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Aetna® member benefits and services FAQs

Your Aetna health plan offers helpful guidance so you can make the most of your member benefits. Have questions along the way? We’re here to help.

Plan documents

A summary of benefits and coverage (SBC) shows what your plan covers and your share of the costs.

 

If you have insurance through your job, or your spouse’s or partner’s job, contact the employer’s benefits office. They can give you a summary of benefits.

 

You may be able to find your summary of benefits online. Log in to your member website.

 

Contacting us

You have options to get the help you need.

 

For personalized service

Call the Member Services number on your ID card. Our representatives are ready to help you.

 

For 24/7 self-service
Use our automated phone system. The menu prompts will guide you. You can also log in to your member website.

 

More ways to reach us

 

Managing my plan

Your member ID card is always available on your member website. When you log in, you can:

 

  • Pull up your digital ID card. You can print it or email it. Your digital ID card is the same as your plastic ID card.

  • Request a new ID card. We can send a new plastic ID card to your home.

 

Need help? Contact us.

Keeping your name and address up to date with your health plan is important.

 

Here’s how to report a change:

 

If you have an Aetna plan through your employer: Let your employer know your name or address has changed. Your employer will send this update to us.

 

If you have a plan that you purchased directly from us (not through an employer): Log in to send your updated name and address to us through the “Contact Us” feature. Or call Member Services at the number on your ID card.

 

If you have an exchange plan: If you purchased your plan on the Health Insurance Marketplace®, contact the plan directly to update your name and address.

There are two steps to change your PCP:

 

  • Log in to your member website. You can search for a PCP by ZIP code, language spoken and other preferences.

  • Call the toll-free Member Services number on your ID card. We can change your PCP for you or help you choose one that’s right for you.

Rest assured — if your PCP is no longer in our network, we can help you find another care provider who’s right for you.

 

First, log in to choose another PCP who participates with us. We offer an expansive network of doctors to choose from. And you can search by ZIP code, language spoken and other preferences.

 

Next, call the toll-free Member Services number on your ID card. We can change your PCP for you or help you choose one that’s right for you.

 

Life changes

First, contact your prior employer’s benefits office. Let them know you’re interested in buying a COBRA (Consolidated Omnibus Budget Reconciliation Act) policy. By federal law, companies with more than 20 employees need to make you aware of your options for buying this coverage.

 

More information about continuing your coverage

Congratulations to you. Your child is generally covered for 31 days from their date of birth. To continue coverage after this time, you’ll need to enroll your child within those 31 days and pay the plan premium. Guidelines apply.*

You can change your coverage, including adding or removing family members, during the annual Open Enrollment Period. To do so, you’ll need to contact your employer.

 

Had a big life event outside the Open Enrollment window? Typically, you can change your coverage within 30 to 60 days of:

 

  • A marriage or divorce

  • The death of your spouse or dependent

  • The birth or adoption of a child

  • The start or end of your spouse’s employment

  • A change from full-time to part-time employment for you or your spouse

  • Unpaid leave of absence for you or your spouse

  • Major change in your coverage, or your spouse’s coverage (when caused by your spouse’s employment)

 

Claims

Once you’ve received your new ID card, here are your next steps:

 

Log in to submit your claim. We’ll ask you a few questions to confirm claim details. And you can upload your bill online.

 

Rather submit a paper copy? Log in to get a medical claim form. Once you complete it, you can mail it to us at the address on the back of your member ID card.

 

Discounts

Aetna plans include extra benefits just for members. These extras can help you save money and feel your best.

 

To learn about the discounts your plan offers and how to get started, log in to your member website.

 

Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

Also of interest: