Aetna Health Insurance

AETNA HIGH DEDUCTIBLE PPO (HSA Qualified)

HSA-qualified plans are amongst the most popular plans offered by Aetna Life Insurance Company.  These plans usually offer the lowest premiums of any HSA plan in many states, along with many additional benefits not covered by other HSA plans.

The Aetna HIGH DEDUCTIBLE PPO plans are designed to provide you with economic incentives for using designated health care providers (PPO network).  They provide coverage for major hospital, medical, and surgical expenses incurred as a result of a covered accident or sickness.  Coverage is provided for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, in-hospital medical services and out-of-hospital care, subject to any deductibles or other limitations which may be set forth in the policy.

Plans at a Glance:

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Plans vary by state.  Please select your state below to view your plan brochure :

Coverage Synopsis:

HIGH DEDUCTIBLE PPO - Aetna offers three versions of their HSA compatible plans - Managed Choice Open Access High Deductible 3000 and 5000 and Preventative and Hospital Care 3000. After you have met your deductible, the Managed Choice Open Access High Deductible 3000 & 5000 pay 100% of all covered expenses. The Preventative and Hospital Care 3000 pays 20% of covered expenses after the deductible has been met ($5,000.00 total out of pocket maximum, including deductible). All three plans pay up to $5 million per person.

These plans qualify as HSA-eligible. Combining a Health Savings Account with any High Deductible PPO plan allows you to make tax-deductible contributions, pay medical expenses with pre-tax dollars, and earn tax-deferred interest. This account works much like an IRA, except you may use your tax-free savings for qualified medical expenses your health plan does not cover, such as your deductible, contact lenses, or most types of alternative medicine (see the qualified medical expenses).  If you do not use these funds, they simply accumulate, with interest, for distribution upon your retirement.

The Managed Choice Open Access High Deductible 3000/5000 plans includes many benefits not commonly offered by other companies offering HSA plans. These include:

• Preventative Care covered at 100%, after $20/$25 co-payment (NO DEDUCTIBLE), up to $200 per year, including annual physicals, lab work, mammography, pap, and PSA
• Annual OB/GYN exam covered at 100%, with NO DEDUCTIBLE
• Physical/Occupational Therapy/Chiropractic care covered at 100% after deductible ($25 Max - 24 visits per calendar year)
  
• Discounts at participating chiropractors, massage therapist, and nutrition counselors, as well as discounts on vitamins and supplements
  
• Optional mail order prescription program (www.AetnaRxHomeDelivery.com), which allows you to order a month's supply through the mail at a discount
  

The Preventative and Hospital Care 3000 plan include the following benefits:

• Preventative Care covered at 100%, after $35 co-payment (NO DEDUCTIBLE), up to $200 per exam
• Annual OB/GYN exam covered at 100%, with NO DEDUCTIBLE
• Hospital admission and outpatient surgery covered at 80% after deductible has been met
  
• Emergency room $100 copay (waived if admitted), 20% co-insurance, after deductible has been met

Optional Riders :

Dental Plan

For a very minimal cost of $10-20 per insured (less than half the cost of most other dental plans), you can add the Aetna Individual Dental PPO Max dental plan.  The quote system shows rates with and without the dental rider.

• $25 annual deductible per member (does not apply to Diagnostic and Preventive Services)
• $75 family maximum
• Unlimited annual maximum
• 100% coverage for diagnostic services, with no deductible
• 100% coverage preventive services (cleanings, fluoride w/cleaning)
• Basic Services (Resin Filling, Oral Surgery)
• 80 percent discount -Major Services- 50 percent discount
• Orthodontic Services- 50 percent discount

Rate Information:

All deductible options have a 6 month rate guarantee.

The premium can be paid via quarterly, semi-annual, or annual billing, or a monthly bank draft or credit card.  The bank draft will occur on the premium due date each month.  The initial premium can be paid with a check or credit card.

Network:

Aetna utilizes varying PPO networks, depending on your state of residence.  You may use Aetna's DocFind to locate Aetna's participating doctors and hospitals, dentists, in addition to Primary Care Physician-referred facilities and vendors where required.  You may obtain covered services from any provider anywhere, but you will pay a higher percentage of the bill for out-of-network expenses.

It is important to note that many non-emergency services require you to obtain pre-authorization before services are rendered.  Receiving this authorization is as easy as making a phone call.  Not doing so can result in your benefits being reduced from 100% to 0%.

Underwriting:

Underwriting of your application with Aetna normally takes two to three weeks, though if medical records are ordered it could take longer.

It is standard practice to request a Blood Pressure Inquiry or medical records for all applicants who are currently being treated for or who have recently discontinued treatment for high blood pressure or elevated cholesterol.  Certain conditions may be waivered with a temporary rider (usually for one to two years), or an indefinite rider.

Effective dates:

The earliest your coverage can go into effect is one day after your signed application has been received by Aetna.  You may request an effective date any time as far out as 60 days after you sign your application.

Please note, if you are requesting an effective date of less than 21 days from the time you complete the application, you may not receive notification of your approval until after your effective date.  If you have claims during this period, they will be eligible for coverage if submitted after you have been approved.  Also note that you will be billed starting on your requested effective date, even if you have not yet been notified that you have been approved.  This is very good for someone who does not have any present coverage and would like for their benefits to begin right away.  For those who are already covered, it is suggested that you maintain your current coverage in force until you have received notice from either HSA for America or directly from Aetna that your coverage has been approved and is in force.

HSA Administrator:

Your health savings account is totally separate from your health insurance, and you may use any approved bank or trustee as your HSA administrator.  We recommend that you choose one from our HSA administrator page, where you can compare rates and features. 

About Aetna:

Formed in 1850, Aetna is one of the nation's leaders in health care, dental, pharmacy, group life, disability, and long-term care insurance and employee benefits.

Aetna is rated "A" (Excellent) by the A.M. Best Company, an independent insurance rating organization. 

HSA for America is an independent authorized Aetna agent.

"You are saving me so much money!  Thank you!"

You are saving me so much money!  You found the perfect program suited for my needs.  Thank you!  I was looking for a cheaper premium and better service than what I had, and I found that with you!

I was paying Mega Health a premium of $133.00 per month and if I remember correctly, I had certain benefits where they would cover up to a certain amount for certain things, but then I had a deductible of $2,000.00....for accidents...I think... It was very confusing.

With Mega Health, I didn't really know all that I was or wasn't covered for.  And since I thought I was covered for doctor visits, etc. I went a few months ago for a check up.  So when I started getting bills which now total $400.00 so far... I decided it wasn't worth spending $133.00 a month if I was going to have to pay most of the bill anyway!

I now pay a premium of $58.00 a month and my deductible is $2,700 which my HSA will be adding up to here in the next year.  I actually understand what I have and what I'm covered for and everything.

I didn't know there was anything like an HSA out there.  It is perfect for someone who never goes to the doctor.

Over all, I didn't have to pay a $120.00 start up fee with you, I'm saving $75.00 per month from what I was paying, and I'm able to deduct from my taxes what I deposit into my HSA, which will save me more money!  And for someone just recently married and starting out in life, $75.00 adds up very quickly.  That's $900.00 a year that I'm saving.  Thank you!

I would definitely recommend you to others!  You've been very helpful when I had questions and prompt with calling me back.  I like the fact that I can call you anytime with a question, and the fact that you will always look for a better premium for me if my current one goes up.

You guys are awesome!

Naomi Hilleshiem
Administrative Assistant
Cedar Rapids, IA

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