FAQs
How do I get a Temporary ID Card? On on after July 1, 2008 You can print a temporary ID card 24 hours a day, seven days a week. Click here for instructions.
Are Referrals required under the AmeriHealth plans? AmeriHealth Point of Service lets you maintain Freedom of Choice by allowing you to select your own doctors and hospitals. You maximize your coverage by having care provided or referred by your Primary Care Physician. With AmeriHealth Point of Service, you have the freedom to self-refer your care to an AmeriHealth participating specialist or to specialists who do not participate in our network, however higher out-of-pocket costs apply.
Can I use my "unexpired" Aetna referrals after July 1, 2008? No. Most physicians use the AmeriHealth Electronic Referral System which eliminates the need to pick up paper referrals.
Can my Primary Care Physician issue AmeriHealth referrals for me or my dependents prior to July 1st? No. Referrals under the new AmeriHealth plan can be issued on or after July 1, 2008.
Where should AmeriHealth claims be sent?
Please send claims to the following address:
AmeriHealth Processing Services
POBox 41574
Philadelphia PA 19010-1574
How do I locate participating providers?
(HINT: Select AmeriHealth HMO/POS/Open Access)
What if my Doctor (Primary or Specialist) does not participate in the AmeriHealth network?
AmeriHealth has staff dedicated to recruitment. Click here to print and complete a Recruitment Form. Return the form to AmeriHealth and staff will reach out to the nominated physician.
What do I do if my Doctor is non-participating with AmeriHealth, but is participating with Aetna, and I have on-going treatment or a surgery scheduled for post July 1? Members may apply for a temporary extension. AmeriHealth will review such circumstances on a case by case basis. Click here to view and print a Continuation of Care form. Click here to view and print the Continuation of Care procedures.
Will pre-existing conditions be excluded as a result of the change in Medical plan carrier?
No.
Will I be required to show proof my child over age 19 is attending college?
No. The medical plan covers eligible dependent children to the last day of the calendar year in which he/she reaches age 23.
What if my child is attending college in an area outside the AmeriHealth network?
When you or a member of your family will be out of the AmeriHealth Service Area for at least 90 days, you can apply for Guest Advantage with AmeriHealth. The Guest Advantage program offers the same benefits while away from home. Simply call AmeriHealth Member Services on or after July 1, 2008 to enroll your child in the Guest Advantage program.
My child has separate coverage through Aetna under Chapter 375. Eligiblity for this coverage was based on my enrollment with Aetna. Does my child now have to re-enroll with Amerihealth?
Yes. Current members enrolled through the Charpter 375, COBRA, and Retiree programs will receive a Packet with instructions within the next few weeks.
Where can I refer a provider who needs the referral requirements or benefit provisions of my Plan?
Most providers who accept AmeriHealth have access to their NaviNet web portal. Through NaviNet providers can confirm eligibility and benefits information, including plan type, coverage dates, and copayments.
Does the Prescription Lens Reimbursement cover contact lenses? Yes. Click Here to view the Vision Benefit Guide and learn more about this benefit.
If I satisfied all of my deductible before June 30, 2008, how do I submit for copay reimbursements from Aetna?
Click Here for important information regarding submitting a claim to Aetna for co-pay reimbursements - 2008.
If I satisfied all or part of my deductible prior to June 30th, will AmeriHealth recognize this and give me credit?
Yes. You must provide AmeriHealth with the required documentation as soon as possible, or no longer than 90 days after your enrollment date to received full credit. Click here to print the Deductible Credit Form and Instructions.
What copays can I submit to AmeriHealth for reimbursement?
· POS $5 Copay: Submit your doctors’ office receipts to AmeriHealth for your copayment to be applied to your deductible. Once your deductible is met you will be reimbursed 70% of your copay amount.
· POS $10 Copay: Submit your doctors’ office and prescription receipts for your copayments to be applied to your deductible. Once your deductible is met you will be reimbursed 80% of your copay amount.
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When does my child’s coverage begin/terminate?
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- A newborn child is covered for 31 days from the date of birth. To continue coverage beyond this initial period,the newborn child must be enrolled within the initial 31 day period.
- Children are covered until the end of the year in which age 23 is attained.
- Newly eligible dependents (due to marriage, adoption, etc.) may enroll within 31 days of the eligibilitydate (date of marriage, adoption, etc.).
- Eligible dependents who are eligible for enrollment, but do not enroll within the first 31 days following eligibility, may be enrolled during any subsequent Open Enrollment period.
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