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Important Notices Important Notices

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Self-Pay Retirees/Medicare Self-Pay Retirees / Medicare

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Coverage Continuation Coverage Continuation

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FAQ’S

Medical FAQ’s

How Do I Contact Aetna Customer Service Departments?  

Aetna HMO Plan Phone:  (800) 370-4526
Aetna Managed Choice POS (Open Access) Plan Phone:  (866) 658-2455

 

Are Resources Available to Manage My Medical Benefits Online?

Aetna Members- Get in the know about your health at Aetna Navigator the one spot to manage your health and coverage.

  • Look up a claim status
  • Find a doctor
  • Check account balances
  • Find costs of tests and doctor visits
  • And much more!

Go to www.aetna.comOn the left hand side under Aetna Navigator, click on

  Aetna Register2

Through the Aetna Navigator you can also find a participating doctor, look up a claim and check your coverage.  For more information on the Aetna Navigator features, Click Here.

My child goes to school out of State. How will they be covered under our plan?
Aetna has nationwide coverage. If your dependent is going to school in an Aetna service area, then they can seek care from in-network providers in their area. If they are enrolled in a plan with out-of-network coverage, they can also utilize their out-of network benefits. They are covered for Urgent and Emergency Care anywhere.

Are Medical Services Covered Overseas?  

Aetna will cover emergency services overseas. Aetna will not, however, cover routine visits outside of the country. If you do have a medical emergency, you can submit your claim to Aetna to have it processed towards your ER benefit.

How Do I Locate Participating Providers?

DocFind Flyer provides instructions on using the Aetna Doc Find to locate participating providers.  Below is a breakdown of the different networks to choose from depending on which plan you are electing.

Finding a provider on Aetna’s website & selecting the right network for your plan.

If you are in any of the following plans:

·       Aetna Choice POS II $15

·       Aetna Choice POS II $10

·       Aetna Choice POS II Core $25/$40

·       HDHP $1,500/$3,000 (HSA)

·       HDHP $2,500/$5,000 (HSA)

 

you will select Aetna Open Access Plans under Select a Plan and choose the Aetna Choice POS II (Open Access) network.

 

If you are in any of the following plans:

·       HMO $10

·        HMO $15

 

you will select Aetna Standard Plans under Select a Plan and choose the HMO network.

How Can I get a Temporary ID Card?

Print a Temporary ID Card– through the Aetna Navigator.

Go to www.aetna.comOn the left hand side under Aetna Navigator, click on REGISTER.


Once you have completed your registration, you will be able to print a temporary ID card.

Through the Aetna Navigator you can also find a participating doctor, look up a claim and check your coverage.  For more information on the Aetna Navigator features, Click Here.

Exciting News for Aetna Members!

Aetna has several discount programs for eye exams, gym memberships, exercise equipment and various other items. Click here to view a complete list of the Aetna discount programs that are available to you.

GlobalFit is the network of gyms that provides the discount program. If there is a specific gym that you are interested in and it is NOT part of the network, you can provide the gym name, zip code and telephone number of the gym that you want to utilize and GlobalFit will make an outreach to see if the gym is willing to be a part of the discount network.  GlobalFit can be reached at 800.298.7800 or through their website at www.globalfit.com/fitness.  If you would prefer to submit your request online, once you register, you can select the exercise tab and then select request a gym.


Prescription FAQ’s

Which of my medications is ideal for Home Delivery (Mail Order)? 

Certain conditions, such as high blood pressure, may require the ongoing use of a medication to treat the condition.  Medications that are taken on an ongoing basis are known as maintenance medications.  Use Home Delivery for your maintenance medications. For short-term illness requiring a one-time prescription, such as an antibiotic, your local participating pharmacy is the best choice.

The Express Scripts Home Delivery allows you to receive up to a 90 day supply of your long term medications, delivered to your home, for one copayment.  To get started, sign in at Express-Scripts.com or call the toll-free number on your ID card.

How Do I Find a Participating Pharmacy?
To locate a participating pharmacy, please contact Express Scripts at (800) 467-2006 or visit their website at www.express-scripts.com.

What Kinds of Drugs Need a Prior Authorization in My Program?
Drugs impacted by your prior authorization program include:
•Prescriptions used outside of the specific, approved medical conditions
•Prescriptions that could be used for non-medical purposes

Click Here to learn more about the Prior Authorization process and what kinds of drugs this process applies to.


 

 Dental FAQ’s

How do I locate participating providers?
Delta Dental- Call 1-800-DELTA-OK (1-800-335-8265) or Search the Internet at http://www.deltadentalnj.com/

Do I need to have an assigned dentist?
No, this plan allows you to be treated by any licensed dentist of your choice. Generally,the least out-of-pocket expense can be achieved by using a dentist who participates with your specific plan type (e.g.: Delta Dental PPO plus Premier).

Do I need a referral to a Dental Specialist?
You are not required to have a referral to a specialist if you or your dependents require specialized care. Generally, you will maximize your benefits by utilizing the services of a specialist who participates with Delta Dental.

Is it required to have a Pre-Treatment Estimate (pre-determination of benefits) for dental services?
No, it is not required by Delta Dental that you obtain a Pre-Treatment Estimate of benefits prior to treatment. If your dentist indicates the need for treatment with dental charges in excess of $300, it is strongly recommended that you request an estimate of dental benefits before receiving the treatment. Both you and your dentist will receive a voucher from Delta Dental showing the estimated payable benefit. It will also indicate your estimated patient responsibility including deductible if applicable. Your dentist needs to complete this voucher and submit it for payment when work has been completed. Pre-Treatment Estimates are onlyestimates and not a guarantee of payment. Payments of the approved services are subject to eligibility and to contract limitations (e.g., annual maximums) at the time services are rendered.

Do I need an ID card as proof of coverage when I visit a dentist?
If your employer has issued an identification card, you should show it to your dentist. However, it is not required that a dentist see an ID card before rendering treatment. An ID card does not verify active coverage. You or your dentist may obtain your group number, current eligibility and benefit information by contacting Delta Dental at (800) 452-9310 24 hours a day, 7 days a week or by accessing Delta Dental’s on-line Benefit’s Connection tool at www.deltadentalnj.com.

What if I have questions about my Delta Dental benefits?
You can call our Customer Service Department at (800) 452-9310 and speak to a representative between 8:00 a.m. and 6:30 p.m. EST Monday-Thursday and between 8:00a.m. and 5:00 p.m. EST Friday. Also, our interactive voice response system can provide benefit, eligibility, remaining maximum and deductible information, and history of your recent claims 24 hours a day, 7 days a week along with Delta Dental’s on-line Benefit Connection tool.

Is there a time limit for submitting dental claims?
Yes, in most cases, you have one full year from the date of service to submit your dental claims. If there is coordination of benefits involved and Delta Dental is not the primary carrier, you have one year from the date on which the primary carrier(s) issues a statement of benefits. If the claim is submitted after these time frames, then the services are not covered.

How do eligible children attending college away from home find a participating dentist?
A customized list of participating dentists for a specific geographic location can be obtained by calling 1-800-DELTA-OK or 1-800-335-8265. This list will be mailed or can be faxed in case of an emergency situation. Also, listings of participating dentists throughout the country are available on our web site at www.deltadentalnj.com.

Please remember your insurance benefits are limited to the terms, conditions, exclusions and limitations of the insurance carrier’s policy. Nothing contained on this website shall be deemed to have altered, waived, or extended the coverage provided by the policy. This overview contains a general description of your health benefits program for your use as a convenient reference. Complete details of your program appear in the policy, which govern the benefits and operation of your program. The policy supersedes if there should be any inconsistency or difference between its provisions and the information in this overview.

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