Individual and Family

Aetna Individual and Family Health Insurance Frequently Asked Questions

If I want coverage to begin the first of the month, when do I need to submit my application form?

We must receive your application form by the last day of the prior month; for example, if you want coverage to begin in October, we must receive your application by September 30. If you don't request a specific date for your coverage, We will assign an effective date of the 1st or the 15th of the month following the approval date of the application form.

Does Aetna request medical records?

As part of the underwriting process we may require your medical records. If we do ask for your medical records, it is your responsibility to facilitate the submission of such medical records to us.

When is my premium due?

We must receive premium payments no later than the first of the coverage month. For example, for coverage during July, we must receive your payment by July 1.

How will Aetna bill me?

It's your choice. You may choose to have us send you monthly paper bills, sign up for our EasyPay system, or pay by credit card when enrolling on-line. With EasyPay, your monthly premium will be automatically deducted from your checking account. For more information and the enrollment form, please contact your broker or call us directly at 1-800-MY-Health.

If I am currently covered under an Aetna Advantage Plan, who do I contact for benefits questions?

HMO members can contact Aetna at 1-800-435-8742.
PPO members can contact Aetna at 1-866-565-1236.

If I am currently covered under an Aetna Advantage plan, who do I contact for billing questions?

HMO members can contact Aetna at 1-800-435-8742.
PPO members can contact Aetna at 1-866-565-1236.

Where do I mail my application form?

Please mail your application form and first premium check to:

Health Coverage Insurance Services, Inc
Aetna Advantage Plans
Po Box 9417
Santa Rosa, CA 95405

You can also fax application to 800-569-1156

What are "generic drugs"?

Generic drugs are medications that contain the same active ingredients in the same amounts as brand-name products, although generics may be a different color, shape or size. Generic drugs are medications that have been approved by the Food and Drug Administration (FDA) as safe and effective. A generic drug can be substituted for a brand-name drug when rated as an equivalent by the FDA and where permitted by law and the prescriber.

What Is a formulary?

A formulary is a list of preferred medications put together by Aetna to help you to access quality, cost-effective medications. Some of Aetna's prescription drug benefit plans use a formulary. Our Preferred Drug Guide gives information about medications covered under the Aetna Advantage Plans.

What is a Non-Specialist (Primary Care Physician)?

A primary care physician (PCP) is trained to manage your entire health care program. Your PCP plays many roles - primary caregiver, health care advisor and consultant, coordinator of specialty care and patient advocate. PCPs can be: 

  • Family/General Practitioners (Doctors who treat patients of all ages)
  • Internists (Doctors who treat adults and may have a subspecialty)
  • Pediatricians (Doctors who treat children)
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