Aetna for Illinois residents

Aetna is one of America's top-rated insurance companies. In 200, Aetna ranked #9 in Barron's survey of the top 500 companies in the U.S. and Canada. Aetna isn't just one of the largest insurance companies - they're also one of the most forward-thinking. Aetna is taking a big step into the future of consumer-driven health care with their Physicians Transparency Program. When this online tool is finished being tested, Aetna members will able to compare prices on common medical procedures from different providers. It will give them even more choice and control over their health care.

Probably the biggest advantage Aetna has over other insurance companies in Illinois is that their individual policies are issued without waivers or riders. Instead, Aetna offers various risk categories based on each applicant. This allows applicants to receive benefits for health conditions that other insurance companies normally exclude by charging an increased premium and ensures applicants with minimal health risk do not have to subsidize the cost of members with a higher health risk.

All Aetna individual plans in Illinois (Managed Choice Open Access, PPO Plans, Managed Choice, PPO High Deductible Plans, and PPO First Dollar Plans) allow you to go directly to any recognized health care provider, including specialists, for covered expenses, but costs will be higher if you choose out-of-network health care providers. The following are standard benefits included in all Aetna individual plans:

Unlimted office visits to your primary care physican and specialists
No referrals required
No waiting periods to access preventive health and routine physicals
Lab work and x-rays included in routine physicals
100% annual routine GYN exam coverage - no waiting period, copay, or deductible!
100% coverage on in-network childhood immunizations
Prescription drug coverage

Individual Plans Descriptions

Managed Choice Open Access First Dollar 30

Our Rating:

Benefit Summary

The Managed Choice Open Access PPO First Dollar 30 Plan is the most expensive individual plan Aetna offers in Illinois. It features the lowest annual deductible options, low annual out-of-pocket maximums, an office visit copays for office visits and prescription drug coverage. In-network plan highlights include:

No deductible
$30 office visit copay (unlimited)
$40 copay for specialists (unlimited)
70% coinsurance (30% member responsibility)
$15 copay for generic prescriptions (no deductible)
$7500 individual out-of-pocket maximum
Prescription drug card benefits
- Generic drugs - $15 copay
- Preferred brands - $40 copay*
- Non-preferred brands - $60 copay*
(*There is a $500 calendar year deductible for brand and non-preferred brand drugs)

Managed Choice Open Access First Dollar 40

Our Rating:

Benefit Summary

The Managed Choice Open Access PPO First Dollar 40 Plan is a watered-down version of Managed Choice Open Access First Dollar 30. The differences are:

$40 office visit copay (unlimited)

$50 copay for specialists (unlimited)

60% coinsurance (40% member responsibility)

$12,500 individual out-of-pocket maximum

$20 copay for generic prescriptions

Preferred brand and non-preferred are not covered, but the Aetna discount applies

Managed Choice Open Access 2500 Plan

Our Rating:

Benefit Summary

Managed Choice Open Access 2500 Plan gives you the comprehensive benefits in the Managed Care Open Access First Dollar 30 Plan at a reduced premium cost by having a $2500 deductible. In-network plan highlights include:

$2500 deductible
$30 office visit copay (unlimited)
$40 copay for specialists (unlimited)
80% coinsurance (20% member responsibility)
$5000 individual out-of-pocket maximum
Prescription drug card benefits
- Generic drugs - $15 copay
- Preferred brands - $35 copay*
- Non-preferred brands - $50 copay*
(*There is a $500 calendar year deductible for brand and non-preferred brand drugs)

Managed Choice Open Access High Deductible 3000 Plan

Our Rating:

Benefit Summary

The Managed Choice Open Access 3000 Plan is designed to work in conjuction with contributions to a Health Savings Account (HSA). An HSA allows you to pay for qualified medical expenses on a tax-advantaged basis. This plan will keep your premiums low because there is no copay benefit and you will are responsible for more out-of-pocket costs before the plan coverage kicks in. In-network plan highlights include:

$3000 deductible
100% coinsurance (0% member responsibility after deductible)
$25 copay for preventive health, deductible waived
Deductible waived for preventive health, routine physicals, and annal routine GYN exam
Prescription benefit - prescription costs count towards $3000 deductible. Once deductible is met, all prescription drugs are covered at 100% for remainder of calendar year.

Preventive and Hospital Care 1250 Plan

Our Rating:

Benefit Summary

The Preventive and Hospital Care 1250 Plan provides basic coverage at the lowest price. It provides coverage for hospitalization, surgery, and emergency services. It also covers routine physicals and annual OBGYN exams but does not cover any additional office visits. In-network benefits include:

$1250 deductible
80% coinsurance (20% member responsibility after deductible)
Deductible waived for preventive health, routine physicals, and annal routine GYN exam
$15 copay for generic prescriptions
Preferred brand and non-preferred are not covered, but the Aetna discount applies

Optional Dental Benefits

Aetna Individual Advantage Dental has two plans to meet your meets - the Aetna Individual Advantage^SM Dental PPO Plan and the Aetna Individual Advantage^SM Dental PPO Plus Plan. They both offer coverage for:

Preventive care services such as cleanings, x-rays and more
Basic care like fillings, simple extractions, root canals, basic restorative work and more
Major services such as bridges, crowns, dentures and more

Our table below offers a side-by-side comparison of the 2 dental plans:

Dental Services

Aetna PPO Plus Plan pays*

Aetna PPO Plan pays*

Preventive (deductible waived)

Diagnostic and preventive

100%

80%

Basic (6 month waiting period)

Periodontal maintenance cleanings

80%

50%

Denture repair, rebase, and relining

80%

50%

Basic restorative (fillings)

80%

50%

Oral Surgery
50%

50%

Endodontics (root canals)
50%

50%

Major (18 month waiting period)

Periodontics (gum disease)
50%

50%

Crown and cast restorations
50%

50%

Prosthodontics (dentures)
50%

50%

Deductibles and Maximums (per member)

Deductible (calendar year)
$50

$100

Maximum benefit (calendar year)
$1200

$1000

2008 Illinois Dental Plan Rates

Aetna PPO Plus Plan Rates (per month)

Aetna PPO Plan Rates (per month)

Ages 49 and Under - Zip Codes 60001 - 60899

1 Person

$37.99

$26.92

2 People

$77.55

$54.96

Family

$128.97

$91.73

Ages 49 and Under - Zip Codes 60901- 62999

1 Person

$28.26

$23.86

2 People

$57.30

$48.44

Family

$95.95

$81.28

Ages 50 and Over - Zip Codes 60001 - 60899

1 Person

$50.61

$36.23

2 People
$96.15

$68.84

Family
$144.84

$103.65

Ages 50 and Over - Zip Codes 60901 - 62999

1 Person

$36.73

$31.45

2 People
$69.79

$59.75

Family

$106.60

$91.01