Paul Sanchez
If you're looking to add your children to your Aetna medical insurance plan, there are a few things you need to know. Firstly, understand that the birth or adoption of a child is considered a qualifying life event by Aetna, which allows you to make changes to your plan outside of the open enrollment period. Typically, you will have a limited time, such as 31 days from the date of birth, to enroll your child and continue their coverage. To do this, you will need to contact your insurance provider or your employer's benefits office, depending on where you purchased your plan. If you bought the plan directly from Aetna, you can log in to their website or call Member Services to update your plan. Alternatively, you can visit health insurance marketplaces or state-specific websites to explore and enroll in family plans offered by Aetna.
| Characteristics | Values |
|---|---|
| Time to enroll children | Within 31 days of their birth |
| How to enroll children | Enroll during the annual Open Enrollment Period |
| Who is eligible for health insurance | U.S.-based "full-time" or "part-time" employees working 30+ hours per week |
| How to get insurance | Buy a plan on the Health Insurance Marketplace, buy directly from Aetna, or get insurance through an employer |
| How to update name and address | Log in or call Member Services |
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What You'll Learn
Enrolling a child within 31 days of their birth
If you have a child or adopt one, you may qualify for a Special Enrollment Period. Your plan can start right away, even if you enroll up to 60 days after the event. Your child is generally covered for 31 days from their date of birth. To continue coverage after this period, you'll need to enroll your child within 31 days of their birth. Then, pay the plan premium.
If you bought a plan directly from Aetna and not through your employer, log in to send your name and address change through the "Contact Us" feature. Or, call Member Services at the number on your ID card. If you bought a plan on the Health Insurance Marketplace, contact the plan to update your name and address.
If you have insurance through your job, your spouse's, or partner's job, contact the employer's benefits office. They can give you a summary of benefits, which you may be able to find online.
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Adding children to your employer-provided plan
If you have employer-provided Aetna insurance, you can add your children to your plan. Contact your employer's benefits office to get a summary of your benefits. You may be able to find this information online by logging into your member website.
Your child is generally covered for 31 days from their date of birth. To continue coverage, you must enrol your child within those 31 days and pay the plan premium. You can also change your plan, including who is covered, during the annual Open Enrollment Period.
U.S.-based employees typically have two open enrollment opportunities each year: when they join the company and can select their initial plan, and when the company's Aetna policy renews in November. Outside of these periods, you can only change your plan if you have a qualifying life event, such as the birth or adoption of a child. If you have had a qualifying life event, reach out to [email protected].
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Contacting Aetna Member Services
If you have any questions about your Aetna insurance plan, there are several ways to contact Member Services. Firstly, you can call the Member Services number on your ID card for personalized service. Alternatively, you can log in to your member website and choose "Help" to get phone number, email, and chat options. If you are not registered, you can send a message via the public form.
For general inquiries, you can reach the corporate headquarters at 1-888-US-AETNA (1-800-872-3862). This line is staffed Monday through Friday, 8 AM to 6 PM ET. If you have questions about pharmacy or CVS Caremark® Mail Service Pharmacy, call 1-800-227-5720 (TDD: 1-800-823-6373). The hours of operation for this line are Monday through Friday 7 AM to 11 PM ET, Saturday 7:00 AM to 9:30 PM ET, and Sunday 8 AM to 6 PM ET.
If you are not ready to register for your member account, you can use the contact form. You can also call the number on your ID card for personalized service. For general questions, call 1-888-792-3862. This line is staffed Monday to Friday, 7 AM to 11 PM ET, Saturday 7:00 AM to 9:30 PM ET, and Sunday 8 AM to 6 PM ET.
If you bought your plan directly from Aetna, you can log in to send your name and address change through the "Contact Us" feature. Or, you can call Member Services at the number on your ID card. If you bought a plan on the Health Insurance Marketplace®, contact the plan to update your name and address. First, contact your past employer's benefit office and let them know you would like to buy a COBRA policy to continue your health coverage for a limited time.
You can also send a message to Aetna's public form or contact their corporate headquarters for general inquiries.
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Understanding the deductible
A deductible is the amount you pay for covered services before your health plan starts contributing. For example, if you have a $1,500 deductible like Courtney, you will pay out of pocket for your medical expenses until you reach that amount. After you meet your deductible, you will only pay a percentage of the costs for the rest of the year. This percentage is called coinsurance. In Courtney's case, she will pay 20% of any costs for the rest of the year because her hospital and doctor are in-network.
It's important to note that not all services are subject to the deductible. Your benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. You can consult your member benefit plan to determine if there are any exclusions or other benefit limitations applicable to specific services or supplies. Additionally, Aetna's conclusion that a particular service or supply is medically necessary does not guarantee that it will be covered by your plan.
You can also take advantage of a health savings account to help you save money on medical expenses. Coinsurance, copays, and premiums are other common insurance payment terms you should understand. Coinsurance refers to the percentage of the bill you pay after meeting your deductible, while copays are flat fees for certain visits. On the other hand, a premium is the amount you pay for your insurance coverage, typically paid monthly, quarterly, or annually.
Remember that you can make changes to your plan, including adding your child, during the annual Open Enrollment Period. Your child is generally covered for 31 days from their date of birth, and to continue coverage, you must enroll them within those 31 days and pay the plan premium.
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Appealing a coverage decision
To add a child to your Aetna medical insurance, you need to enroll your child within 31 days of their birth. You can do this by logging in and filing a claim. You can also do this by mailing a paper copy of the claim form, which can be found on your member website or by contacting Aetna.
As an Aetna member, you have the right to appeal a coverage decision. This includes appealing a decision about your discharge from the hospital. You can also file a complaint about the quality of care or other services you received from Aetna or a Medicare provider.
If your claim is denied, you can appeal the decision. You can file a standard or expedited appeal by fax, mail, or on the Aetna website. You can also call or use the number on your ID card. You will receive a response within 7 days, or 72 hours if you request a faster decision.
If you disagree with a coverage determination, you may be able to request an independent external review of coverage denials. This applies if the denial is based on medical necessity or the experimental and investigational status of the service or supply in question, and if you are financially responsible for it. However, state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA plans.
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Frequently asked questions
Your child is generally covered for 31 days from their date of birth. To continue coverage, you’ll need to enroll your child within those 31 days. Then pay the plan premium.
Adoption is considered a qualifying life event, which enables U.S.-based employees to enroll in benefits outside of open enrollment. Contact your employer's Human Resources department for more information.
Marriage or domestic partnership is considered a qualifying life event, which enables U.S.-based employees to enroll in benefits outside of open enrollment. Contact your employer's Human Resources department for more information.
Losing previous coverage is considered a qualifying life event, which enables U.S.-based employees to enroll in benefits outside of open enrollment. Contact your employer's Human Resources department for more information.
Divorce is considered a qualifying life event, which enables U.S.-based employees to enroll in benefits outside of open enrollment. Contact your employer's Human Resources department for more information.
