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

Dental, vision and supplemental Dental plans Find a dentist Vision plans Find an eye doctor Supplemental plans. Pharmacy Get pharmacy plan information Find a pharmacy. Medicaid Medicaid plans Find a doctor.

Member support Account management Account management Log in to your member website Find a form Get your ID card opens in secure site Check a claim opens in secure site View coverage opens in secure site. 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.

Your guide to qualifying life events By Aetna. Transcript: When can I change my health plan? Health care answers in 60 seconds. When can I change my health plan? Here are common events. Loss of insurance. If you lose coverage because you've aged out of your parents' plan, lost your job, or switched your job, you qualify.

Change in household. If you get married, have a baby, or when the number of people in your family changes, you qualify. Health care question answered. Aging out: Max looks forward to his 26th birthday. Other types of health coverage loss include: Losing existing health coverage, including job-based, individual, and student plans Losing eligibility for Medicare, Medicaid, or CHIP Death in the family: Lisa starts a new chapter.

Other changes in household include: Getting married or divorced Death in the family Having a baby or adopting a child. Read more about this below. Having a baby: Javier adopts a little girl. Change of residence: Gwen moves her family across the country. Other changes in residence include: Moving to a different ZIP code or county A student moving to or from the place they attend school A seasonal worker moving to or from the place they live and work Moving to or from a shelter or other transitional housing Key takeaways about qualifying life events The bottom line is, you might not need to wait for your employer or the government's next open enrollment period to make changes to your health plan.

Qualifying life events trigger a "special enrollment period" that typically lasts 30 to 60 days, depending on your plan, during which you can select a new plan or add a new dependent to your plan. To change your plan selections, notify your current or future health plan sponsor of the qualifying event in your life as soon as possible.

Other qualifying life events include getting married, losing coverage due to divorce, losing eligibility for Medicaid, and exhausting your COBRA coverage. Different plans have different rules. Contact your plan administrator about any change in status that impacts your health coverage to find out your rights.

Related content. Read More Read Less. HSA vs. FSA: What's the difference? You are now being directed to the AMA site Links to various non-Aetna sites are provided for your convenience only. You are now being directed to the Give an Hour site Links to various non-Aetna sites are provided for your convenience only. You are now being directed to the CDC site Links to various non-Aetna sites are provided for your convenience only.

You are now being directed to the CVS Health site. You are now being directed to the Apple. You are now being directed to the US Department of Health and Human Services site Links to various non-Aetna sites are provided for your convenience only. Login Please log in to your secure account to get what you need. You are now leaving the Aetna Medicare website. 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.

Our history Our leadership team Facts and subsidiaries. Corporate responsibility. Health section. Who we are Our mission Our mission Diversity and inclusion Code of conduct. About Aetna Our history Our leadership team Facts and subsidiaries. Investors Investors. Health section Access Community Innovation Well-being.

Health insurance exchanges FAQs for health care professionals. Caring for exchange members What is a qualified health plan QHP? How can I identify an exchange member? Are the precertification, authorization and referral processes the same for exchange plans? Yes, the processes are the same. Are the payer ID and claim address the same for exchange plans? Yes, the payer ID and claim address are the same. Do I have to refer patients to other providers within an exchange?

Reimbursement for health care professionals How will Aetna reimburse health care professionals who are out of network? What does that mean? If an exchange member with a subsidy stops paying the premium, how will health care professionals be reimbursed? Individual members who have not paid their monthly premium are considered delinquent. Health care professionals will be paid for services received during the first 30 days of delinquency.

The carrier is allowed to pend claims for services provided during the second and third months of the grace period. If full payment is not received by the end of the third month, the member's coverage will be terminated. This action is retroactive to the end of the first month of the grace period. If coverage is terminated, Aetna will not pay any pended claims for months two or three. Will Aetna inform health care professionals when exchange members are one month delinquent paying their premiums?

Will Aetna tell me how much longer a member will be in the grace period? Can a member be in a grace period multiple times in a plan year? 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. You are now being directed to the AMA site Links to various non-Aetna sites are provided for your convenience only. You are now being directed to the Give an Hour site Links to various non-Aetna sites are provided for your convenience only. You are now being directed to the CDC site Links to various non-Aetna sites are provided for your convenience only.

You are now being directed to the CVS Health site. You are now being directed to the Apple. You are now being directed to the US Department of Health and Human Services site Links to various non-Aetna sites are provided for your convenience only. Login Please log in to your secure account to get what you need.

You are now leaving the Aetna Medicare website. 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.

In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members.

Since Clinical Policy Bulletins CPBs 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.

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.

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