You can start using your policy as soon as your plan effective date. However, some services have a waiting period.
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.
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.
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.
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.
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.
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.
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.
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.
Claim status can be found under "My Health Plan claim status".
Appeals must be submitted in writing via email to [email protected].
Contact your group.
Your member ID number is a unique identifier that helps protect your identity and can be found: