First things first, how can I find out if my doctor is in network?
Visit the Aetna Find a Doctor site to find out if your provider accepts your Aetna insurance plan.
Does Aetna have an app?
You may download the Aetna Health app for iPhone or Android.
With the Aetna Health app, you can:
- Pull up your ID card whenever you need it
- See benefits and coverage details specific to your plan
- Track spending and progress toward meeting your deductible
- View, filter and pay claims for your whole family
- Find in-network providers near you and search by location or specialty
- Compare cost estimates for doctor visits and procedures
- Receive personalized recommendations to help improve your health
What is open enrollment and how does it affect me?
Open enrollment is the designated time each year when you can enroll in benefits. Employees have two open enrollment opportunities each year: 1) when they join the company and can select their initial plan and 2) when the company’s Aetna policy renews in November. Unless a qualifying event occurs, open enrollment is the only time an employee can enroll in benefits.
What is a qualifying life event?
A qualifying life event is a change which enables employees to enroll in benefits outside of open enrollment. A qualifying life event would include one of the following situations: 1) marriage / domestic partnership, 2) divorce or separation, 3) birth or adoption of a child, 4) loss of previous coverage, 5) moving (this is not a guaranteed event, please contact email@example.com for more information on what qualifies).
When you have a qualifying life event, you can make updates to your benefits coverage by submitting proof of the QLE within 30 days of the event.
I want to add a dependent to my coverage. How can I do that?
Dependents must be added to your plan during open enrollment unless there is a qualifying event. If a qualifying event does occur, simply navigate to your Benefits and select the “Change coverage” button to signal that you need to add a dependent to your plan.
I want to change my plan selection. How can I do that?
I missed my open enrollment period but now would like to enroll. Can I sign-up at any time?
You can only enroll in benefits during open enrollment or if you have a qualifying life event, otherwise you’ll need to wait until the next open enrollment period.
I want to cancel my coverage. How can I do that?
In order to cancel your benefits outside of the open enrollment time, you will need a qualifying life event.
I have to file a claim with Aetna. How can I get started?
You can file a claim directly through your Aetna profile. Navigate to aetna.com and register for an account. From there, you can click “claims” or “Ask Ann” to get more information. If you prefer to mail in your claim, refer to the back of your ID card for the claim mailing address
On the claim forms, the employer should be listed as Justworks:
Justworks Employment Group LLC
P.O. Box 7119
Church Street Station
New York, NY 10008-7119
How can I best reach Aetna?
You can reach out to Aetna Member Services by calling 1-866-208-5994
How can I learn about the details of my plan?
To learn more about your plan, navigate to Benefits on the left navigation bar in Justworks. From there, you’ll be able to see your various plans (medical, dental, vision, etc) and you can click “View plan” to find more details on each plan.
How do I find out how much I’m paying for health insurance each month?
To find your monthly insurance cost, navigate to your Benefits. You’ll then be presented with each benefit for which you’re enrolled as well as each monthly cost.
Can I make changes to my coverage throughout the year?
Once you select a plan and coverage is effective, you cannot make changes unless it is due to a qualifying life event.
I did not get an opportunity to enroll in health insurance, but I think I’m eligible. What do I do?
If you believe your company should be offering you benefits, give us a call or email firstname.lastname@example.org. We’ll do what we can to make sure you’re all set and covered.
What are the eligibility requirements for health insurance?
An employee must be classified as “full-time” or “part-time” working 30+ hours per week in order to be eligible for health insurance in Justworks. Contractors are not eligible for health insurance.
When will I have a chance to change my plan selection?
You can change your plan if you have a qualifying life event or when open enrollment occurs for your company.
What is a deductible?
A deductible is an amount you must spend before your insurance begins to pay claims. Member cost sharing for certain services, as indicated in the plan, are excluded from charges to meet the deductible. Pharmacy expenses do not apply toward your deductible.
What is an out of pocket maximum?
An out of pocket maximum is the most you have to pay for covered services in a calendar year.
What is co-insurance?
Co-insurance is the percentage of health insurance expenses you pay after you’ve met your deductible.
What is a co-pay?
A co-pay is the amount you are responsible to pay for a doctor’s visit after you’ve met your deductible.
This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, legal or tax advice. If you have any legal or tax questions regarding this content or related issues, then you should consult with your professional legal or tax advisor.