Women’s Health Insurance Coverage & Resources | Aetna (2023)

By clicking on “I accept”, I acknowledge and accept that:

Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept".

  • Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. 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.
  • 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 will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. The 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) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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.

See CMS's Medicare Coverage Center

  • Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change.
  • 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. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans.

See Aetna's External Review Program

  • The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT®), copyright 2015 by the American Medical Association (AMA). 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 responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Applicable FARS/DFARS apply.

LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT®")

(Video) How To Choose A Health Care Plan

CPT only copyright 2015 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association.

You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt.

Go to the American Medical Association Web site

(Video) Pregnancy Insurance: What You Need to Know to Protect YOUR BABY and YOU!

U.S. Government Rights

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.

(Video) Health Insurance Basics: How Do I Choose the Right Plan?

This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept".

The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services.

This information is neither an offer of coverage nor medical advice. It is only a partial, general description of plan or program benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.

(Video) High Deductible Health Plans vs PPO Explained // PPO vs HDHP

(Video) Understanding Your Health Insurance Costs | Consumer Reports

FAQs

How much is health insurance a month for a single person? ›

BY Anna Porretta Updated on October 01, 2022

In 2020, the average national cost for health insurance is $456 for an individual and $1,152 for a family per month. However, costs vary among the wide selection of health plans.

What is the best insurance to have while pregnant? ›

There are three types of health insurance plans that provide the best affordable options for pregnancy: employer-provided coverage, ACA plans and Medicaid.

How much is health insurance in Florida per month? ›

How much does health care cost in Florida? For major medical plans, the cheapest individual monthly premium starts at $177, but the average monthly cost of health insurance in Florida is approximately $467 per person.

Which is best health insurance? ›

Best Higher Coverage Health Insurance Plans in India 2022
Health Insurance PlansNetwork HospitalsEntry Age
HDFC ERGO my: Health Suraksha Plan10,000+91 days and above
Care Health Insurance Policy8,250+91 days and above
Care Freedom Policy8,250+91 days and above
Bajaj Allianz Health Guard Policy6,500+3 months to 65 years
6 more rows

Is it worth getting private health insurance? ›

Private health insurance helps people avoid long wait times for non-urgent procedures and lets them access services that Medicare does not cover. But out of pocket costs may be a deterrent for many people to use it to pay for their medical costs.

What is the most affordable health insurance in Florida? ›

In Florida, the cheapest insurer in most counties is Ambetter, which has significantly cheaper policies compared to other major health insurance providers in the state. In 2022, the Ambetter Balanced Care 30 plan costs $503 per month.

What is the income limit for Florida Blue? ›

By Florida Blue
If you're a single adult with no kids and your annual income is:If you're a family of four and your annual household income is:
$12,760 to $19,140$25,520 to $39,300
$19,141 to $51,040$39,301 to $104,800
More than $51,040More than $104,800
1 Apr 2021

What is the income level to qualify for Medicaid in Florida? ›

Who is eligible for Florida Medicaid?
Household Size*Maximum Income Level (Per Year)
1$18,075
2$24,353
3$30,630
4$36,908
4 more rows

Who qualifies for Medicaid? ›

To be eligible for Texas Medicaid, you must be a resident of the state of Texas, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income.

Can a pregnant woman be denied Medicaid? ›

Pregnancy Medicaid Household Size

Medicaid can also deny pregnant women because their household size is too small relative to the total income. Therefore, you do not want to omit a dependent unknowingly or include an extra wage earner and hurt your eligibility.

Is it better to have HMO or PPO when pregnant? ›

Opt for an HMO if one is available in your area.

You can expect to pay the least out-of-pocket money if you choose an HMO, which limits you to specific doctors and hospitals — though you'll typically have to pay a bit more in co-pay ($50 for an HMO vs. $30 for a PPO, for example) for each in-network doctor visit.

How can I get health insurance? ›

How to Enroll and Get Answers to Your Questions
  1. Visit HealthCare.gov to apply for benefits through the ACA Health Insurance Marketplace or you'll be directed to your state's health insurance marketplace website. ...
  2. Contact the Marketplace Call Center.
  3. Find a local center to apply or ask questions in person.

How does health insurance work? ›

And it works the same way your car or home insurance works: you or your employer choose a plan and agree to pay a certain rate, or premium, each month. In return, your health insurer agrees to pay a portion of your covered medical costs.

What are the essential elements of top 5 personal insurance that everyone should have? ›

The Bottom Line

There are many types of insurance available, but there are some which top the charts in terms of importance. Home or property insurance, life insurance, disability insurance, health insurance, and automobile insurance are five types that everyone should have.

How much should you pay for health insurance? ›

A good rule of thumb for how much you spend on health insurance is 10% of your annual income. However, there are many factors to consider when deciding how much to spend on health insurance, including your income, age, health status, and eligibility restrictions.

What are the disadvantages of private health insurance? ›

Potential drawbacks of private health insurance
  • The cost. Private health insurance can be expensive – depending on their policy, an individual, couple or family could pay thousands of dollars in premiums each year, with costs typically increasing annually. ...
  • Complex products. ...
  • Excluded treatments. ...
  • Out of pocket costs.
25 Jan 2022

What happens if you don't have private health insurance after 30? ›

For every year you don't have private health insurance after the age of 30, it will cost you an extra 2 per cent on top of your premiums if you finally buy a policy.

Is there any free healthcare in Florida? ›

The Florida Medicaid program is available, and it is a federal and state funded, free quality health insurance for eligible low-income residents as well as the working poor of the state. It can provide coverage for families with children, eligible low-income individuals, infants and pregnant women.

How do I get health insurance with low-income in Florida? ›

Medicaid. State-sponsored Medicaid benefits are for low-income families and pregnant women to improve the health of people who might otherwise go without medical care for themselves and their children. Sunshine Health is a Florida Medicaid health plan that has been providing services in Florida since 2009.

Is Florida Blue a good health insurance? ›

Florida Blue earned an A+ rating from the Better Business Bureau and 4.5 of 5 stars for overall customer experience from the National Committee for Quality Assurance (NCQA).

Who qualifies for Florida Blue? ›

Household income below 150% of the federal poverty level (as of 2022)

Is Florida Blue based on income? ›

Amount of subsidy and savings is based on subsidy eligibility, annual income, age, county and the plan selected.

What is the highest income to qualify for Medicaid? ›

Federal Poverty Level thresholds to qualify for Medicaid

The Federal Poverty Level is determined by the size of a family for the lower 48 states and the District of Columbia. For example, in 2022 it is $13,590 for a single adult person, $27,750 for a family of four and $46,630 for a family of eight.

What is the highest income to qualify for Medicaid 2022? ›

Income Limit in Most States

Most states — 38 and Washington, D.C. — have the same income limit of $2,523 per month for a single person for most types of Medicaid services. For a married couple, the limit increases to $5,046 in most cases.

What is the 2022 Medicaid income limit in Florida? ›

Effective Jan 1, 2022, the applicant's gross monthly income may not exceed $2,523.00 (up from $2,382.00). The applicant may retain $130 per month for personal expenses. However, even having excess income is not necessarily a deal-breaker in terms of Medicaid eligibility.

What is the 5 year rule for Medicaid in Florida? ›

In order to qualify for long-term Medicaid in Florida, such as nursing home or assisted living care, the applicant must not have given away (i.e., made "uncompensated transfers") assets within five years of applying for Medicaid benefits. This is generally known as the Medicaid “look-back” period.

How much does UK health insurance cost? ›

The average price of a private healthcare policy in the UK is £1,032.84 per year (February 2022); however, you could pay considerably less or more depending on your age and the level of cover you require. For example, a 30 year old would pay on average £581.64 per year, and a 60 year old £1,354.80.

Can you pay monthly for private healthcare? ›

You'll pay a monthly premium for medical insurance which can cover the cost of private treatment, but you'll usually still have to pay an excess for each claim. Choosing a higher excess can bring the cost of your premiums down, but you have to be sure you'll be able to pay it should you need to make a claim.

What is the average cost of private health insurance in UK? ›

According to ActiveQuote and BoughtByMany the average price for an individual private health insurance policy is £1,115 a year (as of October 2021) – but there are many factors that can make the price go up or down.

Is private health insurance worth it in the UK? ›

Is private medical insurance good value for money? It can be good value if you might need specialist, expensive treatment. If you're a sporting enthusiast, for example, you might want access to specialist private treatment that isn't available in the NHS – like surgeons and experts who only do private work.

What is the best private health insurance in the UK? ›

  1. BUPA. BUPA is one of the largest and best private healthcare insurance companies in the UK. ...
  2. Aviva. With 33 million customers globally, Aviva is the biggest insurance company in the UK. ...
  3. AXA PPP. ...
  4. WPA. ...
  5. Saga. ...
  6. Vitality. ...
  7. Freedom Health Insurance. ...
  8. The Exeter.
9 Dec 2021

Is BUPA worth joining? ›

Bupa health insurance – Key benefits

Cover more mental health conditions than any other insurer. Cover includes therapies and mental health cover as standard. Health advice is available 24 hours a day, 7 days a week. Access to breakthrough cancer drugs and treatment.

How do I get private health insurance UK? ›

You can get private treatment from a consultant or specialist without being referred by your GP. But the British Medical Association (BMA) believes it's best practice for patients to be referred for specialist treatment by their GP because they know your medical history and can advise you if a referral is necessary.

How do I go private healthcare? ›

How to pay for private healthcare
  1. Private medical insurance. ...
  2. Self-pay. ...
  3. Personal medical loan. ...
  4. Speak to your NHS GP or a private GP. ...
  5. Attend an outpatient appointment with a consultant. ...
  6. Get a fixed price quote from the hospital. ...
  7. Your consultant may be able to carry out the operation in an NHS hospital. ...
  8. Book your surgery.

Can you get private healthcare with pre-existing condition? ›

If you have pre-existing medical conditions, you can still get private health insurance. Please bear in mind that most policies restrict when they can pay to treat pre-existing conditions.

How soon can you claim private health insurance? ›

17. Can I make a claim within the first few weeks of taking out my policy? Pre-existing conditions will not be covered. Some insurers will not allow you to make a claim within the first few weeks of taking out your policy whereas others, cover you from the moment you sign the form for a new problem.

How much does health insurance cost per month UK? ›

According to our research, the average cost of an individual private health insurance plan sits at around £85 per month or £1,020 per year! However, just like any type of insurance, the cost of private health insurance can vary significantly depending on your circumstances.

Will BUPA cover pre existing conditions? ›

We usually don't cover you (or any family members on your policy) for conditions that existed before you take out insurance with us. With Moratorium you will not be covered for any pre-existing medical conditions until two years have passed without any incident for each condition.

What percentage of UK citizens have private health insurance? ›

Roughly 11 per cent of the UK population has some form of private medical insurance.

What are the disadvantages of private health insurance? ›

Potential drawbacks of private health insurance
  • The cost. Private health insurance can be expensive – depending on their policy, an individual, couple or family could pay thousands of dollars in premiums each year, with costs typically increasing annually. ...
  • Complex products. ...
  • Excluded treatments. ...
  • Out of pocket costs.
25 Jan 2022

Is private health care better than NHS? ›

Due to this, many are left wondering “are private hospitals better than the NHS?” However, this is simply untrue. The standard of care and expertise a patient can expect from an NHS or private hospital is exactly the same.

Is it better to get health insurance through work or private? ›

Employer-sponsored health insurance coverage is usually cheaper than buying your own private plan since your employer must cover at least 60% of the cost. But if they don't cover your dependents, paying out-of-pocket for their premiums can be very costly.

Videos

1. Health Insurance Explained – The YouToons Have It Covered
(KFF)
2. Pregnancy and health insurance plans - Medical Minute
(Avera Health)
3. What’s the difference between an HMO, a POS, and a PPO? | Health care answers in 60 seconds
(Aetna)
4. PREGNANCY INSURANCE - What You NEED to Know from a Midwife!
(CajunStork - Midwife Kira at Natural BirthHouse)
5. Turning 26? Here’s when to apply for health insurance
(Independence Blue Cross)
6. Health Insurance and Pregnancy: What’s Covered and What’s Not
(Debt Free Millennials)
Top Articles
Latest Posts
Article information

Author: Terence Hammes MD

Last Updated: 12/29/2022

Views: 6622

Rating: 4.9 / 5 (49 voted)

Reviews: 80% of readers found this page helpful

Author information

Name: Terence Hammes MD

Birthday: 1992-04-11

Address: Suite 408 9446 Mercy Mews, West Roxie, CT 04904

Phone: +50312511349175

Job: Product Consulting Liaison

Hobby: Jogging, Motor sports, Nordic skating, Jigsaw puzzles, Bird watching, Nordic skating, Sculpting

Introduction: My name is Terence Hammes MD, I am a inexpensive, energetic, jolly, faithful, cheerful, proud, rich person who loves writing and wants to share my knowledge and understanding with you.