General Information
Benefit Updates
Look here for information regarding negotiated plan design modifications, policy amendments and legislative developments that may have a bearing on your benefits. If you should have any questions that are not covered in this handbook or answered by your insurance carrier, please feel free to Contact Us for further assistance.
General Aetna Information
For misspellings on your ID card, change in provider information, or to request additional ID cards, please call the Aetna Member Services number located on your ID card or log onto www.aetna.com. 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.
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:
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Check the status of a medical claim.
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Change your Primary Care Physician.
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Request a new ID card
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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.
NEW Delta Dental Information
Members in the Premier Plan do not need ID cards to visit their dentist. Simply supply your dentist with the following information:
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Name
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Group Number # 3603-0351
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Delta Dental of NJ
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.
Delta Dental Benefits Connection- Your connection to your Delta Dental benefits, eligibility, and claim information.
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Determine your dental maximum and deductible balances
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Check the status of your claims
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Print a copy of your ID card.
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Available 24 hours a day, seven days a week
NEW Express Scripts Information
Members can provide their pharmacy the following information in absence of an ID card:
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RXBIN #: 003858
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RXPCN: A4
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RXGRP #: 0804 0364
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Member Social Security #
Members can also contact Customer Service at 800-467-2006 with any questions or concerns regarding ID cards & claims, etc.
QUESTION- I am currently enrolled in the AmeriHealth Fitness Reimbursement Program. How will my reimbursement be affected once we change to the new Aetna medical carrier effective 7/1/2010?
The fitness reimbursement plan is not a plan year benefit. The reimbursement is based on a 365 day period which begins the day the member signs up for the program. If the member completes the 120 visits prior to the change on July 1, 2010, then they would receive the reimbursement. It is sent out at the time of completion.
For more information on your medical benefits, please click here.
Copay Reimbursements- Submit through Aetna for claims incurred beginning July 1, 2010- All medical and prescription co-pays incurred by you and/or covered dependents are eligible for reimbursement through your Aetna Patriot V and Aetna Patriot X medical coverage.
We ask that members use the following guidelines to insure prompt processing of the claims:
q Complete a Claim Form
q Photocopy as many of the copay receipts as possible onto an 8.5x11 sheet of paper. Claims that include multiple receipts on one page can be processed in a shorter time and result in a quicker turn around time for the member. Please be sure that all necessary information is showing clearly for each receipt (i.e. provider name, provider address, complete drug information or medical procedure code, and the date of service, along with amount paid by member clearly indicated or circled). Aetna does not need the original receipts - photocopies are fine.
q Members should clearly mark their respective Aetna Member ID # on each copay receipt.
q The claim form, along with the receipts, can be sent to the mailing address below (or members can fax the required documentation if less than 5 pages).
Aetna - NJ School Board Claims Unit
730 Holiday Drive
Foster Plaza, Bldg. 8
Pittsburgh, PA 15220
Fax: 860-754-1508 (please be sure to address to NJ School Board Claims Unit)
This process only applies to the submission of copay receipts (office visit copays or Rx copays). All provider claims must continue to be submitted to the El Paso, TX P.O. Box address.
Look here for information regarding copayment reimbursement for all medical and prescription copays.
AmeriHealth requires copayment reimbursement requests be submitted on a quarterly basis. Reimbursement for copayments with a Date of Service more than 1 year prior to the submission of the claim form will be denied. Please see the Special Note below for 1st and 2nd quarter 2009 receipts.
SPECIAL NOTE FOR 1st AND 2nd QUARTER 2009 RECEIPTS:
Members may submit 1st and 2nd Quarter 2009 receipts for reimbursement up to July, 1, 2010. After July 1, 2010, AmeriHealth will no longer accept any copayment reimbursement past one year.
For any member that has a claim that falls within the extended filing timeline and has not yet submitted the copayment receipts to AmeriHealth, should send their claims to the below address:
AmeriHealth Insurance Company
Attn: Phil Woodard
1500 Spring Garden Street
Phila., PA 19130-4009
This address is only to be used for the submissions of 1st and 2nd quarter 2009 receipts up to July 1, 2010. Any member who is submitting claims within a one year period should continue to submit the claims through the normal process.
Any member that has had claims denied due to timely filing should contact Gallagher Benefit Services. Click here for Contact information.
"Elaine's Tip" - When submitting copay reimbursements, group in packets approximating $200 for each member using one claim form for each packet. When you receive your Explanation of Benefits (EOB) form from AmeriHealth it will be much easier to verify you received the correct reimbursement.
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 benefit 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.
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