You can shop for and buy health insurance on your state exchange. Exchanges can help you choose a plan that fits your needs and budget.
We want to help you understand your Aetna plan choices. Our plan brochure is a good place to start. It has details and features of each plan.
You can also compare plans using a document called the Summary of Benefits and Coverage (SBC). It provides an overview of each medical plan in a standard format, in easy-to-understand language. The SBC documents for Aetna plans available in the District of Columbia are listed below.
Once you're enrolled, we'll send you a copy of the SBC for the plan you picked. The SBC will also include the date your plan takes effect.
It's important to choose a plan that will meet your needs. The information below can help you narrow your choices:
1. Check our online directories to find out if your doctor and pharmacy are in our network.
2. Search for drug information and learn about covered drugs.
3. You may pay more for care (including emergency care) from out-of-network doctors and hospitals.
4. You may be eligible for financial help that will make insurance more affordable.
The next open enrollment period begins November 15, 2014, and runs through February 15, 2015. If you have had a life-changing event, you may be able to enroll outside of the open enrollment period. If you have questions or need help with enrolling, call the District of Columbia exchange at 1-800-318-2596.
Don't forget -- you can also buy a plan by shopping with Aetna. However, you won’t be able to apply for financial help.
The Summary of Benefits and Coverage (SBC) is designed to help you understand and compare different medical plan options.
The "Standard" category is where most consumers will find their available plans.
However, the 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 or out of network for the member; for all benefits, you pay nothing out of pocket for covered services.|
|NA CSR LTD||For this Native American plan, you pay nothing for covered services 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.
|Aetna Silver $5 Copay 2750|
|Cost Sharing Reduction (CSR) plans:|
|Aetna Silver $5 Copay 2750 CSR 73|
|Aetna Silver $5 Copay 2750 CSR 87|
|Aetna Silver $5 Copay 2750 CSR 94|
|Native American (NA) Cost Sharing Reduction (CSR) plans:|
|Aetna Silver $5 Copay 2750 NA CSR $0|
|Aetna Silver $5 Copay 2750 NA CSR LTD|
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.
Please Note: Under Aetna health insurance policies in some states, we do not generally accept premium payments from third parties, unless they are related to you or required by law. Examples of third parties we do not accept payment from include (but are not limited to) hospitals and health care providers.
We offer several options to make your monthly premium payment. You can:
Premium payments are due the first of the month.
Health insurance plans are offered and/or underwritten by Aetna Life Insurance Company (Aetna).
This material is for information only. Health benefits and health insurance contain exclusions and limitations. Not all health 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. 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. Investment services are independently offered by HealthEquity, Inc.. Information is believed to be accurate as of the production date; however, it is subject to change.
Investment services are independently offered by the HSA Administrator.
Once you've enrolled, you can reach us by calling the number on your Aetna ID card.
Or, call 1-855-586-6960 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 Member Services representatives can connect you to a special line. 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.
If you're not a member or if you prefer not to log in, e-mail us. 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.
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? Learn more about your health insurance exchange plan.
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 (see “Premium payment payment FAQs” above).
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 marketplace. This includes changing your address or phone number.