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Submission: On March 14 via api from US — Scanned from DE
Effective URL: https://www.aetna.com/individuals-families/member-rights-resources/rights/disclosure-information.html?cid=eml-m-103279...
Submission: On March 14 via api from US — Scanned from DE
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</form>Text Content
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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.
Read More Read Less
* Meeting NCQA standards Aetna Vision℠ Preferred plan - English (PDF)
* Meeting NCQA standards – Spanish (PDF)
CONSUMER DISCLOSURES FOR HEALTH, DENTAL AND VISION PLANS
INDIVIDUAL 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
Error or missing data. Please check your entries for an error message.
LOADING, PLEASE WAIT
State Select FloridaGeorgiaMissouriNevadaNorth CarolinaTexasVirginia
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.
Error or missing data. Please check your entries for an error message.
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State Select
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of
ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew
HampshireNew JerseyNew YorkNorth CarolinaNorth
DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth
DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Product Select
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.
Affordable Care Act Individual Health Insurance Broker Compensation Information
For Policies Sold in Florida, Georgia, Missouri, North Carolina, Nevada, Texas,
and Virginia for the 2022 Calendar Year Aetna Health Inc.
DIRECT BROKER COMMISSIONS SCHEDULE
State
Amount per enrolled member per month*
Florida
$28
Georgia
$22
Missouri
$20
North Carolina
$25
Nevada
$18
Texas
$25
Virginia
$20
State
Florida
Amount per enrolled member per month*
$28
State
Georgia
Amount per enrolled member per month*
$22
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*
$18
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.
In addition to direct commissions, your broker may also be eligible for a bonus
program:
A one-time bonus for new members enrolled on January 1, 2022 and February 1,
2022 according to the following schedule:
Amount of members
Amount of payment per enrolled member
10-24 members
$25
25-49 members
$50
50+ members
$75
Amount of members
10-24 members
Amount of payment per enrolled member
$25
Amount of members
25-49 members
Amount of payment per enrolled member
$50
Amount of members
50+ members
Amount of payment per enrolled member
$75
The broker bonus program applies only to policies sold in these states for the
2022 calendar year. Certain other conditions apply.
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.
* Women's Health and Cancer Rights Act
* Breast Reconstruction After Mastectomy
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.
Your rights
STATE-SPECIFIC INFORMATION
Find health plan policies and guidelines for various states.
State details
LOSING GROUP COVERAGE
Explore your options if you’ve lost your group coverage.
Coverage choices
SPENDING ACCOUNT GUIDELINES
Learn about IRS rules for different flexible spending accounts (FSAs).
FSA guidelines
CHANGING YOUR COVERAGE
Get guidance for changing your health plan as your life changes.
Plan changes
FEDERAL NO SURPRISES ACT
Understand your rights and protections against surprise medical bills.
Surprise billing resources
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.
See all legal notices
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