The following information applies only to plans with a 2013 effective date

Frequently Asked Questions (FAQs)


Benefits Addresses / Phone Numbers Billing Applying

Benefits

Why is Aetna providing a Summary of Benefits and Coverage (SBC) and what does “SBC” mean?

The Summary of Benefits and Coverage or “SBC” is a uniform four-page, double-sided document that describes the benefits and coverage under a plan, including cost-sharing requirements and any information regarding exceptions, reductions, or limitations. Under the Affordable Care Act (ACA), active health plans will be required to provide consumers with a concise SBC document detailing, in plain language and a consistent format, information about health plan benefits and coverage.

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Do the Aetna Advantage Plans offer dental coverage?

Yes, dental insurance coverage is offered in certain states. Dental coverage is available in combination with an applicable medical plan or, in Arizona, Delaware, Illinois and Pennsylvania, as a standalone product.

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What health care services are covered under the Aetna Advantage Plans?

For plan specifics, please see “Request a Quote”.

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Are maternity benefits covered under the Aetna Advantage Plans?

No, maternity benefits are not currently available in most states. Complications of pregnancy are normally covered in most states. A newborn is automatically covered under the policy for 31 days and can be added to the plan during this time.

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What is a Non-Specialist (Primary Care Physician)?

A primary care physician (PCP) is trained to manage your health care. Your PCP plays many roles — primary caregiver, health care advisor and consultant, coordinator of specialty care and patient advocate. PCPs can be:

  • Family/General Practitioners (doctors who treat patients of all ages)
  • Internists (doctors who treat adults; the doctor may have a subspecialty)
  • Pediatricians (doctors who treat children)

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What is a Formulary?

A formulary is a list of preferred drugs put together by Aetna. The goal is to help you to choose quality, cost-effective medications. Some of Aetna's prescription drug plans use a formulary. Our Preferred Drug Guide gives information about drugs covered under Aetna Advantage Plans.

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What does "generic drugs" mean?

Generic drugs contain the same active ingredients in the same amounts as brand-name products. Generics usually cost less than brand-name drugs. Generic drugs may be a different color, shape or size than brand-name drugs. Generics have been approved by the Food and Drug Administration (FDA) as safe and effective. A generic drug can be substituted for a brand-name drug when rated as an equivalent by the FDA and where permitted by law and the prescriber.

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Addresses / Phone Numbers

Where do I send my application form?

Send your completed application form and check to:


Aetna Life Company c/o
Aetna Advantage Plans
1425 Union Meeting Road Mail Stop U22N
Blue Bell, PA 19422


If you are working with a broker, please send your application form to your broker.

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If I am currently covered under an Aetna Advantage plan, who do I contact for billing questions?

HMO members call 1-866-772-3862.

PPO members call 1-866-565-1236.

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If I am currently covered under an Aetna Advantage Plan, who do I contact for benefits questions?

HMO members call 1-800-435-8742.

PPO members call 1-866-565-1236.

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How can I get Aetna Advantage application materials?

You have several options. You can apply online, ask your broker or call 1-800-MY-HEALTH.

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Billing

How will Aetna bill me?

It’s your choice:

  • We can send a monthly paper bill
  • Sign up for EasyPay (your monthly premium will be deducted from your checking account)
  • Pay by credit card when you enroll online

For more information and the application form, call your broker or call us at 1-800-MY-Health.

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When is my premium due?

We must receive your premium payment (your monthly charge) no later than the first of the coverage month. For example, for coverage during July, we must receive your payment by July 1.

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Applying

I am a current Aetna group member. Can I convert my coverage to an Aetna Advantage Plan?

No. If you are interested in an Aetna Advantage plan, you must submit a completed application form even if you are covered under an Aetna group plan. (Conversion plans from group plans are available in some states. Ask your employer for information.) If you do need to submit an application form, you can apply on Aetna’s secure website right now, by clicking here, entering your ZIP code, then selecting a coverage date. (You cannot apply by phone.)


If you’ve found plans that interest you, you can Get a Quote right now on this website or by calling 1-866-582-9629, Monday - Friday, 8 a.m. to 11 p.m. EST. The quote will be an estimate. The real cost is calculated after a review.

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Does Aetna request medical records?

As part of the review process, we may need your medical records.

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If I want coverage to begin the first of the month, when do I need to submit my application form?

We must receive your application form by the last day of the prior month. For example, if you want coverage to begin in October, we must receive your application by September 30. If you don't request a specific date, we will make the effective date the 1st or 15th of the month after the approval date of the application.


If you do need to submit an application form, you can apply on Aetna’s secure website right now, by clicking here, entering your ZIP code, then selecting a coverage date. (You cannot apply by phone.)


If you’ve found plans that interest you, you can Get a Quote right now on this website or by calling 1-866-582-9629, Monday - Friday, 8 a.m. to 11 p.m. EST. The quote will be an estimate. The real cost is calculated after a review.

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How long will it take to process the application form?

It may take as long as three to four weeks. Please note that your coverage does not start until we approve your application.

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Do I need to send my premium payment with the application form?

Yes. You will need to send a check to cover the first month's premium. Your check will be deposited once your application form is approved.

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What ages are eligible to apply?

You must be under 64 ¾.

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How do I choose a primary care physician (PCP)?

It’s easy. Visit DocFind®, the Aetna network of participating physicians, dentists and hospitals. 

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How can I check on a claim or get information about my coverage?

You can check on a claim, request an ID card, change your primary care doctor and more by registering on your secure member website. Visit www.aetna.com to get started.

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Should I cancel my existing coverage?

Do not cancel your current plan until you have received approval from us about your new plan. You must cancel the other plan prior to or on the effective date of your new Aetna Advantage Plan.

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I am applying for coverage with my spouse. Whose age should I use to check for our rate?

Use the birthday of the older spouse.

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What would cause my application to be delayed?

A few things can cause a delay:

  • The application form was not signed and dated
  • Not all questions were answered
  • Questions answered "yes" in the medical history section require details. This information may be incomplete or missing.
  • We are waiting for the medical records we requested
  • We are waiting for other information we requested

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