- How does age, gender and tobacco use affect the price of health insurance?
- What is COBRA?
- What is an exclusion or preexisting condition?
- How does Health Insurance work?
- Can children over 18 be insured on a family health insurance policy?
- Why is individual or family healthinsurance often cheaper than insurance at employers?
- What if I have a question and want to speak with a representative?
- How often are your online doctor and hospital directories updated?
- How do I obtain coverage for my newly adopted child?
- How do I add or delete family members?
- How can I cover my newborn from birth?
- How can I get information regarding discounts that are offered to Aetna Members at health clubs and gyms?
- How can I get information about Alternative Health Care Programs?
- I am a new Aetna member and needed to go to the doctor before I received my ID card, so the doctor required that I pay for the s
- How do I find information on continuing my health insurance after I leave my company?
- How will I be affected if my primary care physician (PCP) leaves the network?
- How do I change my name or address?
- How can I get a new ID card, change PCPs or contact Member Services?
- What are your customer service hours?
- Where can I get a summary of my benefits?
- Am I covered when I am outside my “home” service area? May I see a participating primary care physician in another area?
- My doctor is not in my network. How can he or she apply to participate in my plan?
- My doctor would like to participate in my Aetna network. Can you tell me the status of his (or her) application?
- How does age, gender and tobacco use affect the price of health insurance?
The older you are the higher the cost of the policy. Gender has less impact except if there is maternity coverage. And finally tobacco use may increase the cost of the policy up to 35% for certain insurers.
- What is COBRA?
COBRA is 1985 federal legislation that requires employers with more than 20 employees to allow employees that leave the company to continue their insurance in the company plan for 18 to 36 months. The employee is required to reimburse the employer for the cost of the insurance plus up to a 2 percent administrative fee.
- What is an exclusion or preexisting condition?
An insurance underwriter may accept an application but exclude coverage for “preexisting conditions.” For example, you may have had recent knee surgery and the insurance carrier will accept your application excluding all claims related to your injured knee. Such exclusions may last for a specific period of time or the life of the policy.
- How does Health Insurance work?
As part of the application process, the insurance company will request that you fill out a health statement for each member of the family that you intend to insure. Based on that information the company will make one of the following decisions:
1. Accept all or certain family members,
2. Accept certain family members with limitations,
3. Increase the price by changing the rate from “preferred” to “standard”,
4. Exclude certain preexisting conditions or
5. Decline the application.Depending on the insurer, 70-80 percent of applications are accepted without being uprated or having exclusions.
In the five states (New York, New Jersey, Massachusetts, Vermont and Maine) that do not allow medical underwriting, individual insurance prices are substantially higher than group policies and many insurers avoid the market.
- Can children over 18 be insured on a family health insurance policy?
Family Health Insurance companies will typically insure children of the policyholder through age 23 if they are enrolled as full time students. Otherwise they are required to obtain their own insurance when reaching age 18.
- Why is individual or family healthinsurance often cheaper than insurance at employers?
Individual health insurance products typically cost one third to one half of group insurance. This price difference is mostly due to medical underwriting, whereby insurance companies can deny or limit coverage based on an applicant’s health status. In addition, individual and family health insurance policies often have high deductibles, limited maternity and limited prescription drug coverage. As you shop for health individual or family health insurance please pay particular attention to these items.
- What if I have a question and want to speak with a representative?
Please dial 707-578-3333 and we will be happy to answer any question you may have. Alternatively email us at contact@hcisinc.com and we will respond within 24 hours.
- How often are your online doctor and hospital directories updated?
For the most up-to-date information, members can access DocFind, our online directory of doctors and hospitals, on the Internet at www.aetna.com. DocFind is refreshed/updated three times a week.
- How do I obtain coverage for my newly adopted child?
Special provisions may apply to legally adopted child or a child for whom an individual is a court appointed legal guardian. However, we must receive the request to enroll adopted children within 31 days of the birth or adoption. Eligibility provisions may vary by state law and the plan of benefits elected by your employer. Refer to your plan documents for details.
- How do I add or delete family members?
Members may add or delete family members at open enrollment through their employer. In addition, we will generally accept enrollments for eligible members within 31 days of their eligibility date due to the following events, provided that documentation is submitted to us:
* A marriage or divorce of the employee
* The death of the employee's spouse or a dependent
* The birth, proposed adoption, or adoption of a child of the employee
* The termination or commencement of employment of the employee's spouse
* The switching from part-time to full-time employment status or from full-time to part-time status by the employee or employee's spouse
* The taking of an unpaid leave of absence of the employee or employee's spouse
* The significant change in health coverage of employee or spouse attributable to spouse's employment- How can I cover my newborn from birth?
Contact your employer's benefits department for instructions and an enrollment change form. In general, an eligible newborn child is covered for 31 days from his/her date of birth. To continue coverage beyond this initial 31-day period, the eligible child must be enrolled within 31 days of birth and any applicable premium must be paid. Special provisions may apply to legally adopted child or a child for whom an individual is a court appointed legal guardian. Eligibility provisions may vary by state law and the plan of benefits elected by your employer. Refer to your Certificate of Coverage for details.
- How can I get information regarding discounts that are offered to Aetna Members at health clubs and gyms?
Go to the Members & Consumers page on www.aetna.com and select Products & Programs, Health & Wellness, and then Fitness. You will find information on the discount Fitness Program, including a link to a directory of participating health club locations, as well as general fitness information on Aetna InteliHealth®, our consumer health information website.
- How can I get information about Alternative Health Care Programs?
The Alternative Health Care Programs from Aetna offer you access to reduced rates on alternative therapies and products, including visits to designated acupuncturists, chiropractors, massage therapists and nutritional counselors. Participants can also save on vitamins, herbal supplements, books and many other health-related products, such as aromatherapy, foot care and natural body care.