Cinnaminson EBH

Medical FAQs

What is the Aetna Navigator?
The Aetna Navigator allows you to access your personal benefits information on-line. After you register, under "Select From Your Memberships and Programs" choose the SNJ Regional Employee Benefit Fund (Please note- you will see an option for Cinnaminson Board of Education. This is your previous Aetna plan). Once logged in, you will be able to:

Check the status of a medical claim.
Change your Primary Care Physician.
Request a new ID card
Review the Aetna Benefit Booklet specific to your group.

It's easy to sign up. Log into https://www.aetna.com and click on register under Member Log-In.

Make Changes Over The Phone. Call the toll-free Member Services number on your member ID card 24 hours a day, 7 days a week. All calls are answered by the Aetna Voice Advantage system (AVA). This is an automated telephone assistant that recognizes natural speech, or selections from your touch-tone keypad, and responds to you in a conversational voice. Just follow the menu options on AVA to:

Order an ID card
Change your primary care physician.

During regular business hours, you can ask to speak with a Member Services representative.

How do I locate participating providers?

Aetna: www.aetna.com/docfind/ (NOTE: Under "Select a Plan" - Choose "QPOS" under Standard Plans) When selecting a Primary Care Physician, please make sure to select QPOS as your plan selection. Members who do not select QPOS will have the wrong Provider ID number and will not have the correct PCP listed on their ID card.

How do I reach the customer service departments?

Aetna- (866) 267-3368

What is Aetna’s Referral Policy?

The following points are important to remember regarding referrals.

The referral is how your PCP arranges for you to be covered for necessary, appropriate specialty care and follow-up treatment.
You should discuss the referral with your PCP to understand what specialist services are being recommended and why.
If the specialist recommends any additional treatments or tests that are covered benefits, you may need to get another referral from your PCP prior to receiving these services. If you do not get another referral for these services, you may be responsible for payment.
Except in emergencies, all hospital admissions and outpatient surgery require a prior referral from your PCP and prior authorization by Aetna.
If it is not an emergency and you go to a doctor or facility without a referral, you must pay the bill.
Referrals are valid for one year as long as you remain an eligible member of the plan; the first visit must be within 90 days of referral issue date.
In plans without out-of-network benefits, coverage for services from nonparticipating providers requires prior authorization by Aetna in addition to a special nonparticiapting refrral from the PCP. When properly authorized, these services are fully covered, less the applicable cost sharing.
The referral provides that, except for applicable cost sharing, you will not have to pay the charges for covered benefits, as long as the individual seeking care is a member at the time the services are provided.

When Do I Need Precertification of Services? Certain health care services, such as hospitalization or outpatient surgery, require precertification with Aetna. When you are to obtain services requiring precertification from a participating provider, the provider is responsible to precertify those services prior to treatment. If your plan covers out of network benefits and you may self-refer for covered benefits, it is your responsibility to contact Aetna to precertify those services which require precertification to avoid a reduction in benefits paid for that service.

How About Emergency Care? If you need emergency care , you are covered 24 hours a day, seven days a week – anywhere in the world. Generally speaking, an emergency is a situation in which you could reasonably expect that the absence of immediate medical attention could result in serious jeopardy to your health, or if you are a pregnant woman, to the health of your unborn child. This definition may vary based on state regulations.

What should I do in an emergency?

Call your local emergency hotline (911) or go to the nearest emergency facility. If possible, you should also call your primary care doctor. In all cases, you should contact your primary care doctor as soon as possible after receiving treatment.
Once an emergency facility has stabilized your condition, their staff members should try to contact your primary care doctor. Your primary care doctor knows your medical history and is also responsible for coordinating your health care.
Please note that all follow-up care must be coordinated through your primary care doctor.

What is the difference between deductibles and copayments? A deductible is the amount of covered medical expenses you’ll pay out of your own pocket each calendar year before benefits begin to be paid by your Aetna plan. Your deductible only applies to certain expenses. A copayment is the fee charged to you for a covered medical expense or for a covered prescription drug expense.

How does my out-of-pocket maximum work? An out-of-pocket maximum is the total amount you’ll need to pay on your own before your Aetna plan benefits are paid in full. Once you’ve met the out-of-pocket maximum for a calendar year, your Aetna plan will then pay your covered expenses in full.

Does Aetna have a fitness program? Yes. Please contact Member Services at the toll-free number listed on your ID card. Member Services will send you information about our Fitness Program including a program description, a list of participating health clubs in your area, and a list of home exercise equipment available for purchase.

Dental FAQ's

How Do I Contact Customer Service?

For the Delta Dental Premier plan, members can contact Member/Provider customer service line at 800-452-9310 for additional ID card, Claim info etc.

For the Delta Care NJ6 and Complete Care plans, Members can contact DMO – Customer Service line in NJ at 800-722-3524.

Do I need to have an assigned dentist for the Premier Plan? No, the Premier plan allows you to be treated by any licensed dentist of your choice. Generally,the least out of-pocket expense can be achieved by using a dentist who participates with your specific plan type.

Why Select a Participating Dentist for the Premier Plan? All Delta Dental participating dentists have agreed, in writing, to abide by our claims processing procedures. Through their commitment and support, Delta Dental, in turn, can provide you with a program that’s tailored to meet your dental health wants and needs.

Participating dentists have agreed to accept the least of their actual charge, their pre-filed fee, or Delta Dental’s maximum allowable fee for the program as payment in full and to not charge patients for amounts in excess of those indicated in the “patient payment” portion of the Explanation of Benefits. Participating dentists will usually maintain a supply of claim forms (also referred to as Attending Dentist’s Statements) in their office. You may be asked to complete a portion of the form when you visit.

Participating dentists will complete the rest of the form, including a description of the services that were performed or will be performed in the case of a Pre-Treatment Estimate, and require that you sign the claim form in the appropriate place. For dentists who submit claims electronically to Delta Dental, you will need to authorize your dentist to maintain your signature on file.

Participating dentists will mail, fax, or electronically submit the claim form, together with the appropriate diagnostic materials, directly to our offices for processing.

Participating dentists agree to abide by Delta Dental processing policies. For example, participating dentists agree not to bill separate charges for infection control measures. Nonparticipating dentists are not bound by such policies.

Participating dentists will, in the case of dental services which have been completed, receive payment directly from Delta Dental for that portion of the treatment plan which is covered by your dental program. You will receive an Explanation of Benefits with a detailed description of covered benefits and the amount of your obligation. If you visit a non-participating dentist, you will be responsible for payment. Delta Dental will reimburse you for the portion of your services covered by your program.

Delta Dental advises that you check with your dentist to confirm whether he or she participates in the Delta Dental program under which you are covered. While a dentist may participate with Delta Dental, he or she may not participate in all of our programs.

Prescription FAQ's

How do I contact customer service? Prescription Plan (Express Scripts)- Members can contact Customer Service at 800-467-2006 with any questions or concerns regarding ID cards & claims, etc.

Which of my medications is ideal for Home Delivery (Mail Order)? Use Home Delivery for your maintenance medications. For short-term illness requiring a one-time prescription, such as an antibiotic, your participating pharmacy is the best choice.

How do I order specialty medications? CuraScript, the Express Scripts Specialty Pharmacy, is a full service specialty pharmacy that provides personalized care to each patient. With CuraScript, your specialty medications are quickly delivered to your home or to your doctor's office, at no additional charge. To get started, contact CuraScript at 866-848-9870.

Please remember your insurance benefits are limited to the terms, conditions, exclusions and limitations of the insurance carrier's policy. Nothing contained on this website shall be deemed to have altered, waived, or extended the coverage provided by the policy. This overview contains a general description of your program for your use as a convenient reference. Complete details of your program appear in the policy, which govern the benefits and operation of your program. The policy supersedes if there should be any inconsistency or difference between its provisions and the information in this overview.