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Company:
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Plans:
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Aetna
Advantage Plans
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Aetna
Advantage plans offer a variety of quality health insurance
in Colorado. You can visit any doctor or hospital you choose. Your
out-of-pocket costs will be lower in Aetna's network of participating
physicians and hospitals. You can visit your doctor's office as
often as you like and you don't need a referral to see a specialist.
When
you choose Aetna as your health insurance provider, you are gaining
a lot of advantages. Easy to understand plans, easy to choose, easy
to afford, and easy to manage.
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Coverage
Synopsis:
Aetna offers
many different plans exclusive to Colorado members. Each one works for
you in different ways and helps customers get the care they need. With
Aetna's Managed Choice plans you have the freedom to visit any doctor or physician
you choose as well as unlimited office visits to a primary care provider with
no claims or referrals needed. The Managed Choice Open Access plan offers
low premiums and low coinsurance rates with extended coverage, and gives members
more options and control over their insurance policy. Managed
Choice Open Access 1000, 1500, 2500, 5000
Individual
and family deductible rates for all four levels of the Managed Choice Open
Access plan are our most affordable premium rates with the highest amount
of lifetime coverage offered. - MC
1000 has a deductible of $1,000 for individual and $2,000 for families.
MC 1500 has a deductible of $1,500 for individuals and $3,000 for families.
Both have an individual coinsurance maximum of $1,500 and family maximum
of $3,000.
Rates
for the higher lever plans are more but members will also receive increased
coverage for the higher deductible. - MC
2500 individual deductible is $2,500 and the family rate is $5,000, while
the MC 5000 individual deductible is $5,000 and the family rate is $10,000.
Coinsurance
maximum rates start out at $1,500 and increase as your deductible plan increases.
All plans, though, guaranteed a $5 million lifetime maximum per insured
person. For
visits to specialists, members have to produce a copay. Your copay
rates are lower with the MC 1000 and 1500 plans, at a rate of $20 and $25
respectively. With the MC 2500 and 5000 your copay rates slightly
increase for any hospital visit. All
four of the Managed Choice Open Access plans offer low coinsurance rates
for all hospital admissions, outpatient surgery, urgent care facility use,
emergency room visits, and annual routine GYN exams. All rates start
at 20% coinsurance after deductible has been met.
The Managed Choice Open Access plans allow members to visit any doctor or
hospital they choose with unlimited office visits to a primary care physician
or specialist.
Managed
Choice Open Access Value 2500 and 5000
Aetna's
Managed Choice open Access Value 2500 and 5000 offer low monthly premiums
so that members pay less out-of-pocket. Nominal copay rates for doctor
visits apply as well as no deductible charge for any generic prescription
drugs. -
Individual deductible rates start at $2,500 for the Value 2500 plan and
$5,000 for the Value 5000. Rates double for families.
- 30% coinsurance
rates apply after deductible is met.
- Doctor
visits cost a $30 dollar copay for the first two visits and a 30% coinsurance
rate on three or more visits
- $20 copay
on generic prescription drugs without deductible
First
Dollar Managed Choice Open Access 25
Aetna's
First Dollar Managed Choice Open Access is a plan constructed so that members
have freedom from deductibles when you use any in-network provider. It allows
you to get the care you need while paying the lowest deductible possible.
The First Dollar Managed plan also offers a low copay for in-network provider
visits as well as no deductible for generic prescription drugs. - While
your are free from deductibles for in-network care, members are responsible
for the 25% coinsurance rate. $6,000/$12,000 dollars coinsurance maximum
to start
- 25% copayment
rates also apply most medical costs including hospital admission, outpatient
surgery, urgent care facility costs, and emergency room costs
- Prescription
drug coverage required a $25 copay on most prescriptions, and a $250 copay
on the pharmacy deductible
This
plan gives members low deductibles while using in-network providers, with
moderate out-of-pocket costs and coinsurance rates.
Preventative
and Hospital Care 1250
Preventative
and Hospital Care plans give members to opportunity to take their health
in their own hands. With low deductibles and low coinsurance rates, you
receive incentives for preventive care coverage, annual GYN exams, routine
physical exams, and coverage for inpatient hospital care, and outpatient
surgery. - No
coverage for both specialist, non-specialist visits, X-Ray costs, physical/occupational
care costs, or medical equipment costs
- Prescription
drug coverage only covers generic prescriptions with a $15 dollar copay
- 20% coinsurance
rate for most costs after deductible is met
- Deductibles
start at $1,250/individual and $2,500/family for 1250 plan and $3,000/individual
and $6,000/family for 3000 plan
All rates above apply
to in-network providers. Members pay more for out-of-network care.
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
Rates:
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.
PPO
Network:
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 ColoHealth
or directly from Aetna Insurance that
your coverage has been approved and is in force.
About
Aetna Insurance:
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. ColoHealth
is an independent authorized Aetna agent in Colorado.
"You
were the most helpful in guiding me through the process of selecting
what was right for me."
You
were very responsive when I first called, followed up well, and were patient
and helpful despite me taking so long to make my decision. You were
the most helpful in guiding me through the process of selecting what was right
for me. In today's world of web-based and long-distance business, your
personal touch was and continues to be important for me.
I appreciate
your willingness to work with the customers, providing information online
for the customers to peruse before they buy, providing choices to the customers,
and assisting the customers in selecting from them.
Thanks for continuing
to follow up, you have been very helpful. I would most definitely recommend
you to others. Murali
Gopalakrishnan
Computer Analyst
Superior, CO Read
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