Skip to main content

Important disclosure information

This information can help you understand what your plan covers, the costs of and rules for using your plan, how to file a grievance and more.

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)

Health plans

Loading, please wait

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.

Loading, please wait

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

 

Loading, please wait

 

Direct broker commissions schedule for individual & family plans

State

Amount per enrolled member per month*

California

$20

Florida

$28

Georgia

$25

Illinois

$25

Missouri

$20

North Carolina

$25

Nevada

$25

New Jersey

$20

Texas

$25

Virginia

$20

State

California

Amount per enrolled member per month*

$20

State

Florida

Amount per enrolled member per month*

$28

State

Georgia

Amount per enrolled member per month*

$25

State

Illinois

Amount per enrolled member per month*

$25

State

Missouri

Amount per enrolled member per month*

$20

State

North Carolina

Amount per enrolled member per month*

$25

State

Nevada

Amount per enrolled member per month*

$25

State

New Jersey

Amount per enrolled member per month*

$20

State

Texas

Amount per enrolled member per month*

$25

State

Virginia

Amount per enrolled member per month*

$20

 

*Commissions are payable to a maximum of five members per policy.

 

Broker bonus program for 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
(by state and quarter)

Earned credit per new enrolled member

0-24 members

N/A

25-49 members

$25

50-149 members

$50

150+ members

$75

New enrolled members
(by state and quarter)

0-24 members

Earned credit per new enrolled member

N/A

New enrolled members
(by state and quarter)

25-49 members

Earned credit per new enrolled member

$25

New enrolled members
(by state and quarter)

50-149 members

Earned credit per new enrolled member

$50

New enrolled members
(by state and quarter)

150+ members

Earned credit per new enrolled member

$75

 

**Excludes Buncombe county in North Carolina and Bexar and El Paso counties in Texas.

Arizona, Delaware, Georgia, Illinois, Missouri, New Jersey, Nevada and Virginia

New enrolled members

(by state and quarter)

Earned credit per new enrolled member

0-14 members

N/A

15-29 members

$25

30-59 members

$50

60+ members

$75

New enrolled members

(by state and quarter)

0-14 members

Earned credit per new enrolled member

N/A

New enrolled members

(by state and quarter)

15-29 members

Earned credit per new enrolled member

$25

New enrolled members

(by state and quarter)

30-59 members

Earned credit per new enrolled member

$50

New enrolled members

(by state and quarter)

60+ members

Earned credit per new enrolled member

$75

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.

Rights and responsibilities

Understand your rights as an Aetna HMO or PPO member.

State-specific information

Find health plan policies and guidelines for various states.

Losing group coverage

Explore your options if you’ve lost your group coverage.

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.

Also of interest: