Things to know before you apply with AARP
To qualify for an AARP® Essential Premier Health Insurance plan, you must be:
- Between the ages of 50 and 64-3/4 (if you are applying as a couple, both you and your spouse or domestic partner must be under 64-3/4), and
- Under age 19 for eligible dependent* children; between ages 19 and 25 for unmarried eligible dependent children with proof of full-time student status, and
- A legal resident in a state with products offered by these plans, and
- A legal U.S. resident for at least 6 continuous months, and
- An AARP member. However, you do not need to be a member to get a quote.
Your premium payments
Your premium payments are guaranteed not to increase for 6 months from your effective date. After that, your premiums may change. Final rates are subject to a review of your health history (also known as “medical underwriting”).
Your coverage will remain in effect as long as you pay the required premiums on time, and as long as you maintain AARP membership eligibility. Your coverage will end, for example, if you:
- Do not pay premiums on time, or
- Do not meet residency requirements, or any other eligibility requirements noted above, or
- Have or obtain similar coverage (duplicate coverage) from another insurance company, or
- Become ineligible for other reasons permitted by law. For more information, ask your insurance agent for the Disclosure Document.
- AARP Essential Premier Health Insurance plans are medically underwritten by Aetna, and you may be declined coverage depending on your health condition.
- AARP Essential Premier Health Insurance plans are not guaranteed issue plans and require a review of your health history (called “medical underwriting”).
- Some people may be federally eligible under the Health Insurance Portability and Accountability Act (HIPAA) for a special guaranteed issue plan under Florida laws and regulations.
- All applicants, enrolling spouses or domestic partners and dependents are subject to medical underwriting to determine eligibility and appropriate risk levels.
- Aetna offers various risk levels based on the known health and medical risk factors of each applicant.
Levels of coverage and enrollment
After processing of your application, you may be:
- Enrolled in your selected plan at the standard premium charge (lowest rate available), or
- Enrolled in your selected plan at a higher rate, based on medical findings, or
- Declined coverage, based on significant medical risk factors.
* An eligible dependent is defined as an unmarried person age 0 through age 18, and through age 24 (subject to state mandates) if a full time student and is primarily dependent upon an AARP member for support and maintenance and is one of the following: natural child, stepchild, legally adopted child, child placed for adoption, child for whom legal guardianship has been awarded to the AARP member, or relative of the AARP member by blood or marriage.
If you currently have major medical coverage through another insurer, you must agree to discontinue that coverage before or on the effective date of your AARP® Essential Premier Health Insurance Plan. Do not cancel your current insurance until you are notified you have been accepted for coverage.
- During the first 12 months after your effective date of coverage, no coverage will be provided for treatment of a pre-existing condition unless you have prior creditable coverage. A “pre-existing condition” is any physical or mental condition you’ve been diagnosed or treated for before the date your coverage begins. “Prior creditable coverage” is a person’s prior medical coverage as defined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
- You are considered to have prior creditable coverage if the difference between the prior coverage termination date and signature date on your application is NOT greater than 63 days.
- Prior creditable coverage does not guarantee acceptance into the AARP Essential Premier Health Insurance Plan, insured by Aetna.
- Your coverage will be medically underwritten, and you must submit a completed application including health history.
- If you have prior creditable coverage within 63 days immediately before the signature date on your application, then the pre-existing conditions exclusion of the plan will be waived.
Limitations and exclusions
The health insurance plans in this booklet do not cover all health care expenses, and they include exclusions and limitations. Refer to plan documents to determine which health care services are covered and to what extent.
Services and supplies that are generally NOT covered include, but are not limited to:
- Surgery or related services for cosmetic purposes to improve appearance, but not to restore bodily function or correct deformity resulting from disease, trauma or congenital or developmental anomalies.
- Private duty nursing.
- Personal care services and home care services not stated in the plan description.
- Non-replacement fees for blood and blood products.
- Dental work or treatment, unless otherwise specified in covered services, including hospital or professional care in connection with:
-The operation or treatment for fitting or wearing of dentures
- Immunizations related to foreign travel.
- The purchase, examination or fitting of hearing aids and supplies, and tinnitus maskers, unless included as a covered benefit.
- Arch support, orthotic devices, in-shoe supports, orthopedic shoes, elastic supports, or exams for their prescription or fitting, unless these services are determined to be medically necessary.
- Inpatient admissions primarily for physical therapy unless authorized by the plan.
- Charges in connection with pregnancy care, other than for pregnancy complications.
- Treatment of sexual dysfunction not related to organic disease.
- Services to reverse a voluntary sterilization.
- In vitro fertilization, ovum transplants and gamete intrafallopian tube transfer, or cryogenic or other preservation techniques used in these or similar procedures.
- Practitioner, hospital or clinical services related to the procedure commonly referred to as “Lasik Eye Surgery,” including radial keratomy, myopi keratomileusis, and surgery that involved corneal tissue for the purpose of altering, modifying or correcting myopia, hyperopia or stigmatic error.
- Nonmedical ancillary services such as vocational rehabilitation, employment counseling, or educational therapy.
- Services that are not medically necessary.
- Medical expenses for a pre-existing condition, for the first 12 months after the member’s effective date. Look-back period for determining a pre-existing condition (conditions for which diagnosis, care or treatment was recommended or received) is 6 months prior to the effective date of coverage. If the applicant had prior creditable coverage within 63 days immediately before the signature of the application, then the preexisting conditions exclusion of the plan will be waived.
- Weight control services including surgical procedures, medical treatments, weight control/loss programs, dietary regiments and supplements, appetite suppressants and other medication: food or food supplements, exercise programs, exercise or other equipment; and other services and supplies that are primarily intended to control weight or treat obesity, including Morbid Obesity, or for the purpose of weight reduction, regardless of the existence of comorbid conditions.
10-day right to review
- Do not cancel your current insurance until you’re notified you’ve been accepted for coverage.
- Aetna will review your application to determine if you meet underwriting requirements. If you’re denied, you will be notified by mail. If approved, you’ll be sent an AARP Essential Premier Health Insurance contract and ID card.
- If, after reviewing the contract, you are not satisfied for any reason, simply return the contract to us within 10 days of your receipt. We will refund any premium you have paid, less the cost of any services paid on behalf of you or any covered dependent.