Benefits & Coverage FAQ

Aetna Advantage Plans have a 12-month rate guarantee. After that period, rates may be modified if such modification is approved by the regulators and we give at least 30 days notice before a rate modification. You will receive notice of the rate change before its application.

Yes, dental insurance coverage is offered in certain states. Dental coverage is available in combination with an applicable medical plan or, in Arizona, Delaware, Illinois and Pennsylvania, as a standalone product.

For plan specifics, please see “Request a Quote”.

No, maternity benefits are not currently available in most states. Complications of pregnancy are normally covered in most states. A newborn is automatically covered under the policy for 31 days and can be added to the plan during this time.

A primary care physician (PCP) is trained to manage your health care. 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; the doctor may have a subspecialty)
• Pediatricians (doctors who treat children)

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

Generic drugs contain the same active ingredients in the same amounts as brand-name products. Generics usually cost less than brand-name drugs. Generic drugs may be a different color, shape or size than brand-name drugs. Generics 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.

Send your completed application form and check to:

Aetna Life Company c/o
Aetna Advantage Plans
1425 Union Meeting Road Mail Stop U22N
Blue Bell, PA 19422

If you are working with a broker, please send your application form to your broker.

HMO members call 1-866-772-3862.

PPO members call 1-866-565-1236.

HMO members call 1-800-435-8742.

PPO members call 1-866-565-1236.

You have several options. You can apply online, ask your broker or call 1-800-MY-HEALTH.

It’s your choice:

• We can send a monthly paper bill
• Sign up for EasyPay (your monthly premium will be deducted from your checking account)
• Pay by credit card when you enroll online

For more information and the application form, call your broker or call us at 1-800-MY-Health.

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

No. If you are interested in an Aetna Advantage plan, you must submit a completed application form even if you are covered under an Aetna group plan. (Conversion plans from group plans are available in some states. Ask your employer for information.) If you do need to submit an application form, you can apply on Aetna’s secure website right now, by clicking here, entering your ZIP code, then selecting a coverage date. (You cannot apply by phone.)

If you’ve found plans that interest you, you can Get a Quote right now on this website or by calling 1-866-582-9629, Monday - Friday, 8 a.m. to 11 p.m. EST. The quote will be an estimate. The real cost is calculated after a review.

As part of the review process, we may need your medical records.

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, we will make the effective date the 1st or 15th of the month after the approval date of the application.

If you do need to submit an application form, you can apply on Aetna’s secure website right now, by clicking here, entering your ZIP code, then selecting a coverage date. (You cannot apply by phone.)

If you’ve found plans that interest you, you can Get a Quote right now on this website or by calling 1-866-582-9629, Monday - Friday, 8 a.m. to 11 p.m. EST. The quote will be an estimate. The real cost is calculated after a review.

It may take as long as three to four weeks. Please note that your coverage does not start until we approve your application.

Yes. You will need to send a check to cover the first month's premium. Your check will be deposited once your application form is approved.

You must be under 64 ¾.

It’s easy. Visit DocFind®, the Aetna network of participating physicians, dentists and hospitals. 

You can check on a claim, request an ID card, change your primary care doctor and more by registering on your secure member website. Visit www.aetna.com to get started.

Do not cancel your current plan until you have received approval from us about your new plan. You must cancel the other plan prior to or on the effective date of your new Aetna Advantage Plan.

Use the birthday of the older spouse.

A few things can cause a delay:

• The application form was not signed and dated
• Not all questions were answered
• Questions answered "yes" in the medical history section require details. This information may be incomplete or missing.
• We are waiting for the medical records we requested
• We are waiting for other information we requested