Here are the answers to some of our most frequently asked questions.

When can I start using my policy?

You can start using your policy as soon as your plan effective date. However, some services have a waiting period.

What is an annual maximum?

It is the maximum amount of money the policy will pay out during your policy's year from your plan effective date to the next. You may select either $1,000, $1,500, $2,000, $2,500 or $3,000 for dental, vision and hearing combined.

What is my deductible?

Your deductible is a dollar amount you must pay for covered expenses in a plan year. You must meet your $100 deductible (combined for dental, vision and hearing) before your plan covers your eligible expenses. After your deductible, your policy reimburses expenses up to the yearly maximum. Refer to your brochure for more details.

What is the "allowed" amount on my dental insurance policy?

The allowed amount is the maximum amount the policy will pay for a covered dental service. Your policy will pay a certain percentage of the allowable amount - depending on the policy year.

Why does it cost less to see an in-network provider than an out-of-network provider?

In-network providers have agreed to offer services at a negotiated discounted rate. If you visit an in-network provider, you may pay less out of pocket.

How do I find an in-network provider?

You can find an in-network provider through your agent. Once you sign up for a policy, simply visit www.aetnaseniorproducts.com and log in to access the online provider search tool.

Can I see an out-of-network dentist?

Yes. However, dentists who are not in-network may bill you their normal fee for procedures. Your plan provides benefits using amounts that we have set as the "maximum allowed amount" for each service in your geographic area. When we set the "maximum allowed amount," we may consider other factors, including the prevailing charges in your area. The "maximum allowed amount" does not suggest your dentist's fees are not reasonable and proper.

Your dentist may bill you for the difference between his or her normal fee and our "maximum allowed amount." This amount is not covered, and you must pay it.

Is there a way for me to save additional money on my vision and hearing care?

Yes, your plan includes value-added discounts on eye care services, eyewear, LASIK vision correction surgery and hearing aids. By selecting an in-network vision or hearing care provider, you will pay a discounted rate. With these discounts, you can reduce your out-of-pocket expenses. When you file a claim, the discounted rate will be reflected, which means you'll have more left of your benefit maximum to use for other services. You can submit a claim for reimbursement for your vision and hearing care.

How do I file a claim for my vision and hearing benefit?

Dental Claims should be submitted by your provider. For Vision and Hearing claims, please use the Vision and Hearing Claim Form. Click Here for more claims information.

What is the status of my claim?

Claim status can be found under "My Health Plan claim status".

How do I appeal a claim?

Appeals must be submitted in writing via email to [email protected].

How do I change my mailing address?

Contact your group.

What is my member ID number and where can I locate it?

Your member ID number is a unique identifier that helps protect your identity and can be found:

  • On your secure Member Dashboard.
  • On your Dental ID card.
  • By calling our Customer Care Team