Emergency Care FAQs for Individuals & Families

Yes, we cover emergency care. In fact, emergency care is covered 24 hours a day, seven days a week – anywhere in the world. Generally speaking, an emergency is a situation in which you could reasonably expect that the absence of immediate medical attention could result in serious jeopardy to your health, or if you are a pregnant woman, to the health of your unborn child. This definition may vary based on state regulations.

If an emergency happens close to home:
 

• Call your local emergency hotline (911) or go to the nearest emergency facility. If possible, you should also call your primary care doctor. In all cases, you should contact your primary care doctor as soon as possible after receiving treatment. 
• Once an emergency facility has stabilized your condition, their staff members should try to contact your primary care doctor. Your primary care doctor knows your medical history and is also responsible for coordinating your health care. 
• Please note that all follow-up care should be coordinated through your primary care doctor.

If an emergency happens when you’re traveling away from home:
 

• Remember that urgently needed care is covered while you are traveling outside of your local Aetna service area. 
• You should seek immediate treatment for any illness or injury that would be considered an emergency, or for the care of any urgent problem. 
• If you are admitted to an inpatient facility, you should immediately notify your primary care doctor and Aetna.
• In other cases, you should notify your primary care doctor and Aetna within 48 hours of an emergency.

When seeking emergency care, please note that:
 

• Any services you receive must be covered under the terms of your Aetna plan. 
• You are responsible for any emergency room copay.
• An emergency room copay does not apply when you are admitted for an overnight hospital stay.