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Member rights FAQs

 

Member Services questions

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

 

Depending on your plan, you also may find the summary of benefits information on your secure member website.

 

If neither of these options applies to you, please contact Member Services. A representative can send you a summary of benefits.

You may call the toll-free number on your member ID card at any time. An automated telephone system will answer your call.

 

During regular business hours, you can ask to speak with a member services representative.

 

See all of the ways you can contact us

If you need a duplicate or additional ID card, you can view and print one within your secure member website.

 

A digital or printed card is identical to a plastic ID card.

 

If you’re having trouble, contact us and we can help.

 

Contact us

Give changes of name or address to the employer through which you have Aetna coverage. The employer will send this information to us.

 

If you are covered by a plan you purchased on the exchange (also called the Health Insurance Marketplace), you should contact the plan directly.

 

If you are covered by a plan that you purchased directly from us (not through an employer), send us the updated information. There are two ways to do this:

 

  • Log in to your secure member website and use the “Contact Us” feature
  • Call Member Services (use the number on your ID card)

You can change your PCP through your secure member website. You also can call the toll-free number on your ID card, and follow the menu options.

If your doctor leaves the network, you will need to select another Aetna participating provider. You can use our online directory of doctors and hospitals to find one.

Contact your prior employer's benefits office and tell them you're interested in purchasing a COBRA policy. According to federal law, companies that employ more than 20 employees must make you aware of your options for purchasing this coverage.


See more information about continuing your health coverage

Once you have received your ID card:

 

  • Print and complete a medical claim form
  • Submit the form, and a copy of the doctor's bill (indicating payment), to the address on your ID card. Be sure to include your member ID number.

Medical claim form (PDF)

Log in to your secure member website.

In general, an eligible newborn child is covered for 31 days from the date of birth. To continue coverage beyond this time, you must enroll the child within those 31 days and pay any applicable premium. Special provisions may apply to a legally adopted child or a child for whom you are a legal guardian. Eligibility provisions may vary by state, as well as the plan of benefits chosen by your employer. Please refer to your Certificate of Coverage or other plan documents for more details.

You may add or delete family members during the annual open enrollment period. In addition, we will generally accept enrollments for newly eligible members within 31 days after the following events (with proper documentation submitted to us):

 

  • An employee's marriage or divorce
  • Death of an employee's spouse or dependent
  • The birth, proposed adoption or adoption of a child by an employee
  • Beginning or ending of employment by an employee's spouse
  • A change in full-time or part-time employment status by an employee or an employee's spouse
  • Unpaid leave of absence taken by an employee or an employee's spouse
  • Significant change in the health coverage of an employee or an employee's spouse (when caused by a spouse's employment

Page last reviewed Dec. 21, 2015

Legal notices

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

This material is for information only. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Information is believed to be accurate as of the production date; however, it is subject to change.