Does anyone have Aetna Health Insurance?

[Loves Vintage]

Date: 1/15/2010 11:14:59 AM
Author: Smurfyimproved

Date: 1/15/2010 11:11:35 AM
Author: Loves Vintage
Smurfy - You mentioned that you are covered until the end of the year. I just wanted to mention that most plan coverage ceases at the end of the month in which employment ceases. (I am so sorry for bringing this up in this thread, but this is important, and I want you to know what to plan for.) After employment ends, the employee is offered COBRA coverage, so the same benefits apply; however, you have to pay 102% of the actual plan cost. Assuming your employer now pays $300, and you pay $300, then you would have to pay $612 per month to retain your coverage. This is something you would want to discuss with HR. I only mention this because you mentioned that you are covered until the end of the year and just wanted to be sure your undertanding is correct.

Thanks for the concern

I actually did my research on this. I am on a plan specifically tailored towards contract workers and hourly workers. Since contract work can be iffy, that is why they allow you to be covered til the end of the year. It just is not deducted from your paycheck and you have to send your payments into the company

Oh, good! I just added a little ETA to my above post because I thought maybe your company was offering something different. Sounds like you are getting a very good deal!

ETA: I just read your ETA, and yes, that makes total sense.

 

[Smurfysmiles]

Date: 1/15/2010 11:17:25 AM
Author: ts44
Second the folks who are saying to get your ID number from online and use that in lieu of a card. I don''t know what state you live in Smurfy, and benefits do vary by state a good deal. First, verify if you have a HMO (health maintenance organization) or a PPO (preffered provider organization)-style plan. HMO''s generally require referrals from your primary care provider (PCP) to go see a different doctor. PPO plans do not. If you have a HMO plan, 99% sure you will have no out-of-network benefits, meaning you cannot see a provider outside of the Aetna network. PPO plans you can, but you generally have a reduced benefit compared to in-network. Some Aetna plans are a POS (point of service) and POS plans combine characteristics of HMO''s and PPO''s. POS plans will have out of network benefits like a PPO, at a reduced benefit from in-network, but also use referrals for the most part. One keyword to look for regarding referrals is if the plan is ''gatekeepered.'' Gatekeeper plans require referrals. Aetna customer service can explain all of this to you as well.


You should call customer service to verify that your husband has made it onto your plan before seeking service however, because if he hasn''t and he sees a provider, you may have to file a manual claim form to get benefits covered once he gets into the system and that''s a pain in the tuchus.


One thing which I always tell my clients is to never let a provider turn you away because ''they can''t verify coverage.'' If you know you have coverage, and you have your member ID number or even just your SSN, you make them call the carrier (in this case Aetna) and verify your coverage while you''re there. Providers get lazy about that all the time and it drives me nuts. If your husband goes to the doctor about his hernia once he''s in the system and doesn''t have a card yet, make sure he pulls the Aetna customer service number from the website and brings it in with him along with his SSN.

Ok great, thanks for the tip!

 

[Smurfysmiles]

Date: 1/15/2010 11:18:17 AM
Author: Loves Vintage

Date: 1/15/2010 11:14:59 AM

Author: Smurfyimproved

Date: 1/15/2010 11:11:35 AM

Author: Loves Vintage

Smurfy - You mentioned that you are covered until the end of the year. I just wanted to mention that most plan coverage ceases at the end of the month in which employment ceases. (I am so sorry for bringing this up in this thread, but this is important, and I want you to know what to plan for.) After employment ends, the employee is offered COBRA coverage, so the same benefits apply; however, you have to pay 102% of the actual plan cost. Assuming your employer now pays $300, and you pay $300, then you would have to pay $612 per month to retain your coverage. This is something you would want to discuss with HR. I only mention this because you mentioned that you are covered until the end of the year and just wanted to be sure your undertanding is correct.

Thanks for the concern

I actually did my research on this. I am on a plan specifically tailored towards contract workers and hourly workers. Since contract work can be iffy, that is why they allow you to be covered til the end of the year. It just is not deducted from your paycheck and you have to send your payments into the company

Oh, good! I just added a little ETA to my above post because I thought maybe your company was offering something different. Sounds like you are getting a very good deal!

Lol yeah you totally scared me for a second there before I thought about what I had been told. It''s easy to forget you work through a contract company when you work at a completely different business haha

 

[Haven]

Date: 1/14/2010 5:28:41 PM
Author: Smurfyimproved
I'm not sure what you mean by a referral?

However, I asked my parents advice, especially my dad as he is a litigator and really good at reading the fine print and he said we were getting a really good deal so that's why we chose it Basically we are gettin full dental, full medical, full vision, life insurance, 10 dollar co pays for walk in visits, 15 for doctors visits, plus all the pharmacy cards and that jazz. the medical includes maternity leave and all the bills associated with pregnancy (with co pays of course) and it is something like 300 a month. from what i'm told that's about normal for full coverage?

This sounds like an amazing deal to me!

Holy moly--We've been carrying our own health insurance since I resigned from my FT teaching position, and it costs us just about $500 per month, and I thought that was a great price. I have BCBS (because they are the only individual carrier that offers maternity coverage--JUST IN CASE, we're not trying) and DH has Humana.

And, we only have medical coverage. No dental or vision, and we pay for our life insurance policies separately. We just pay for dental and vision out of pocket, it isn't really that much, anyway.

So, you say Aetna pays for maternity? Our insurance agent told us that BCBS was the only carrier who will cover maternity for an individual plan. I wonder if this differs state-to-state?

ETA: I hope your husband is better! That's why I responded in the first place, but then I saw what you're paying and wanted to tell you what a great deal it sounds like you're getting.

 

[Smurfysmiles]

Date: 1/15/2010 11:22:36 AM
Author: Haven

Date: 1/14/2010 5:28:41 PM

Author: Smurfyimproved

I''m not sure what you mean by a referral?


However, I asked my parents advice, especially my dad as he is a litigator and really good at reading the fine print and he said we were getting a really good deal so that''s why we chose it Basically we are gettin full dental, full medical, full vision, life insurance, 10 dollar co pays for walk in visits, 15 for doctors visits, plus all the pharmacy cards and that jazz. the medical includes maternity leave and all the bills associated with pregnancy (with co pays of course) and it is something like 300 a month. from what i''m told that''s about normal for full coverage?

This sounds like an amazing deal to me!


Holy moly--We''ve been carrying our own health insurance since I resigned from my FT teaching position, and it costs us just about $500 per month, and I thought that was a great price. I have BCBS (because they are the only individual carrier that offers maternity coverage--JUST IN CASE, we''re not trying) and DH has Humana.


And, we only have medical coverage. No dental or vision, and we pay for our life insurance policies separately. We just pay for dental and vision out of pocket, it isn''t really that much, anyway.


So, you say Aetna pays for maternity? Our insurance agent told us that BCBS was the only carrier who will cover maternity for an individual plan. I wonder if this differs state-to-state?


ETA: I hope your husband is better! That''s why I responded in the first place, but then I saw what you''re paying and wanted to tell you what a great deal it sounds like you''re getting.

I hope he gets better too, better get this fixed soon or he''ll be laying in bed with a little bell for when he needs something, and that doesn''t sound like fun at all!!! lol

 

[Shoopy]

Smurfy, is it that you will be kept on their payroll (obviously not getting checks) as a contractor and that is why they let you keep the insurance as long as you pay?

If not then I think that company needs to do some better financial strategic planning lol but it works out awesome for you! ha!

 

[elrohwen]

Smurf, DH had hernia surgery last year, so we''re experts now

It wasn''t really that bad and he was up on his feet pretty quickly. Good luck your DH! Surgery''s no fun, but at least hernias are very fixable.

 

[Smurfysmiles]

Date: 1/15/2010 11:34:33 AM
Author: fiery
Smurfy, is it that you will be kept on their payroll (obviously not getting checks) as a contractor and that is why they let you keep the insurance as long as you pay?


If not then I think that company needs to do some better financial strategic planning lol but it works out awesome for you! ha!

Yup that is basically how it works. Since I have been with Randstad (contracting company) for over 6 months I am eligible to keep my insurance. I will probably do a lot of job hunting through them for similar jobs too since I enjoyed my current job so much, hopefully get set up with a company that isn't going to close this time

Oh it probably doesn't hurt that a lot of aetna employees end up getting their jobs through Randstad too.

 

[Smurfysmiles]

Date: 1/15/2010 11:37:09 AM
Author: elrohwen
Smurf, DH had hernia surgery last year, so we''re experts now

It wasn''t really that bad and he was up on his feet pretty quickly. Good luck your DH! Surgery''s no fun, but at least hernias are very fixable.

WHAT! I didn''t know it involved surgery!!!! Geez now I''m worried

 

[ts44]

Date: 1/15/2010 11:22:36 AM
Author: Haven

Date: 1/14/2010 5:28:41 PM
Author: Smurfyimproved
I''m not sure what you mean by a referral?

However, I asked my parents advice, especially my dad as he is a litigator and really good at reading the fine print and he said we were getting a really good deal so that''s why we chose it Basically we are gettin full dental, full medical, full vision, life insurance, 10 dollar co pays for walk in visits, 15 for doctors visits, plus all the pharmacy cards and that jazz. the medical includes maternity leave and all the bills associated with pregnancy (with co pays of course) and it is something like 300 a month. from what i''m told that''s about normal for full coverage?

This sounds like an amazing deal to me!

Holy moly--We''ve been carrying our own health insurance since I resigned from my FT teaching position, and it costs us just about $500 per month, and I thought that was a great price. I have BCBS (because they are the only individual carrier that offers maternity coverage--JUST IN CASE, we''re not trying) and DH has Humana.

And, we only have medical coverage. No dental or vision, and we pay for our life insurance policies separately. We just pay for dental and vision out of pocket, it isn''t really that much, anyway.

So, you say Aetna pays for maternity? Our insurance agent told us that BCBS was the only carrier who will cover maternity for an individual plan. I wonder if this differs state-to-state?

ETA: I hope your husband is better! That''s why I responded in the first place, but then I saw what you''re paying and wanted to tell you what a great deal it sounds like you''re getting.

Haven this does vary state-to-state. In Ohio, most carriers offer maternity riders that you can pay extra to add onto an individual policy. They are very expensive though, generally speaking. Kaiser Permanente here in Ohio has an affordable maternity plan, but it is a HMO so you have to stay in Kaiser''s network. Since Smurfy is technically on a group plan, not an individual plan, her plan will cover maternity regardless. Individual plans have no way to spread risk like group plans do, so they cover less and are more restrictive.

 

[Smurfysmiles]

Date: 1/15/2010 11:57:19 AM
Author: ts44

Date: 1/15/2010 11:22:36 AM

Author: Haven

Date: 1/14/2010 5:28:41 PM

Author: Smurfyimproved

I''m not sure what you mean by a referral?


However, I asked my parents advice, especially my dad as he is a litigator and really good at reading the fine print and he said we were getting a really good deal so that''s why we chose it Basically we are gettin full dental, full medical, full vision, life insurance, 10 dollar co pays for walk in visits, 15 for doctors visits, plus all the pharmacy cards and that jazz. the medical includes maternity leave and all the bills associated with pregnancy (with co pays of course) and it is something like 300 a month. from what i''m told that''s about normal for full coverage?

This sounds like an amazing deal to me!


Holy moly--We''ve been carrying our own health insurance since I resigned from my FT teaching position, and it costs us just about $500 per month, and I thought that was a great price. I have BCBS (because they are the only individual carrier that offers maternity coverage--JUST IN CASE, we''re not trying) and DH has Humana.


And, we only have medical coverage. No dental or vision, and we pay for our life insurance policies separately. We just pay for dental and vision out of pocket, it isn''t really that much, anyway.


So, you say Aetna pays for maternity? Our insurance agent told us that BCBS was the only carrier who will cover maternity for an individual plan. I wonder if this differs state-to-state?


ETA: I hope your husband is better! That''s why I responded in the first place, but then I saw what you''re paying and wanted to tell you what a great deal it sounds like you''re getting.

Haven this does vary state-to-state. In Ohio, most carriers offer maternity riders that you can pay extra to add onto an individual policy. They are very expensive though, generally speaking. Kaiser Permanente here in Ohio has an affordable maternity plan, but it is a HMO so you have to stay in Kaiser''s network. Since Smurfy is technically on a group plan, not an individual plan, her plan will cover maternity regardless. Individual plans have no way to spread risk like group plans do, so they cover less and are more restrictive.

Hopefully I won''t need it regardless for a little while though nice to have *just in case* lol

 

[elrohwen]

Date: 1/15/2010 11:47:16 AM
Author: Smurfyimproved

Date: 1/15/2010 11:37:09 AM
Author: elrohwen
Smurf, DH had hernia surgery last year, so we're experts now

It wasn't really that bad and he was up on his feet pretty quickly. Good luck your DH! Surgery's no fun, but at least hernias are very fixable.

WHAT! I didn't know it involved surgery!!!! Geez now I'm worried

Oh yes, they definitely require surgery in order to repair the hole in the muscle that is allowing the intestine to poke through. They basically put a little mesh thingy over the hole. The way they can do it now is pretty non-invasive and doesn't leave a big scar or anything. It does require full anesthesia and a day in the hospital, so it's not cheap - good thing you guys have great coverage! At the time DH had the more minimal coverage plan and we ended up paying a few thousand out of pocket for it.

 

[Smurfysmiles]

Date: 1/15/2010 1:27:22 PM
Author: elrohwen

Date: 1/15/2010 11:47:16 AM

Author: Smurfyimproved

Date: 1/15/2010 11:37:09 AM

Author: elrohwen

Smurf, DH had hernia surgery last year, so we''re experts now

It wasn''t really that bad and he was up on his feet pretty quickly. Good luck your DH! Surgery''s no fun, but at least hernias are very fixable.

WHAT! I didn''t know it involved surgery!!!! Geez now I''m worried

Oh yes, they definitely require surgery in order to repair the hole in the muscle that is allowing the intestine to poke through. They basically put a little mesh thingy over the hole. The way they can do it now is pretty non-invasive and doesn''t leave a big scar or anything. It does require full anesthesia and a day in the hospital, so it''s not cheap - good thing you guys have great coverage! At the time DH had the more minimal coverage plan and we ended up paying a few thousand out of pocket for it.

Oi hopefully it will end up not being a hernia but he lifts really heavy stuff at work and has the whole groin pain and all that

ugh

 

[Little Monster]

Smurfy,

Unfortunately I was covered by Aetna from May - November of this year. I never got a card. Period. I called often. I complained. I tried to reason. I tried threatening. I contacted our HR rep. She tried reasoning. She tried threatening.

Long story short, I am now covered by someone else... and I still never got a card from them in literally 6 months of paying my fees and being pro-active about getting a card.

makes me angry just thinking about it : (

Good luck with your dealings with them!

 

[Smurfysmiles]

Got the card today

I guess it says Smurfy + 1 dependent....weird but works I guess

 

[jewelz617]

I had Aetna a couple years ago. It took well over a month to get my card but I called and got my account number over the phone in case I did need to go to the hospital or doctor.

 

[purrfectpear]

Most hernia repair these days is done as an outpatient at a day clinic. They do put you out, but once you''re in recovery they watch you for a few hours and then you''re sent limping off to home. It''s not an overnight hospital stay.

 

[Cehrabehra]

we have aetna world while we''re on assignment and there are no cards that I know of - we submit everything ourselves.