulary. Our Preferred Drug Guide gives information about medications covered under the Aetna Advantage Plans.

What are "generic drugs"?
Generic drugs are medications that contain the same active ingredients in the same amounts as brand-name products, although generics may be a different color, shape or size. Generic drugs are medications that have been approved by the Food and Drug Administration (FDA) as safe and effective. A generic drug can be substituted for a brand-name drug when rated as an equivalent by the FDA and where permitted by law and the prescriber.

Where do I mail my application form?
Please mail your application form and first premium check to:

Aetna Life Company c/o
Aetna Advantage Plans
1425 Union Meeting Road Mail Stop U22N
Blue Bell, PA 19422

If you are working with a broker, please submit your application form to your broker.

If I am currently covered under an Aetna Advantage plan, who do I contact for billing questions?
HMO members can contact Aetna at 1-800-435-8742.
PPO members can contact Aetna at 1-866-565-1236.

If I am currently covered under an Aetna Advantage Plan, who do I contact for benefits questions?
HMO members can contact Aetna at 1-800-435-8742.
PPO members can contact Aetna at 1-866-565-1236.

How can I get Aetna Advantage application materials?
You can get Aetna Advantage application materials from your broker, at our website, www.aetna.com, or by calling us direct at 1-800-MY-HEALTH.

How will Aetna bill me?
It's your choice. You may choose to have us send you monthly paper bills, sign up for our EasyPay system, or pay by credit card when enrolling on-line. With EasyPay, your monthly premium will be automatically deducted from your checking account. For more information and the enrollment form, please contact your broker or call us directly at 1-800-MY-Health.

When is my premium due?
We must receive premium payments no later than the first of the coverage month. For example, for coverage during July, we must receive your payment by July 1.

I am a current Aetna group member. Can I convert my coverage to an Aetna Advantage Plan?
The Aetna Advantage plans are voluntary plans that are medically underwritten, they are not conversion plans. If you are interested in an Aetna Advantage plan, you must submit a completed application form and you will be medically underwritten, even if you are covered under an Aetna group plan. If you want a conversion plan from the group plan, such plans are not available in every state so please contact your employer for information.

Does Aetna request medical records?
As part of the underwriting process we may require your medical records. If we do ask for your medical records, it is your responsibility to facilitate the submission of such medical records to us.

If I want coverage to begin the first of the month, when do I need to submit my application form?
We must receive your application form by the last day of the prior month; for example, if you want coverage to begin in October, we must receive your application by September 30. If you don't request a specific date for your coverage, We will assign an effective date of the 1st or the 15th of the month following the approval date of the application form.

How long will it take to process the application form?
Processing your application form may take as long as three to four weeks. Please note that your coverage does not become effective until Aetna has underwritten and approved your application form.

Do I need to send my premium payment with the application form?
Yes, you will need to send in a check to cover the first month's premium. Your check will be deposited once your application form is approved.

Do you offer child-only policies?
Yes. We offer policies for children covered as part of a family, or policies that cover the children only.

What ages are eligible to apply?
You must be under 64¾.

How do I choose a primary care physician (PCP)?
Please visit our website at http://www.aetna.com/docfind/custom/advplans/.

How can I check on a claim or get information about my coverage?
You can check on a claim, request an ID card, change your primary care physician, and more by logging on to Aetna Navigator, your secure member website. To enroll in Aetna Navigator, please visit www.aetna.com.

Should I cancel my existing coverage?
Applicants who are currently covered by another carrier must agree to discontinue the other coverage prior to or on the effective date of the Aetna Advantage Plan. Coverage should not be discontinued until you have received approval from the Aetna Advantage Underwriting Department.

I am applying for coverage with my spouse. Whose age should I use to check for our rate?
Rates are based on the earlier birthday, so use the older spouse's birthday.

What would cause my application to be delayed?
Your application could be delayed for a number of reasons:

• Application not signed and dated.
• All questions not answered.
• Detail to questions answered "yes" in the medical history section incomplete or not answered.
• Medical records requested.
• Other information requested