Employee Resources

If you have insurance through your job or your spouse’s/partner’s job, the employer’s benefits coordinator can provide you with a summary of your benefits.

You may call the toll-free number on your member ID card at any time. An automated telephone system will answer your call.

During regular business hours, you can ask to speak with a member services representative.

If you need a duplicate or additional ID card, you can view and print one within your secure member website. You must register on the carriers website in order to print a copy of your member ID card.    

A digital or printed card is identical to a plastic ID card.

Give changes of your name or address to the employee benefits coordinator.   The employer will enter the change into the eligibility database or Benefits Express.   Benefits Express will send electronic files to all carriers, Aetna, Express-Scripts and Delta Dental to update the information in your eligibility file.

You can change your PCP through your secure member website if you are registered.  You also can call the toll-free number on your ID card and follow the menu options or ask for a Customer Service Representative for assistance. 

If your doctor leaves the network, you will need to select another Aetna participating provider. You can use our online directory of doctors and hospitals at aetna.com to find one or contact member services for assistance.

Go to your employer / benefits coordinator, they will then enter a termination date for your coverage in the Benefits Express eligibility system, a Cobra package will be generated and sent to you for consideration of continuing coverage. You will have 60 days to elect coverage.  Within the Cobra Package there will be contact information for Benefits Express should you have any questions regarding continued coverage or the cost for continuation.

Once you have received your ID card:

• Print and complete a medical claim form.
• Submit the form, and a copy of the doctor's bill (indicating payment), to the address on your ID card. Be sure to include your member ID number.
• You may contact the Office of the Program Manager to obtain a claim form. 

Log in to your secure member website at aetna.com. 

In general, an eligible newborn child is covered for 31 days from the date of birth. To    continue coverage beyond this time, you must enroll the child within those 31 days and pay any applicable premium. Special provisions may apply to a legally adopted child or a child for whom you are a legal guardian.

Please remember that you MUST enroll your newborn child within the specified time frame to be covered – even if you already have family coverage.  

You may add or delete family members during the annual open enrollment period.

In addition, we will generally accept enrollments for newly eligible members within 31 days after the following events (with proper documentation submitted to us):

• An employee's marriage or divorce
• Death of an employee's spouse or dependent
• The birth, proposed adoption, or adoption of a child by an employee
• Beginning or ending of employment by an employee's spouse
• A change in full-time or part-time employment status by an employee or an employee's spouse
• Unpaid leave of absence taken by an employee or an employee's spouse
• Significant change in the health coverage of an employee or an employee's spouse (when caused by a spouse's employment

If you are utilizing an In Network provider, they would be responsible for obtaining the Prior Authorization for services when required.

If you utilize an Out of Network provider, you, the member is responsible for obtaining any required Prior Authorizations. We highly recommend that you contact Aetna to discuss coverage and obtain a Pre-Certification of services prior to any services being rendered by an Out of Network provider. 

Out of Network claims are paid at an Out of Network fee schedule which can leave the member responsible for a large portion of the charges. Out of Network providers can not only bill you for the coinsurance (re: if your plan pays 80% of the recognized charge, you are responsible for 20%) as well as any amounts over the amount of the recognized charge.  

We strongly suggest you utilize In Network providers. If there is a situation where an In Network provider cannot be located to perform the services required, you must contact Aetna directly to see if an exception to use the Out of Network provider can be granted.