AETNA Individual Health Insurance – Krow

Maybe you’ve had a prosperous career and decided it’s time to go it alone. Or perhaps you wish to retire at age 56. Congratulations on your significant career shift, whatever the cause you’ll need to purchase your own reasonably priced individual health insurance.

Find a suitable, affordable short-term health plan

Employer-sponsored health insurance is handy and, depending on how much your employer contributes to the premiums, typically less expensive than individual health insurance. Your employer makes most of the decisions and gives you one or more options. You can select your insurance provider, plan layout, and level of coverage as you embark on your new career. You can maintain the insurance for as long as possible because it isn’t linked to a particular company. How do you go about that? It’s simple: use a licensed broker or an insurer to make your transaction.

Meaning of Individual Health Policy

An individual health policy is an insurance that a person acquires to protect their health and pay for medical care when needed. It is a common fallacy that individual health insurance only covers one person. You must pay a medical insurance premium before using your coverage. Contrary to popular belief, you can add additional family members and provide them with coverage based on your needs on an individual sum-insured basis.

Benefits of Individual Health Insurance

The following are some advantages of purchasing individual health insurance:

  • Customized Benefits: You can select the individual health insurance plan that best suits your needs because it is customized to order. A specific disorder, such as critical illness and personal accident insurance, may be covered. Maternity coverage is offered by certain individual health insurance plans, allowing women to seek assistance with pregnancy-related costs
  • Assured Coverage Amount: If you get individual health insurance, you get a set sum toward your medical expenses. As a result, you won’t need to be concerned about using up your money if you get sick
  • Coverage designed specifically for you: The individual health insurance plan’s sum insured is only available to you. Unlike the family floater plan, which allows all covered members to use the insurance amount as needed
  • Risks and Premiums: Not all insurance may be right for you. When choosing an individual health insurance plan, you must be practical and ensure it meets your needs and criteria. If you choose a family floater, the premium may be more expensive because age is a risk factor that affects the premium. You ought to choose individual health insurance in this situation
  • Savings and other benefits: When purchasing healthcare plans for more than one person, many insurance providers offer a variety of offers and excellent discounts. Choosing an individual health insurance plan in such a situation might help you and your loved ones save a lot of money
  • Sole tax liability: It is a significant benefit of private health insurance. When you choose any insurance, you must pay a premium, but you may also be eligible for a deduction. The premium is subtracted from your taxable income under Section 80 D of the Income Tax Act of 1961. This results in a decrease in your tax obligation
  • Full Individual Benefits: Regardless of the health of other family members, the plan covers risks, including medical and critical sickness. A waiting period is not necessary for an individual health insurance policy if one member exhausts the policy’s coverage
  • Additional Benefits: An individual health insurance plan also comes with other benefits, such as a restoration benefit that allows the covered amount to be renewed during the policy’s term in the event of unconnected medical emergencies. Plans for individual health insurance may also include extra built-in or add-on advantages, such as personal accident insurance, global coverage, etc
  • Cashless Claim Facilities: Your satisfaction with cashless claim facilities is almost universal among health insurance providers. These facilities have special arrangements, so you don’t have to pay anything out of pocket. Instead, the insurer is responsible for covering all medical costs
  • It is advised to use all of the hospital recommendations made by your insurance company. You might need to present a pre-authorization form and your health insurance card to receive these services
  • Uninterrupted Safekeeping: In group insurance policies, the claim will not be recognized if an employee quits the organization. Contrarily, with an individual health insurance plan, coverage remains until the policy’s expiration date, even if the employee has left the company

How to Apply for an Individual Health Insurance?

Through numerous online broker and aggregator sites, you may now purchase a health insurance coverage thanks to technological advancements. The individual health insurance application is a simple process. Your basic information, prior medical history, and the best plan for you are all shared during the process. After that, you can pay and get coverage right away. Before deciding, you should always compare the many individual health insurance plans on the market. Look at the insurance providers’ benefits, then choose the one that best meets your requirements.

AETNA Individual Health Insurance

You must obtain an individual health plan on your own, independent of your company. These health plans are available for purchase directly from Aetna or through a health insurance exchange, often known as the health insurance market. The following categories define some of the phrases we use in relation to these health plans and provide an overview of how your health plan functions. All information may cover not all health plans. See your summary of benefits and coverage if you’re looking for information unique to your health plan.

Network coverage

A network is a group of medical specialists. It includes dentists, doctors, hospitals, and other healthcare facilities like operating rooms. We have a written contract with these healthcare providers. The agreement stipulates that they must provide our members with several services. This cost is typically cheaper than what they would charge if they weren’t a part of our network. These service providers agree to be paid in full at the agreed-upon fee. You pay the agreed-upon amount for your deductible, copay, and coinsurance. In our accessible web directory, we list network hospitals, clinics, pharmacies, and other healthcare suppliers. By using this directory, you may determine whether your Aetna plan covers the medical professionals you use before purchasing it

Out-of-network coverage and balance billing

Your health plan covers network healthcare providers. We don’t have any agreements in place for prices with non-network medical professionals. Therefore, an out-of-network healthcare provider determines the cost of your care. The exact amount of that tariff is unknown at this time. Only in an emergency and when you receive treatments from specific categories of non-participating providers whose cost is deemed a surprise are out-of-network healthcare providers covered by your health plan.

Balance billing is when an out-of-network provider bills you for costs other than copayments, coinsurance, or the amount of your deductible that is still owed. You may be shielded from balance billing by an out-of-network healthcare provider in an emergency or when you receive treatment from one in a participating facility under federal law and some state statutes. To find out how your health plan pays out-of-network healthcare providers, contact Member Services at the toll-free number listed on your Aetna ID card if you have Aetna coverage.

Enrollee claim submission

A claim is a request for payment of medical services made to an insurance provider. A network healthcare provider or facility will submit your claims if you use their services. When using an out-of-network healthcare practitioner, a person with a health plan that offers such benefits may be required to submit their claim. You can file claims by filling out and sending us a claim form—or alternative supporting documentation—as soon as is reasonably practical. The claim form includes the postal address.

Grace periods

Your premium must be paid by the due date specified. You will get a grace period if you don’t pay your premium on time. A grace period is when your insurance coverage will continue even if you haven’t paid your monthly premium. For private health insurance:

  • Total monthly premium payments are required

  • Payments made in part are refunded

  • No exceptions are made

You will be given a one-month grace period if you are enrolled in an individual health plan and fail to pay your premium on time. Your claims can be suspended during your grace period of one month. Your coverage will cease back at your last paid-through date if the premium amount is not paid by the end of the grace period, which is set at one month. Consider a scenario in which you obtain an Advance Premium Tax Credit (APTC) and are enrolled in an individual health plan through the Health Insurance Marketplace, but you fail to pay your premium on time. In that case, you will get a 3-month grace period, and we will pay all claims for covered services appropriately submitted during the first month of the grace period. If state law permits, your claims in months two and three of your grace period may be postponed until complete payment is received. Your coverage will expire on the last day of the first month of the grace period if the entire amount of the outstanding premium is not paid by the conclusion of the three-month grace period. A 30-day reminder letter informing members of their unpaid premium owing will be sent to them if they have received APTC and entered the 3-month grace period.

Claims pending

If a claim is pended within a premium grace period, it indicates that no claims will be paid until your past-due premium is fully paid.

Retroactive denials

Premiums that are not paid may result in a retroactive refusal. A retroactive denial revokes an earlier claim payment. It happens when coverage for a service, operation, or medication is later rejected. We might decline to pay for services rendered during the unpaid period, for instance, if your cover fails due to your failure to pay your monthly payments.

Refunds of overpayments

You would have the right to a refund if you overpaid for your health plan’s coverage. Individual health plan subscribers should call the number listed on their statement or member ID card to request a refund.

Prior authorization/medical necessity review timeframes and enrollee responsibilities

Medical necessity is a term used to define reasonable, required, and proper treatment based on clinical standards of care supported by evidence. Before you receive some services, we must first approve their medical need. Precertification or prior authorization is the term used for this. Before a member can obtain a covered benefit (such as surgery or another medical procedure), a health plan must first authorize the request based on assessing the member’s medical needs.

We reserve the right to refuse coverage for a service or operation if a healthcare professional fails to acquire prior authorization before using it. We advise requesting at least two weeks before the planned treatment or procedure.


The first step to a secure future and financial safety is to purchase health insurance. Your medical needs will never be compromised, which will prevent medical stress. The best defense for yourself is personal health insurance. We advise speaking with your financial experts if you have questions about buying individual health insurance.