Message from Wiley Long
President - ColoHealth
Share this page:

Aetna Health Insurance

 

Plans: Aetna Advantage Plans

 

 

Coverage synopsis Optional Riders Rate Information PPO Network Underwriting Effective Dates About Aetna

 

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.

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.

This plan gives members low deductibles while using in-network providers, with moderate out-of-pocket costs and coinsurance rates.

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:

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 More...