Paul Sanchez
If you're wondering whether you can have two medical insurance policies with Aetna, you may be thinking about secondary health insurance. This can be another medical plan, such as through your spouse, or a different type of plan you've purchased to extend your coverage. Your primary and secondary plans work together to offer you coordinated benefits. However, it's important to note that each benefit plan defines which services are covered, excluded, or subject to dollar caps or limits. Therefore, it's essential to consult your benefit plan to understand any exclusions or limitations. Additionally, Aetna's determination of medical necessity does not guarantee coverage, and your benefit plan will govern in case of discrepancies.
| Characteristics | Values |
|---|---|
| Number of insurance policies allowed | No specific mention of a limit on the number of insurance policies |
| Portability | Members can buy an insurance plan on their own or join a government program like Medicaid |
| Coverage | Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits |
| Pre-existing conditions | No specific mention |
| Waiting period | No specific mention |
| Claim process | Members can log in to file a claim or send a paper copy |
| Network hospitals | Yes, Aetna has a network of doctors, specialists, dentists, hospitals, surgical centers, and other healthcare providers and facilities |
| Grace period | If the premium isn't paid by the due date, there is a one-month grace period for individual health plans and a three-month grace period for plans on the Health Insurance Marketplace with an Advance Premium Tax Credit (APTC) |
| Discounts | Yes, Aetna plans include extra benefits and discounts for members |
| Coverage for family | Yes, family health insurance plans are available |
| Coverage for pre and post-hospitalization | No specific mention |
| Maternity coverage | No specific mention |
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What You'll Learn
Primary and secondary plans
Primary and secondary insurance plans work together to provide coordinated benefits. A primary health insurance plan covers basic medical expenses like doctor's visits, lab tests, and prescription drugs, as well as some additional benefits. However, a primary plan doesn't cover all expenses, so a secondary insurance plan can be purchased to extend coverage. This is often referred to as voluntary or supplemental coverage.
For example, dental insurance covers routine teeth cleanings, preventive care, fillings, and extractions. Vision insurance helps cover the cost of prescription glasses, contact lenses, and routine eye exams. Hospital indemnity insurance provides cash payments to help manage the costs of a hospital stay, including your deductible and everyday expenses. Disability insurance provides income on a weekly or monthly basis if an injury or illness prevents you from working, helping you pay for day-to-day expenses.
Supplemental health insurance from Aetna pays cash to help with your deductible, hospital charges, and living expenses. This can include unexpected costs due to events covered under your plan, such as accidents, critical illnesses, or hospital stays.
Each benefit plan defines which services are covered, excluded, or subject to dollar caps or other limits. Aetna's determination that a service is medically necessary does not guarantee that it is covered. If there is a discrepancy between Aetna's policy and a member's plan of benefits, the benefits plan will govern.
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$59.52
Special policies for extra costs
Aetna offers a range of special policies to help cover extra costs that your primary medical plan might not include. These are referred to as voluntary or supplemental coverage plans.
Supplemental health insurance plans pay you cash to help with your deductible, hospital charges, living expenses, and even unexpected costs when you have events that are covered under your plan. For example, if you or a family member gets into an accident, is diagnosed with a critical illness, or has any type of hospital stay.
Aetna offers accident plans that provide cash benefits for common services related to a covered injury. They also offer critical illness plans to help cover everyday expenses so you can focus on your health.
Dental insurance typically covers routine teeth cleanings and preventive care, as well as procedures like fillings and extractions. Vision insurance usually helps to cover the cost of prescription glasses, contact lenses, and routine eye exams.
Hospital indemnity insurance provides cash payments to help manage the costs of a hospital stay, including your deductible and everyday expenses like daycare. Disability insurance provides you with income on a weekly or monthly basis if an injury or illness prevents you from working, so you can still pay for your day-to-day expenses.
Medicare Extra Help is another program offered by Aetna to help people with limited income and resources pay for Medicare prescription drug program costs. This can help lower your out-of-pocket prescription drug costs such as premiums, copays, or coinsurance.
It is important to note that each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to a specific service or supply.
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Appealing a coverage decision
While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In the event that a member disagrees with a coverage determination, they have the right to appeal the decision. Members can submit a dispute online through the Availity provider website, and Aetna will determine whether it goes to a reconsideration or an appeal. An appeal is a written request by a practitioner or organisational provider to change an adverse initial claim decision based on medical necessity or experimental/investigational coverage criteria.
If a member's request for medical coverage is denied, they can appeal the decision. This can be done by filing a standard or expedited appeal, and members have the option to call, fax, or mail their information. Members can also request a medical appeal if they have a Medicare Advantage plan.
In addition, members may have the opportunity for an independent external review of coverage denials based on medical necessity or the experimental and investigational status of the service or supply in question. This opportunity is available when the member is financially responsible for a service or supply costing $500 or more. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA plans.
Members also have the right to appeal their discharge decision if they believe they are being discharged from the hospital too soon. They can request to continue coverage by contacting the Quality Improvement Organization no later than noon on the day after receiving the written notice.
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Exclusions and limitations
While Aetna does not explicitly prohibit having two medical insurance policies, it is important to understand the exclusions and limitations of their plans.
Each Aetna benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their healthcare providers must refer to their specific benefit plan to determine if there are any exclusions or other limitations applicable to a particular service or supply.
The conclusion that a particular service or supply is medically necessary does not guarantee that it will be covered (i.e., paid for by Aetna) for a specific member. The member's benefit plan ultimately determines coverage. Some plans may exclude coverage for services or supplies that Aetna deems medically necessary. In such cases, the member's benefit plan takes precedence over Clinical Policy Bulletins (CPBs) or Dental Clinical Policy Bulletins (DCPBs).
Additionally, coverage may be subject to applicable legal requirements of a state, the federal government, or CMS for Medicare and Medicaid members.
It is essential to note that health benefits and health insurance plans from Aetna contain exclusions and limitations. These limitations may include special coverage provisions for specific relationships, such as a legally adopted child or a child for whom one is a legal guardian. Eligibility can also vary by state and plan type.
For individuals with multiple insurance policies, it is crucial to understand the coordination of benefits rules, which determine the primary and secondary insurance providers in the event of a claim. This coordination helps establish which insurance provider pays first and can impact the overall coverage and out-of-pocket expenses for the insured individual.
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Individual health plans
An individual health plan is one that you buy on your own. It is not offered by a group such as an employer or school. You can apply for an individual health plan in three ways: directly with the insurer, with an insurance broker or insurance navigator, or on Healthcare.gov or a state health insurance exchange. These are also referred to as health insurance marketplaces.
Aetna offers individual and family health insurance plans and coverage. These plans are offered and/or underwritten by different companies under the Aetna brand name, depending on the state. In Idaho, for example, these plans are offered and/or underwritten by Aetna Health of Utah Inc. and Aetna Life Insurance Company. In all other states, they are offered and/or underwritten by Aetna Health Inc., Aetna Health of California Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company, and/or Aetna Life Insurance Company.
Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to a particular service or supply. Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern.
Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care, or treatment. All services deemed "never effective" are excluded from coverage.
If you have Medicare as your other health plan, Medicare will pay before your individual health plan. If you are moving or relocating, be sure to update your new address as soon as possible. You can do this by visiting the enrollment and billing portal or calling the number on the back of your ID card for help.
For plan year 2022, you have 24 months from the date of service to file a claim. For plan years 2023 and 2024, you have 95 days from the date of service to file a claim. You have 15 months from the date of service to file a claim. Review your policy documents for additional claim filing details. You are required to pay your premium by the due date. If your premium isn't paid by this due date, you'll receive a grace period during which your claim may be pending. If the total premium due isn't paid by the end of the grace period, your coverage will terminate back to your last paid-through date.
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Frequently asked questions
Yes, you can have two medical insurance policies with Aetna. You can have a primary and a secondary plan that work together to offer you coordinated benefits.
You can purchase a secondary health insurance plan through your spouse or by buying a health plan on your own.
A secondary health insurance plan can help cover extra costs that your primary plan does not. For example, dental insurance covers routine teeth cleanings and procedures like fillings, while vision insurance helps cover the cost of prescription glasses and contact lenses.
