State
We meet quality standards
We meet quality standards
We follow health plan accreditation standards of the National Committee for Quality Assurance (NCQA) to offer you quality health plans. Learn how we meet those standards — plus how you can get plan details online or by phone, find out about your rights and responsibilities, understand plan costs and more.
Consumer disclosures for health, dental and vision plans
Individual & family plans
In certain states we offer health plans for you and your family. Just select a state to find documents that describe these plans, along with state-specific disclosure requirements to help you determine the right coverage.
Dental — a stand-alone plan for individuals
Individual dental disclosure (PDF)
Vision — a stand-alone plan for individuals
Individual vision disclosure (PDF)
Health plans
Group plans
We also offer group health, dental and vision plans (available through an employer). Just select a state to find documents that describe these plans, along with state-specific disclosure requirements to help you determine the right coverage.
Beginning January 1, 2022, covered dental services provided to Texas members through Teledentistry by a licensed health professional, will be covered the same as if the services were performed in an in-person setting.
Transparency in coverage
Direct broker commissions schedule for medical individual & family plans
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Amount per enrolled member per month* |
|---|---|
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California |
$20 |
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Florida |
$28 |
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Georgia |
$25 |
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Illinois |
$25 |
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Missouri |
$20 |
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North Carolina |
$25 |
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Nevada |
$25 |
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New Jersey |
$20 |
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Texas |
$25 |
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Virginia |
$20 |
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*Commissions are payable to a maximum of five members per policy.
Broker bonus program for medical individual & family plans
In addition to direct commissions, your broker may also be eligible for a bonus program. It’s a one-time bonus for new members enrolled with 2023 effective dates according to the schedule below. Note: The broker bonus program applies only to policies sold in these states for the 2023 calendar year. Certain other conditions apply.
Florida, North Carolina and Texas**
|
New enrolled members |
Earned credit per new enrolled member |
|---|---|
|
0-24 members |
N/A |
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25-49 members |
$25 |
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50-149 members |
$50 |
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150+ members |
$75 |
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**Excludes Buncombe county in North Carolina and Bexar and El Paso counties in Texas.
Arizona, Delaware, Georgia, Illinois, Missouri, New Jersey, Nevada and Virginia
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New enrolled members (by state and quarter) |
Earned credit per new enrolled member |
|---|---|
|
0-14 members |
N/A |
|
15-29 members |
$25 |
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30-59 members |
$50 |
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60+ members |
$75 |
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Women’s Health and Cancer Rights Act (WHCRA)
Women’s Health and Cancer Rights Act (WHCRA)
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the WHCRA of 1998. We’ll determine what your coverage will be based on our consultations with you and the attending physician regarding:
- All stages of reconstruction of the breast on which the mastectomy was performed
- Surgery and reconstruction of the other breast to produce a symmetrical appearance
- Prosthesis
- Treatment of physical complications of the mastectomy, including lymphedema
You’ll also receive benefits if you’ve had a mastectomy as a result of breast cancer while covered under a different health plan. Your coverage is provided in accordance with your plan design and is subject to plan limitations, copays, deductibles, coinsurance and referral requirements, if any, as noted in your plan documents.
For more information, contact Member Services at the number on your ID card. You can also find resources from the Centers for Medicare & Medicaid Services and the National Institutes of Health.
Additional resources
Brush up on benefits details and your rights as a health care consumer so you can make the right decisions about your care.
State-specific information
Find health plan policies and guidelines for various states.
Spending account guidelines
Learn about IRS rules for different flexible spending accounts (FSAs).
Changing your coverage
Get guidance for changing your health plan as your life changes.
Federal No Surprises Act
Understand your rights and protections against surprise medical bills.
Legal notices
Note about employer-funded plans: State mandates do not apply to self-funded plans governed by ERISA. If you are unsure if you’re plan is self-funded and/or governed by ERISA, please confer with your benefits administrator. Specific plan documents supersede general disclosures contained within, as applicable.
Managed plans offered by HMO entities are: Aetna Health Network OnlyTM, Aetna Primary CareSM Plan HMO, Aetna Health Network OptionSM, Aetna Open Access® HMO, Aetna Choice® POS and QPOS®.
Managed plans offered by Aetna Life Insurance Company are: Managed Choice® POS, Aetna Choice® Plan POS, Aetna Open Access® Managed Choice, Open Choice® PPO, Aetna Choice® Plans PPO, Aetna Open Access® Elect Choice, Aetna Choice® POS, Aetna SelectSM and Open Access Aetna SelectSM.
Dental plans are offered, underwritten or administered by: Aetna Health Inc., Aetna Health of California Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company, Aetna Life Insurance Company (Aetna), Aetna Dental Inc. and/or Aetna Dental of California Inc.
Policy forms issued in OK include: GR-/GR-9N, GR-29/GR-29N-29N.