Change your healthcare coverage

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Member login. Health coverage ACA individual and family health plans Health plans through an employer Options without employer coverage Student plans International plans.

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The health guide All health resources Living healthy Understanding health care Managing health. Additional resources Mental health Women's health Health insurance rights and resources Contact us Frequently asked questions Prior authorization guidelines. Changing your coverage. When life changes, so can your health plan If you have health benefits through your employer, you can change them during "open enrollment.

The only other times you can change your health benefits is when you: Get married Get a divorce or legal separation Give birth or adopt a child Lose your health coverage because your spouse or domestic partner lost his or her job Lose your health coverage because your spouse or domestic partner died Check with your employer to learn more. When job relayed changes happen Losing a job or changing jobs usually means giving up the health insurance plan you have through work.

Here are some options for getting new health coverage: Find out if you can stay on your employer's health plan for a period of time through the Consolidated Omnibus Budgets Reconciliation Act of COBRA. Understand your rights. Buy an insurance plan on your own. Join a government program, such as Medicaid. Graduating college? To get covered consider these options: Join or stay on your parent's health plan.

Contact the employer's Human Resources department for more information. Sign up through a new employer. Buy a health plan on your own. Legal notices Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates Aetna. Health benefits and health insurance plans contain exclusions and limitations. See all legal notices. In this section. Thank you for your feedback. You are now being directed to the AMA site Links to various non-Aetna sites are provided for your convenience only.

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Error or missing data. Please check your entries for an error message. This search uses the five-tier version of this plan Each main plan type has more than one subtype. I Accept. I accept. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members.

Not all plans are offered in all service areas. All services deemed "never effective" are excluded from coverage.

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. Visit the secure website, available through www. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians.

The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc.

Disclaimer of Warranties and Liabilities. Treating providers are solely responsible for dental advice and treatment of members. While the Dental Clinical Policy Bulletins DCPBs are developed to assist in administering plan benefits, they do not constitute a description of plan benefits.

The Dental Clinical Policy Bulletins DCPBs describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. 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. Your benefits plan determines coverage.

If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Since Dental Clinical Policy Bulletins DCPBs can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies.

Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. Aetna Clinical Policy Bulletins CPBs are developed to assist in administering plan benefits and do not constitute medical advice. Members should discuss any Clinical Policy Bulletin CPB related to their coverage or condition with their treating provider.

While the Clinical Policy Bulletins CPBs are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Clinical Policy Bulletins CPBs express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Aetna has reached these conclusions based upon a review of currently available clinical information including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors.

Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins CPBs. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins CPBs , including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame.

Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services.

New and revised codes are added to the CPBs as they are updated. When billing, you must use the most appropriate code as of the effective date of the submission. Unlisted, unspecified and nonspecific codes should be avoided. If there is a discrepancy between a Clinical Policy Bulletin CPB and a member's plan of benefits, the benefits plan will govern.

How can you get the best coverage for you and your family? This article discusses the kinds of life events that may give you a chance to make changes in your health insurance. It notes how you may need to document those events. And it describes the kinds of choices you may make when those events happen or are about to happen.

Losing coverage and losing eligibility may include if you no longer have access to health coverage through a job or an insurance policy you bought on your own, you become ineligible for Medicare, Medicaid, or the Childrens Health Insurance Program or you lose coverage through a family member. For example, children turning 26 and can no longer be covered by your parents health plan or if your spouse loses a job and you no longer have health coverage.

There are also other situations in which you may qualify for a special enrollment period see Healthcare. It depends. However, you must have experienced a qualifying life event to cancel group health insurance through your employer — unless you leave the job. Also Check: Starbucks Medical Insurance. You can cancel your individual health insurance plan without a qualifying life event at any time.

But it is important to remember that once you cancel your policy, you cannot enroll again until the next open enrollment period. During this time you will have no health insurance coverage, which could be costly if you happen to get injured. On the other hand, you cannot cancel an employer-sponsored health policy at any time.

Under Section of the Internal Revenue Code , if you do decide to cancel without a QLE, then you and your employer will incur tax penalties. The first option is to consider enrolling in a Medicaid plan if you meet the income requirements.

Medicaid is a federally-funded health insurance program thats reserved for low-income families. It can help you get affordable coverage outside of open enrollment if you have kids. These policies can be purchased in most states directly from private health insurance companies at any point during the year, without a qualifying life event. These low-cost plans have limited benefits, so its wise to only keep short-term health insurance until youre eligible for a health plan with comprehensive coverage, such as an ACA or employer plan.

You might also look into membership health insurance or a temporary health plan. Membership health insurance can be obtained if you belong to an organization that provides it. A short-term health plan can help in the event of a catastrophic event, but it might not be a good long-term option, because coverage is often just minimal.

Becoming eligible for Medicare isnt specifically a qualifying event, but you can drop the coverage you buy on your own from Healthcare. Medicare generally becomes your primary coverage when you turn So, you usually want to sign up during your initial enrollment period.

That period runs from three months before to three months after the month you turn age You arent required to drop marketplace coverage at that point, but most people do so because youll no longer receive a subsidy to help pay premiums after you enroll in Medicare.

If you have coverage from an employer with 20 or more employees, that coverage pays first and Medicare is secondary. You may want to delay signing up for Medicare while youre still working.

If your employer has fewer than 20 employees, however, Medicare becomes your primary coverage at You can keep your employer coverage, too, to supplement Medicare. A special enrollment period generally lasts 60 days before or after the qualifying event and allows an individual to make plan changes or sign up for a new health insurance plan immediately.

Join us for a panel discussion with thought leaders from BambooHR and Zane Benefits as we explore how optimizing your benefits helps you recruit and retain the best people for your organization. This qualifying event only applies within the exchanges carriers selling coverage off-exchange are not required to offer a special enrollment period for people who gain citizenship or lawful presence in the US. There are special rules that allow recent immigrants to qualify for premium subsidies in the exchange even with an income below the poverty level , since they arent eligible for Medicaid until theyve been in the US for at least five years.

Read Also: Starbucks Insurance Cost. Usually, an individual or a family can only purchase a health insurance plan during the Open Enrollment Period. Any life event that triggers a Special Enrollment Period during which you are freely able to enroll in a new health insurance plan is considered a qualifying event.

There are several important questions to keep in mind when talking about qualifying events. For example, what life events are considered to be worthy of an SEP? What types of health insurance plans have qualifying events? How long does one have to select a plan following a qualifying event?

You can get answers to all these questions and more right here at Health Insurance Providers. You may become eligible for another QLE that allows you access to health coverage without having to wait for the next open enrollment period.

Here is a list:. Good news: If you lost your health coverage after returning from military service, this qualifying event opens a special enrollment period for you. In an effort to make your transition into post-military life smoother, let us help you find a health insurance plan that gives you the coverage you need.

Your Special Enrollment Period is a day health insurance enrollment window. It begins on the day your qualifying life event takes place. This means that if you get married on May 31, you must enroll in a new health insurance plan before the end of July.

If you quit your job to form your own business, you have 60 days from the last day of employment to get new healthcare coverage. Once the day window has passed, you have to wait until the regular Open Enrollment Period to obtain health insurance coverage or update your current coverage.

Qualifying events are usually connected to moving, losing health coverage, or needing to add or remove someone from your health plan. When you experience a qualifying event, you have 60 days to select a plan from the individual or family ACA insurance market or switch to a new plan.