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Transition to Aetna Q&A

Prescription/Pharmacy

Q:  Where can I find medications covered under the Aetna plan?

A:  On Aetna.com, we recommend you sign up for Aetna Navigator, Aetna’s online member portal.  Through this portal, you can search for drugs by name.  See link below.

Aetna Premier Formulary - Your Pharmacy Plan

Q:  If I have a prescription set up for mail order with Express Scripts with HealthAmerica, was it transferred over to Aetna Rx Home Delivery?

A:  Yes, as long as the prescription has refills available, it would have transferred over to the Aetna Rx Home Delivery system.  You will need to sign onto Aetna Navigator or call the Pharmacy Care Center at 888-792-3862 to request refills.  If you prefer, you can set up your mail order prescriptions for autofill, and make any payment arrangements/provide necessary credit card information.  Financials and special arrangements were not transferred over to the Aetna Rx Home Delivery System.  Express Scripts is no longer the pharmacy benefit manager.  It is Aetna Rx Home Delivery, backed by CVS/Caremark.

Q:  Is there a document that provides instructions on how to use the Aetna Rx Home Delivery for a new prescription or a prescription we currently use but want to use mail order?

A:  The below flyer explains where and how to set up a new prescription for mail order delivery.

Aetna Rx Home Delivery Mail Order Pharmacy

Q:  If I was enrolled in the VBID program for HealthAmerica, am grandfathered, and I go to the pharmacy and realize that the override to grandfather the copays is not working, what do I do?

A: Overrides were placed in Aetna’s Rx system to allow for the same $0 copay for those who were grandfathered from the HealthAmerica VBID program.  This was a manual process.  If you have overpaid for your prescription due to VBID grandfathering issues, (prior to July 25th) you will automatically be reimbursed via check by mail in August.   If for some reason after July 25th, the copay is different, please notify your HR team and they will get it corrected for you and submitted for reimbursement.  We apologize for any inconvenience.  After July 25th, you are able to ask your pharmacist to call the Aetna Customer care number at CVS/Caremark -  888-792-3862 for VBID grandfathered issues.  They have a listing of those grandfathered VBID medications and those members that are a part of this program.  They are able to perform the override for the pharmacist.

Q: Since VBID is no longer available, are there any other programs with Aetna to assist with cost of medications for certain disease states?

A: Yes, Healthy Actions Rx Discount program now is available.  This will help with the cost of approved generic and brand name medications.  There is no need for enrollment, this is based on the medication prescribed and the discount will be at the time of purchase at your pharmacy.   See below link for additional information. 

2016 Aetna Healthy Actions Preferred Medicine List

Q:  We realize there was an error with the pharmacy copays in the beginning of July when our plan was effective and I overpaid for a prescription.  How do I get my reimbursement?

A:  There was an error with applying a deductible to the pharmacy benefit, which has been corrected.  If you overpaid for a prescription, you will be receiving a reimbursement check from Aetna Rx in August. We apologize for any inconvenience this error caused.

Q:  What is the CVS Aetna ExtraCare Card?

A:  Because of the relationship Aetna has with CVS/Caremark, they have provided a 20% discount on CVS brand items within CVS retail stores.  You will receive a card and key fobs in the mail.  Feel free to use them at any CVS pharmacy retail store.  You do not have to only use CVS pharmacy to get prescriptions filled, you can use the national network of pharmacies that used with the previous plan.

ExtraCare Health Card


ID Cards

Q:  I received two ID cards in the mail.  Do I need both?

A:  No.  Please discard the first ID card.  Retain and use the second ID card (with Aetna group number 0869976-101-00001).

Q:  Can I get extra plastic ID cards?

A:  Aetna is trying to go digital as much as possible.  It would be convenient to print your ID card from Aetna Navigator or use Aetna Mobile to view it on your smart phone.  If you need an extra plastic card, call the Customer Service phone number on the back of your ID card.

How to View ID Card - Online or Aetna Navigator


Deductible

Q:  How do deductible, coinsurance and payment limits (out of pocket maximum) work on the medical plan?

A:  Your plan is a policy year deductible/payment limit (July 1, 2016 to June 30, 2017).  Your deductible and payment limits reset on July 1, 2016.  Any services that apply to the deductible and coinsurance will do so until those limits have been satisfied.

Q: Will Explanation of Benefits (EOB) change?

A:  Yes, the set up of the Explanation of Benefits for Aetna is different.  If you have questions regarding the Explanation of Benefits, please call the Customer Service phone number on the back of your ID card.


Urgent Care & ER

Q:  What is the Urgent Care cost share in and out of network?

A:  Aetna’s policy is to charge the plan’s out-of-network deductible and coinsurance for non-contracted Urgent Care Facilities.  This means the member could pay more out-of-pocket for seeing a non-participating Urgent Care provider.  Please use a contracted Urgent Care provider.  Use your Aetna Mobile App to locate the nearest Urgent Care provider participating in your plan.

Q: How is the Emergency Room covered?

A:  Emergency care is available no matter where you are.  Please use your Aetna Mobile App or log into DocFind to locate participating hospitals and emergency rooms.

Q: Am I covered for Emergencies when I am out of the country?

A:  Yes, you are covered for Emergency Care if you are out of the area or out of the country.  See below for helpful tips.

Top Tips for Safe Healthy Travel


Aetna Navigator and Web Tools

Q: What is Aetna Navigator (Aetna’s online member tool)?

A:  Aetna Navigator is an online tool that will allow you to view and print your ID card, view and print claim information, view all of Aetna’s discount programs, find participating Aetna doctors and facilities, compare costs of services between facilities and providers and much, much more.  See below for more information. 

Welcome to Aetna

Q: Can I use my smartphone to access Aetna Navigator?

A:  Yes, download the free Aetna App on your smartphone.  Use the App to enable your GPS and search for participating providers and the App will provide directions.  You can enroll for Aetna Navigator using your App.  You can view your ID cards, your personal health record, and much more.

Aetna Mobile


General Information

Q:  I have a question about how my claims have been processed.   Where can I get help?

A: Please use the Customer Service phone number on the back of your ID card, or ask a question using the Ask a Question feature on Aetna Navigator.   You can also always stop in to see our Aetna representative when she is on campus.  Watch for Vitality and Dickinson Today for dates and times.

Q:  Is Health Advocate still available to assist with health insurance questions?

A:  Yes

Q:  Is there a list of useful phone numbers?

A: Phone numbers are listed on the back of your ID Cards.  See below:

Aetna Navigator

Aetna Navigator Technical support:  800-255-3375

Medical Member Services:  800-962-6842

Pharmacy:  800-238-6279 (Enter 0, prompt 2)

Pharmacy Mail Order:  888-792-3862

Aetna Behavioral Health:  800-424-4047

Health Advocate:  866-695-8622