Aetna Health Insurance Plan To Qualify
Aetna company has a variety of health plans in many states. It offers different rates for individuals and families, so you can find the plan that meets your needs and budget.
Aetna is an American managed health care company which provides benefits to employees of schools, as well as retirees from the university. We also offer benefits to public sector employees, including state, school districts, cities and counties as well. Aetna sometimes uses other companies or agencies to offer our product and services in some markets where we do not operate directly. We offer healthcare products through group contracts with employers or unions on behalf of their members (approximately 49% of beneficiaries). Aetna also operates directly outside the employer-group market through a variety of healthcare products and services.
Aetna company is the second largest health insurance company in the United States after UnitedHealthcare.com. Majority of its customers are insured by Medicare or Medicaid, along with a significant percentage from commercial policies, and others from self-employed individuals (currently, approximately 21% of Aetna customers have incomes that exceed $100,000 per year).
Aetna receives its revenue by receiving premiums paid by customers for their health insurance coverage. Customers purchase health insurance from Aetna after paying a premium and receiving an exchange of benefits. Aetna pays a portion of its premium dollars to medical service providers, such as physicians, hospitals and other providers.
A common Aetna plan is the Aetna Health Insurance Plan (AHIP) which covers the following:
This is a comprehensive basic plan with an unlimited deductible (which means you pay nothing all year for covered services). It also provides services not covered by Medicare, such as eyeglasses and hearing aids. Other cost-sharing options are available for various add-on health services, such as diabetes testing equipment or physical therapy.
AHIP comes in two versions: "Active" and "Saver. Active is offered to individuals who are younger than 65 and are not covered under Medicare. If a person enters the Medicare program during the year, he or she must enroll in the Saver plan. This plan is also available to retirees who are enrolled in Medicare.
AHIP plans cover only ambulatory care and hospital services and pay limited benefits for surgery and other procedures performed in a hospital (also called "inpatient" care). Coverage for drugs (including birth control), diagnostic tests, and outpatient hospital treatment is also limited. AHIP plans do not cover routine physical examinations, dental exam fees, eyeglasses or hearing aids except by special arrangement with Aetna's network providers.
AHIP plans come in three coverage levels:
Aetna Health Insurance Plan also offers an Essence Plan, which is a basic plan with an unlimited deductible. The two are similar in all respects except that the Essence Plan includes some Medicare supplements and has a higher income limit.
This is an unrestricted plan with a $1,000 deductible. It includes additional medical costs that may be covered by Medicare but not by AHIP, such as eye exams and routine physicals. It also pays for some drugs and benefits for routine office visits including physicals, prenatal care visits or immunizations (when part of the newborn screening program). However, most benefits are not covered.
Aetna also has AHUG – it is a Medicare Supplement policy underwritten by Aetna Life Insurance Company, a subsidiary of Aetna. It covers the cost-sharing and Medicare deductibles, coinsurance and copayments. It also covers services not covered by Medicare. AHUG plans pay the same benefits that are covered by the original Medicare Parts A and B.
This plan is designed to provide comprehensive health coverage for eligible individuals with high medical costs who are not currently eligible for (or enrolled in) any other group health insurance plan, as well as their spouse and dependents.
Some of Aetna's services include:
In December 2009, the Vermont Department of Vermont Health Access filed a complaint against Aetna alleging that the company was not providing information about its policyholders' healthcare records to the state. The complaint asked the Vermont Attorney General's Office to investigate whether Aetna was acting in a "fraud-like manner", and said it would seek "a full accounting of all funds received from Vermont residents that have been used for marketing activities related to Coventry and any other health insurance plans." The complaint argued that, by not responding to subpoenas, Aetna was engaged in an effort to evade monitoring by state officials. The Attorney General subsequently dismissed the case without action.
In June 2010, Aetna cancelled its Medicare Advantage plans; they were replaced by individual plans under the name Aetna Medicare HealthConnect (previously Harken Health). These new policies were available in all 50 states and the District of Columbia (with some restrictions as noted below).
In October 2011, Aetna offered Anthem Blue Cross a merger deal. Anthem was inclined to accept the offer and withdrew from negotiations with UnitedHealth Group. The UnitedHealth Group then made a hostile takeover bid for Anthem effective January 1, 2012 with an announced cash price of approximately $42.5 billion. The takeover was blocked by the Justice Department and labeled as anticompetitive.
In October 2012, Aetna announced it would be purchasing Coventry Health Care for $7.6 billion. It would not have any effect on the individual business of either Coventry or Aetna as both companies were managed by a common parent company, CVS Health. The merger was completed in July 2013.
In April 2014, Aetna announced plans to spend $44 million over three years to begin building a global health-services network - its first foray outside of the United States.
In July 2014, Aetna withdrew from 11 of 15 states where it offered Medicaid managed care.
In 2016, Aetna refused to pay for a procedure that would have saved the life of a 10-month-old child. The child was suffering from appendicitis, but Aetna refused to pay for the surgery because it was classified as a pre-existing condition. The child died as a result of his condition.
In May 2017, Aetna announced that it would withdraw from the individual health insurance markets in California and Pennsylvania effective January 1, 2018.
Conclusion of Open Enrollment for 2018 coverage
Aetna's sales and services are delivered through a network of providers. These providers include medical groups, independent health-care practitioners, hospitals, home health agencies and pharmacies. Aetna contracts directly with more than 50,000 providers nationwide. It also has affiliations with certain local and regional provider networks that serve communities where Aetna does not have an established provider network. The following companies provide a variety of health care products and services for Aetna members:
Aetna's headquarters is in Hartford, Connecticut. The Hartford campus also includes customer service centers as well as the company's pharmacy benefit management (PBM) operations.