Plan Structure & Administration:
How can I tell if my doctor is in-network?
Go to http://www.aetna.com/dse/search. Find the plan or network at the top of each plan details PDF in Justworks. Your current network is also listed in the “Benefits” section of your Justworks account.
*Note: All of the Justworks medical plans are “open access,” meaning a referral isn’t required to see a specialist. Aetna may make changes to their network at any time, so it’s best to confirm with your doctor before any appointments.
What happens to my deductible?
Deductibles are based on the calendar year so they won’t reset until January 1. Aetna will automatically carry over your deductible balance to the new plan, so you’ll continue to pay towards the deductible through December 31, unless the balance is met.
What is a waiting period?
A waiting period is the length of time that a new employee must wait before enrolling in insurance benefits upon joining a company. Justworks plans can include either a 30-day or 60-day waiting period.
Who can be a dependent?
Dependents include a spouse and children, as well domestic partners, if you provide the proper documentation.
What’s the difference between a copay and coinsurance?
A copay is the dollar amount an employee has to pay for a specific type of service or visit, regardless of its cost, before the deductible is met. Co-insurance is the percentage of costs that a provider will cover once an employee satisfies their deductible. (For more information about health insurance terms, you can check out our Health Insurance Glossary).
When can I enroll in the FSA?
FSAs are based on the calendar year. If the benefit is available to you, open enrollment will occur in December for the following year.
What is an HSA?
A Health Savings Account is a pre-tax savings account for employees who are enrolled in a High Deductible Health Plan. Those who are enrolled in HDHPs will be able to contribute towards HSAs immediately once their plans are active. Learn more about HSAs.
When will my benefits be effective?
Benefits for new employees become effective on the first of the month after enrollment is opened, even if enrollment is opened on the first of the month. For example, if a company with no waiting period welcomes a new employee on 9/15, the employee’s benefits will be effective on 10/1. If the company had a 60-day waiting period, enrollment for this employee would open on 11/15, and benefits would be effective 12/1.
After the annual open enrollment period for all employees, any changes in coverage become effective on November 1.
I have questions about specific medical services, procedures, claims, or costs. Who can help me?
Employees with specific questions related to these topics should reach out to Aetna directly or Health Advocate. Health Advocate is a third-party resource who can help answer questions about plans, claims, and provide help for finding specialists who accept your insurance. This service is available at no cost to anyone enrolled in a medical insurance plan through Justworks. The above listed topics typically involve “Protected Health Information” and can only be discussed with a HIPAA-compliant resource.
Aetna Member Services: 888-982-3862 | MetLife Member Services: 800-942-0854 | Health Advocate: 866-695-8622 or firstname.lastname@example.org
Where do I find out about prescription coverage?
Find detailed information on prescription coverage in the plan details PDF for each plan. Use Aetna’s ‘Find a Medication’ tool to find a specific drug and its price, under your plan.
Will I receive a new medical/dental/vision card each year? Will my Aetna Member ID change after annual open enrollment?
No, employees will maintain their same Member ID each year so you will continue using your existing vision or medical card. If you need a replacement card, you can always download and print a copy through your Aetna Navigator account or request a new card by reaching out to Aetna. Member IDs are also listed in the “Benefits” section of each employee’s Justworks account.
Dental cards are not provided by the carrier. Use your social security number to provide proof of coverage.
I’m having trouble enrolling in the open enrollment opportunity in Justworks. Who can help me?
Please contact Justworks Support at email@example.com or 888-534-1711 and we’ll be happy to help out!