Aetna is rolling out a new artificial-intelligence-powered, conversational tool designed to make it easier for members to understand and navigate their health and benefits.
The AI assistant is embedded in the insurer's website and member app to readily answer questions that they may have about benefits and coverage, with session awareness that makes the experience feel less like a traditional chatbot. And members do not need to use healthcare jargon to secure answers, according to the company.
For example, a member is told by their doctor that they need surgery. They can ask the assistant about their coverage for the procedure and receive a full and personalized breakdown of their costs and options, including estimates for fees and copayments.
The tool can also provide key details on related queries, such as postsurgical rehabilitation, proactively, Aetna said. The insurer offered Fierce Healthcare an exclusive look at the new platform.
Nathan Frank, senior vice president and Aetna's chief digital and technology officer, told Fierce Healthcare that the launch is part of the insurer's "transition from a transactional experience to more of a consumer health experience."
It builds on the previous launch of Aetna's Care Paths, he said, which pairs people with certain care needs more directly with their care team and with a more in-depth look at their benefits. Care Paths currently focuses on individuals with diabetes, joint health and maternity health.
"You're going to get this 'ask anything', generative-AI-enabled experience throughout the entire experience," Frank said, "but we've also brought that to the Care Paths that we're bringing to market as well."
The tool is also designed to make it clear to the member when generative AI is being used to provide information, Aetna said in the announcement.
Frank said the development team within Aetna as well as colleagues across the CVS Health enterprise offer a great opportunity as early adopters for feedback and iteration. He said his own family got a firsthand look at how this tool can work for users.
His son was prescribed a tonsillectomy by a physician, and his wife was able to look up all the key coverage information they would need for the surgery. That initial query revealed that a nasal endoscopy would be required, and the tool was able to provide further information on what that entails, too.
"I think that's the real difference here, versus just sitting in maybe an AI-powered chatbot where you're asking the question and getting an answer: You're actually being led to additional information that you probably wouldn't expect," he said.
Aetna said the tool initially launched to a beta group last month, with plans to expand it further through the first half of 2026. In the first few months, the team plans to enhance the tool to support other methods of communication, including voice and screen-reading, to make it easier to use.
The team is also currently working to build out additional Care Paths, so these programs are set to grow together, Frank said.
"For '26, you'll see a more rich experience with these two capabilities tied together," Frank said.