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Disclosure information for individual & family plans

This information can help you understand what your Affordable Care Act (ACA) individual & family plan covers. You can also learn about your plan guidelines and your rights and responsibilities as a member.

NCQA accreditation
We meet quality standards to bring you quality health plans

Your experience with us matters. That’s why we follow health plan accreditation standards of the National Committee for Quality Assurance (NCQA). NCQA is a leader in accreditation dedicated to improving the quality of health care.

Learn how we meet quality standards. You can also learn how to get plan details online or by phone, find out about your rights and responsibilities and understand your plan costs.

Individual & family plan disclosures by state


We have individual & family plans in certain states. If we offer a plan where you live, you can find state-specific plan information and disclosures to help you choose the right coverage.

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Transparency in coverage


We’re here for you with helpful guidance so you can understand your plan and costs. As part of the federal transparency in coverage rule, machine-readable files are available to show clear pricing for in-network services. 


Keep in mind: Machine-readable files show data in a format easily processed by a computer. These files are not a consumer tool.


ACA individual & family plans – machine-readable files

To find personalized cost estimates for your plan, log in to your member website.


Direct broker commissions: Individual & family plans


Brokers are eligible to receive a commission amount for each enrolled member every month they’re enrolled (up to five members per policy). Find commission amount by state.


Broker commission schedule – all states (PDF)

Broker commission schedule – Covered California (PDF)

Broker bonus program: Individual & family plans


In addition to direct commissions, brokers may be eligible for a one-time bonus for new members. Review our bonus schedules for program guidelines.

Broker bonus schedule – all states (PDF)


Broker bonus schedule – California (PDF)

Women’s Health and Cancer Rights Act
Protecting your rights after a mastectomy

If you’ve had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act. This federal law protects patients who choose breast reconstruction after a mastectomy.


We’ll consult with you and your attending doctor to determine your coverage for: 


  • All stages of reconstruction of the breast on which the mastectomy was performed

  • Surgery and reconstruction of the other breast to create a symmetrical appearance

  • Prosthesis or breast implant 

  • Treatment of physical complications of the mastectomy, including lymphedema 


You’ll also receive benefits if you’ve had a mastectomy to treat or prevent breast cancer while you were covered under a different health plan. Your coverage is based on your plan design. You may have limits, copays, deductibles, coinsurance and referrals. Check your plan documents for details. 


For more information

Call Member Services at the number on your ID card. You can also find resources from the Centers for Medicare & Medicaid Services and the National Institutes of Health. 


Women's Health and Cancer Rights Act: What you need to know

Breast reconstruction after mastectomy: Your questions answered

Legal notices

Health plans are offered or underwritten or administered by Aetna Health of California Inc., Aetna Health Inc. (Florida), Aetna Health Inc. (Georgia), Aetna Life Insurance Company, Aetna Health of Utah Inc., Aetna Health Inc. (Pennsylvania), or Aetna Health Inc. (Texas) (Aetna). Aetna and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health® family of companies.

Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Information is accurate as of the production date; however, it is subject to change.

Health benefits and health insurance plans contain exclusions and limitations.