We’ll provide you answers.
Using the health plan
Includes questions about plan deductibles, coinsurance, out-of-pocket maximums and ID cards.
Is there a separate deductible for each covered dependent?
There are two types of deductibles:
- Individual — The individual deductible applies separately to each covered person in the family. When a person’s deductible expenses reach the individual deductible amount, the person’s deductible is met. The Plan then starts to pay benefits for that person at the appropriate coinsurance percentage.
- Family — The family deductible applies to the family as a group. When the combined deductible expenses of all covered family members reach the family deductible, the family deductible is met. The Plan then begins to pay benefits for all covered family members at the appropriate coinsurance percentage.
What is coinsurance?
You and the plan share in the costs for covered health care services. Coinsurance represents the percent share that you and the plan pay. You usually pay the lower percent. For example, 80/20 means the plan pays 80% and you pay 20% for certain covered charges. Coinsurance begins after you meet your deductible. It is not the same as "copay," which is a flat dollar amount that applies to certain services like office visits.
What does "out-of-pocket maximum" mean?
This is the most you will have to pay for covered services during any plan year. Once you have paid the out-of-pocket maximum, the plan pays 100% of covered expenses for the remainder of the year.
Do all covered expenses count toward the out-of-pocket maximum?
The out-of-pocket maximum does not include:
- Plan premiums
- Amounts you pay for non-covered products or services
- Amounts billed from non-network doctors that are above the "reasonable and customary" amount paid by the plan.
When will my new member ID card(s) arrive?
You can expect to receive new member ID cards or new benefit plan ID cards in late December for coverage effective January 1, 2024. If you do not receive your new ID card, please call Member Services at 1-866-851-0754.
Will each of my covered family members have a separate ID card?
You will receive a family ID card. All covered members of your family may use the same card. If your spouse is covered by the plan, you will receive two ID cards. If you need additional ID cards, please contact Member Services at 1-866-851-0754.
How can I get a new ID card?
You have two ways to do this:
Online — Log in to your secure member website. Click ID Card on the top right of the home page.
By phone — Call the toll-free Member Services number on your member ID card 24 hours a day, 7 days a week. The automated telephone assistant recognizes natural speech, or you can make your selections from your touch-tone keypad. Say, "Order an ID card" and the system will guide you from there. You can also speak live with a Member Services representative during regular business hours.
General Medical Plan Information
Here, you'll find information on managing your benefits information, including how to find specific doctors.
How do I know if my provider (doctor, hospital, etc.) is in the network?
To search for doctors, hospitals, and other health care providers in your area, visit our online provider directory. There, you'll find more than just a list of doctors’ names and addresses. The directory also includes information about:
- Where the physician attended medical school
- Board certification status
- Language spoken
- Gender
- Driving directions to their office.
Visit the version of the online provider directory that has been customized for State of Kansas.
You can also call Aetna Member Services toll-free at 1-866-851-0754 and speak to a representative who can answer your questions about participating providers.
Do I need to select a primary care physician (PCP)?
No, the plan does not require that you select a PCP. However, you may want to establish a relationship with a primary doctor because they do more than give you a checkup — they know you, your medical history, and they can help guide you on important health decisions and direct your care.
Do I need a referral for visits to a specialist?
No, the plans do not require a referral for visits to a specialist. Your plan is a Preferred Provider plan, which means you can go to any doctor without ever needing a referral.
Does the plan have an online secure member website that allows me to get information about the plan, what’s covered, and other features? If so, how do I access it?
Yes. The secure member website is your connection to all your active plan information and links to resources and tools. Once you receive your ID card, visit the login page to register. After you are enrolled and register for your secure member website, you can log in anytime — day or night — to:
- Look up plan information
- View information on your covered dependents
- Find network doctors, dentists, hospitals, vision providers and labs faster and easier with the DocFind search tool
- Take a health assessment and get started on the road to wellness
- Access cost of care and hospital comparison tools
- Download forms
- Order a replacement ID card
- Send an e-mail to Member Services with your questions
- Review your explanation of benefits (EOB) for recent claims
How do I know that my personal health information will remain private?
Your privacy is important to us. Our policies protect your personal information from unlawful use. By personal information, we mean information that can identify you as a person, as well as your financial and health information.
If you’d like a copy of our privacy policy, 1-866-851-0754 or view the Privacy Notice page online.
Provider Network
This section focuses on questions relating to in-network and out-of-network care, including prior authorization or precertification.
What are the advantages of using network doctors?
There are three main advantages to using network doctors: quality, convenience, and savings.
Quality — Doctors who are admitted to the network have met our tough standards for quality.
Convenience — Your network doctor will file claims for you. Your network doctor will also get any plan permissions (called precertification requirements) for you.
Savings — We have negotiated contracts with our network providers to determine how much they will charge you for covered services. That amount is less than what they would charge you if they were not in our network. Network doctors also agree to not bill you for any amount over their contract rate. All you have to pay is your coinsurance or copayments, along with any deductible.
What if my doctor is not in the network?
Remember, you have non network coverage, though you generally pay more for health care. If your doctor does not participate in the network, you may encourage your doctor to join our network. Here’s how you or your doctor can start the process:
- To nominate your doctor to join our network, just call Member Services at 1-866-851-0754.
- If your doctor is interested in joining the network, have them call 1-800-353-1232.
Do I need to follow certain rules to receive non network care?
While our network is large, it’s possible that you may want to seek care from a provider who doesn’t participate in the network. Please note that you pay more for care received outside of the network. Also, if the doctor is not in the network, you may have to file your own claims and get any necessary permission (called precertification requirements) for certain services. You can see the list of services that require precertification.
File a claim — Once you are an Aetna member, you can download and print claim forms and later track your claims from your secure member website. No Internet Access? Member Services can help with that. Just call 1-866-851-0754 for assistance.
Request precertification — To begin the process, call the "precertification" phone number shown on your new ID card, which you should receive in December.
How can I find out if my vision care provider participates in the Aetna network?
The Aetna VisionSM Preferred, featuring the EyeMed network of providers, includes more than 170,000 vision offices and retailers * including popular chains such as LensCrafters®, Pearle Vision®, Sears Optical®, JCPenney Optical and Target Optical®. To find a doctor or vision care retailer, use DocFind®, the online provider directory customized for State of Kansas. Enter your zip code to gain access. Then, you can either do a manual search, or just select "Vision" in the "Find what you need by category" section.