Aetna was founded in 1853 and has been protecting American families’ health for over 170 years. As a leading health insurance provider, we’ve been at the forefront of healthcare innovation for over a century.
In 2018, our journey with CVS Health began, showing our commitment to providing top healthcare solutions. We’re proud to be the third-largest health insurance provider in the United States. We serve millions of Americans with dedicated care and innovative insurance plans.
At Aetna, we see health insurance as a partnership in your wellness journey. With over 35,000 employees nationwide and a revenue exceeding $35 billion, we’re ready to deliver the best health insurance solutions for you.
Key Takeaways
- Founded in 1853, Aetna is one of America’s oldest health insurance providers
- Part of CVS Health family in 2018
- Third-largest health insurance provider in the United States
- Nationwide network of over 35,000 employees
- Comprehensive health insurance solutions across all 50 states
Our Commitment to Quality Healthcare
At Aetna, we focus on top-notch medical coverage and care management. We go beyond just health insurance. Our goal is to put patients first and always improve.
Quality healthcare is at the heart of what we do. We know that great medical care makes a big difference in how patients feel and do. We work hard to create new healthcare solutions that meet each patient’s unique needs.
Why Quality Matters
Quality healthcare is important for many reasons:
- It leads to better patient outcomes
- It makes patients happier
- It helps save money on healthcare
- It helps manage health better
Our Quality Assurance Processes
We have strict care management rules to ensure top medical coverage. Our detailed plan includes:
| Process | Key Focus |
|---|---|
| Provider Evaluation | Regular checks on performance |
| Patient Feedback | Always looking for ways to get better |
| Clinical Guidelines | Following the best evidence-based practices |
| Technology Integration | Using the latest health monitoring tech |
Our work with healthcare providers like Community Care of North Carolina shows our dedication to changing healthcare for the better. We do this through new care management strategies.
Understanding Aetna’s Health Insurance Plans
Health insurance can seem complicated, but Aetna makes it easier. We offer plans that fit different needs. This way, everyone gets the right coverage for their health and peace of mind.
We have a wide range of plans to suit various budgets and needs. You can easily find the right plan for you.
Individual and Family Plans
Our plans for individuals and families offer great benefits:
- 20% discount on select CVS Health Brands for eligible members
- Comprehensive coverage in multiple states including Arizona, Florida, and Texas
- Flexible plan structures to match different healthcare needs
Employer-Sponsored Plans
Our employer plans are great for companies and employees. They provide:
- Cost-effective coverage options
- Comprehensive health protection
- Streamlined administrative processes
Medicare Supplement Plans
Our Medicare plans offer extra support for seniors. These plans help manage healthcare costs beyond Original Medicare. They provide more financial protection and services.
At Aetna, we believe in delivering health insurance that adapts to your unique life circumstances.
Navigating Your Benefits with Us
At Aetna, we know that dealing with medical coverage can be tough. We aim to make your healthcare journey easier. We offer clear, easy-to-use resources to help you understand and use your insurance benefits well.
Our goal is to help you manage your healthcare and money matters with confidence.
How to Access Your Benefits
Getting to your benefits is easy with us:
- Online Member Portal
- Mobile App
- Customer Service Hotline
- Email Notifications
Understanding Your Coverage
We make insurance terms easy to grasp:
| Term | Definition |
|---|---|
| Co-pay | Fixed amount paid for specific medical services |
| Deductible | Annual out-of-pocket expense before insurance coverage begins |
| Out-of-Pocket Maximum | Maximum amount you’ll pay for covered services in a year |
“Knowledge is the first step toward effective healthcare management.” – Aetna Health Insights
Our Explanation of Benefits (EOB) gives you clear info on your medical services, including:
- Date of service
- Billed amount
- Approved amount
- Aetna’s payment
- Your remaining balance
Members can get paperless EOBs online for up to 24 months. You’ll also get email reminders. For help, call our Member Services team at 1-833-570-6670.
The Importance of Preventive Care
Preventive care is key to staying healthy and saving money on medical bills. Our wellness programs and care management focus on early action. This helps catch problems before they get worse.
Spotting health issues early is essential. Our preventive care services include many screenings and actions. They aim to keep our members healthy and well-informed.
Routine Screenings and Check-Ups
Regular health checks are vital for spotting risks early. Our care team suggests these important screenings:
- Annual wellness visits for full health checks
- Cancer screenings including:
- Colorectal cancer screening
- Breast cancer mammograms
- Prostate cancer screening
- Lung cancer screening
- Diabetes screenings for those at risk
- Depression and mental health checks
- Glaucoma tests for those at high risk
Vaccinations and Immunizations
Immunizations are a big part of staying healthy. Our wellness programs make sure everyone gets the vaccines they need:
| Vaccine Type | Recommended Frequency | Target Groups |
|---|---|---|
| Flu Vaccine | Annually | All members, specially high-risk groups |
| Childhood Vaccinations | Per recommended schedule | Children under two years old |
Our aim is to help you on your health journey. We do this through detailed preventive care plans. These plans empower you to manage your health.
Our Network of Healthcare Providers
At Aetna, we’re proud of our wide and varied network of top healthcare providers. We go beyond basic medical care, providing solutions for all kinds of health needs.
Our network covers many care settings, so members get great support wherever they are. We’ve picked a wide range of doctors and places to make sure you’re covered.
Choosing the Right Provider
Finding the right doctor is key for the best care. Think about these things:
- What the doctor specializes in
- How close they are to you
- What others say about them
- If they take your insurance
Easy Access to a Diverse Network
Our network offers many care options through CVS Health. This means you get flexible healthcare solutions:
| Provider Type | Services Offered | Accessibility |
|---|---|---|
| CVS MinuteClinic | Urgent care and basic health screenings | Walk-in convenience |
| CVS Specialty | Specialized medication management | Comprehensive support |
| Oak Street Health | Primary and preventive care | Senior-focused services |
Our network makes sure you get smooth, top-notch care in many places and ways.
How to File a Claim Successfully
Filing health insurance claims can seem tough, but we’ve made it simpler. We know managing care is key for our members. That’s why our claims system is clear and easy to use.
Our claims process aims to ease your stress and make healthcare smoother. Here’s how to submit claims without a hitch.
Step-by-Step Claim Process
- Gather all necessary medical documentation
- Complete the claim form accurately
- Verify provider information
- Submit claim through our online member portal
- Track claim status electronically
Common Claim Issues and Solutions
- Incomplete Documentation: Ensure all medical records are attached
- Incorrect Coding: Double-check procedure and diagnosis codes
- Timely Filing: Submit claims within 90 days of service
Our care management team is here to help with any claim issues. Use our digital tools to make submissions easier and get your money back faster.
Aetna’s Digital Tools for Members
Managing healthcare can be tough. Our digital tools make it easier. They give members control over their health. We focus on making digital health management smooth with telehealth and care management.
Member Portal: Your Health Command Center
Our member portal has great features for your health:
- Real-time claims tracking
- Provider network search
- Personalized health insights
- Prescription management
Mobile App: Healthcare at Your Fingertips
Our mobile app makes telehealth easy. Members can:
- Access virtual ID cards
- Schedule appointments
- Receive medication reminders
- Connect with healthcare providers remotely
| Digital Tool | Key Features | Benefits |
|---|---|---|
| Member Portal | Claims tracking, provider search | Transparent healthcare management |
| Mobile App | Virtual consultations, reminders | Convenient care management |
Empowering members through technology is our mission.
Our digital tools are designed to make healthcare more accessible, transparent, and user-friendly.
Health and Wellness Resources We Offer
At Aetna, we know health is more than just medical care. Our wellness programs and care management help members reach their best health. We want to help people take charge of their health.
Comprehensive Educational Programs
Our wellness programs cover important health topics. We offer workshops and resources on:
- Nutrition and healthy eating strategies
- Stress management techniques
- Physical fitness and exercise guidance
- Chronic disease prevention
- Mental health awareness
Advanced Online Health Assessments
We have online health tools that give members insights into their health. These tools help people:
- Identify health risks
- Track health metrics
- Make wellness plans
- Connect with care specialists
We aim to support your health journey with innovative, accessible, and tailored wellness resources.
Understanding Prescription Drug Coverage
Understanding pharmacy benefits can be tricky. But our health insurance plans make it easier. We know how important prescription coverage is for your health. It helps you get the medicines you need while keeping costs down.
We offer flexible and affordable medication options. Our approach to prescription drug coverage focuses on your health and wallet. We want to help you manage your medications well.
How Our Formularies Work
Our formulary system sorts medications into tiers. Each tier affects how much you pay out of pocket:
- Tier 1: Generic medications with lowest copayments
- Tier 2: Preferred brand-name drugs
- Tier 3: Non-preferred brand-name medications
- Tier 4: Specialty medications
Tips for Managing Your Medications
Here are some tips to make the most of your pharmacy benefits:
- Choose generic alternatives when possible
- Use our mail-order pharmacy services
- Review your medications with your doctor every year
- Check for any drug interactions
Note: Our pharmacy benefits exclude items like alcohol, pre-paid gift cards, and certain pseudoephedrine products.
Effective medication management is key to maintaining your overall health and controlling healthcare expenses.
Support for Chronic Conditions
Managing chronic health conditions needs a lot of care and medical support. At Aetna, we get how tough it is for people with long-term health issues. We offer personalized help to help members manage their health better.
Comprehensive Disease Management Programs
Our disease management programs tackle chronic health problems head-on. We have special support for many conditions, like:
- Diabetes management
- Heart disease support
- Asthma and respiratory condition care
- Hypertension monitoring
Specialized Care Coordination
We make sure you get to see specialists for complex health needs. Our network offers:
- Personalized treatment plans
- Regular health monitoring
- Advanced care coordination
| Condition | Support Services | Key Benefits |
|---|---|---|
| Diabetes | Nutritional counseling | Blood sugar management |
| Heart Disease | Cardiac rehabilitation | Lifestyle modification support |
| Asthma | Medication management | Breathing technique training |
We do more than just treat symptoms. We support the whole person. Our innovative care helps members live better lives and achieve better health.
Mental Health Support and Services
At Aetna, we know how important mental health is for our well-being. We offer a wide range of mental health services. These services are designed to support and care for our members through innovative healthcare solutions.
Comprehensive Mental Health Resources
We have many mental health resources for our members. Our telehealth services make it easy and private to get help. This helps break down barriers to mental health care.
- Individual and group therapy sessions
- Psychiatric medication management
- Online counseling platforms
- Specialized treatment programs
Importance of Mental Well-Being
Mental health is key to our overall health. Our healthcare providers know that mental health affects our physical health, work, and life quality. We aim to make mental health support more accessible and reduce stigma.
| Service Type | Coverage Details |
|---|---|
| Therapy Sessions | Copays as low as $0 |
| Psychiatric Consultations | Medication management included |
| Online Counseling | Access within days through Talkspace |
Our commitment goes beyond traditional treatments. We take a holistic approach to mental health support. We offer many resources, like cognitive behavioral therapy and dialectical behavioral therapy. We also provide specialized care for depression, anxiety, and PTSD.
Customized Financial Solutions for Health Insurance
Health insurance can be complex. At Aetna, we know everyone’s healthcare needs and budget are different. We aim to offer comprehensive health insurance solutions that are affordable yet cover a lot.
We help you make smart choices about your healthcare spending. Our flexible options let you manage your medical costs well.
Understanding Premiums and Deductibles
Health insurance finances can be tough to get. We explain two key parts:
- Premiums: Your monthly payment for health insurance
- Deductibles: What you pay first before insurance kicks in
Health Savings Accounts (HSAs): Smart Financial Planning
Our Health Savings Accounts are a smart financial move. They let you:
- Save for medical costs
- Lower your taxes
- Keep unused funds for next year
| HSA Feature | Benefits |
|---|---|
| Tax-Free Contributions | Lower your taxable income |
| Investment Opportunity | Grow funds for future healthcare |
| Flexibility | Use for qualified medical expenses |
We’re here to help you find the best financial plan for your health insurance. Our team will help you pick a plan that’s both covered and affordable.
Frequently Asked Questions (FAQs)
Health insurance can be tricky to understand. We know our members have lots of questions. Our FAQ section aims to give clear answers to help you choose the right healthcare.
We’ve gathered the most common questions. This will help you understand our health insurance plans better.
Eligibility and Enrollment Queries
- Who can enroll in Aetna health insurance plans?
- What are the different enrollment periods?
- How can I change my current health insurance plan?
Our enrollment process is easy. You can usually enroll during:
- Open Enrollment Period
- Special Enrollment Period
- Qualifying Life Events
Benefits and Coverage Clarifications
It can be hard to understand your health insurance benefits. We’ve made a quick guide to help you see what’s covered:
| Service Category | Typical Coverage |
|---|---|
| Preventive Care | Annual check-ups, screenings |
| Emergency Services | Hospital visits, urgent care |
| Prescription Medications | Generic and brand-name drugs |
“Knowledge is the first step to making the best healthcare decisions for you and your family.” – Aetna Healthcare Team
If you have specific questions, our customer support team is here to help. They can guide you through your options.
Joining Aetna: Enrollment Process Explained
Choosing the right health insurance can be tough. But our process is easy and straightforward. Aetna offers many ways to get the coverage you need without stress.
We make finding the right health insurance easy. We know everyone’s health needs are different. That’s why we tailor plans to fit your life.
How to Get Started
Starting with Aetna is easy. Just follow these steps:
- Visit our official website
- Review available health insurance plans
- Compare coverage options
- Gather required documentation
- Complete online application
Important Dates and Deadlines
Choosing health insurance on time is key. Here are important dates to remember:
| Enrollment Period | Dates | Description |
|---|---|---|
| Open Enrollment | November 1 – December 15 | Annual standard enrollment window |
| Special Enrollment | 60 days from life event | Qualifying events like marriage or job change |
| Medicare Enrollment | October 15 – December 7 | Annual Medicare plan selection period |
“Choosing the right health insurance is an investment in your well-being.” – Aetna Healthcare Team
Our team is here to help. We’ll guide you to the best Aetna plan for your life and budget.
Testimonials: Our Members Share Their Stories
At Aetna, we’re more than just a healthcare provider. We believe in the power of real stories. These stories show how we support our members on their health journeys.
A member from California told us how our Medicare Advantage plan helped her. She got a $0 primary care copay and access to many specialists. This made her care affordable and stress-free.
A member from Texas talked about our digital tools, like the Attain by Aetna app. He earned rewards for staying healthy. This made him feel motivated to take care of his wellness.
We believe in working together for better health. We keep improving our services based on what our members need. With an A+ rating from the Better Business Bureau, we’re proud to be a trusted healthcare partner for millions.
