Health Benefits - Point of Service Plan: Frequently Asked Questions

(For active employees and non-Medicare retirees)

Do I need to choose a primary care physician ("PCP") under this plan?
Yes. You should select a PCP in order to receive the highest level of benefits and the least out of pocket expenses.  Just call Aetna Member Services at 1-855-850-0039 to make the selection.  You will then receive a new ID card with your doctor's name on it.

Do I need to notify Aetna if I change my primary care physician ("PCP")?
Yes. It is important to keep this information up to date with Aetna.  Just call Aetna Member Services at 1-855-850-0039 to update your information.  You will then receive a new ID card with your new doctor's name on it.

I have received a medical bill from my hospital for services and I don’t understand why; who do I call?
Aetna Member Services at 1-855-850-0039.

I received an Explanation of Benefits from Aetna regarding a recent medical claim and I believe it is incorrect; who do I call?
Aetna Member Services at 1-855-850-0039.

I have met my in-network out-of-pocket maximum; will I have to continue to pay copays?
Once you have met your in-network out-of-pocket max for the calendar year, you will no longer have to pay medical copays for in-network services. (You will continue to pay for prescription copays.) More information (Power Point)

I was charged a different copay for my prescription than I usually pay; how do I find out if I paid the correct amount?
Call Aetna Member Services at 1-855-850-0039.

How do I verify correct premium for my health insurance is being deducted from my pay check?
You can look at the premium rates at http://www.maine.gov/deh/healthbenes/health/index.html or call Employee Health & Benefits at (207) 624-7380.

Who do I contact to request a new Aetna identification (“ID”) card?
You can order additional ID cards by either logging onto Aetna Navigator at www.AetnaStateOfMaine.com (see Toolkit) or by calling Aetna Member Services at 1-855-850-0039.

How can I view my medical claims on line?
You can view your medical claims on Aetna's secure member website called Aetna Navigator. For more information about all of the useful features of the Navigator site click here.

How long can my dependent stay on my health/dental/vision insurance policy?
Up to the first of the month following their 26th birthday.  If your child is disabled, please contact your insurance carrier at the Member Services number on the back of your ID card. 

What is the premium cost for the health insurance?
The health insurance premium rate sheet can be found on our Health Benefits page.

When will my next opportunity be to participate in the health credit premium program and to qualify for the 5% savings on my individual health insurance premium?
We expect the program to be offered again in the Spring/Summer 2015.