Overview of Aetna plans available on Texas exchange (also called "marketplace")
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 Texas 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.
Picking the plan that’s right for you
It's important to choose a plan that will meet your needs. The information below can help you narrow down 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.
Ready to enroll?
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 Texas 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.
Summary of Benefits and Coverage (SBC) documents for exchange plans available in Texas
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 Texas 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; for all benefits, you pay nothing out of pocket for covered expenses.|
|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, or Gold). 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.
Aetna Bronze $20 Copay
Aetna Memorial Hermann Bronze $20 Copay
Aetna Memorial Hermann Bronze
Aetna Bronze $20 Copay Austin Community Plan
Aetna Bronze Austin Community Plan
Aetna Bronze $20 Copay San Antonio Community Plan
Aetna Bronze San Antonio Community Plan
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
Aetna Silver $10 Copay
Aetna Memorial Hermann Silver $5 Copay 2750
Aetna Memorial Hermann Silver $10 Copay
Aetna Silver $5 Copay 2750 Austin Community Plan
Aetna Silver $10 Copay Austin Community Plan
Aetna Silver $5 Copay 2750 San Antonio Community Plan
Aetna Silver $10 Copay San Antonio Community Plan
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 Gold $5 Copay
Aetna Memorial Hermann Gold $5 Copay
Aetna Gold $5 Copay Austin Community Plan
Aetna Gold $5 Copay San Antonio Community Plan
Premium Payment FAQs
What forms of payment does Aetna accept?
- Electronic funds transfer (payment made to us directly from your bank)
- Credit cards (American Express®, Visa® and MasterCard®)
- Debit cards (Visa or MasterCard)
- Check or money orders
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.
How can I make my monthly payment?
We offer several options to make your monthly premium payment. You can:
- Log in to your Aetna Navigator® secure member website and pay online.
- Use EasyPay. We will automatically withdraw your payment from your checking account on the due date.
- Call our Member Services department to make your payment through our automated call system.
- Send your payment by mail. 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.
Health benefits and health insurance plans are offered and/or underwritten by Aetna Health Inc., Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). Each insurer has sole financial responsibility for its own products.
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. 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 you to specialists and hospitals that are affiliated with the delivery system or physician group. 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.