Frequently Asked Questions

LOGGING IN

BENEFITS

PRESCRIPTIONS

RATES

ADDRESSES / PHONE NUMBERS

BILLING

APPLYING


LOGGING IN

Why do I need a user name and password?
Your user name is a name you choose to identify yourself on Aetna’s website.  Your password is a word, phrase or string of letters and numbers you choose.  You need both a user name and password to log into the website.  When used together, they help to ensure that your information is kept private.

The user name must be between 6 and 25 characters (letters and numbers) in length and contain no spaces.  It is not case-sensitive.

Your password is a word, phrase or string of letters and numbers you choose.  You should keep your password secret.  You will need both a password and user name to log into the website.  Your case-sensitive password must:

  • have between 8 and 20 characters;
  • contain at least one letter and at least one number and can include any of these symbols _ - @
  • differ from your user name;
  • not be your first or last name or your first initial with your last name;
  • contain no spaces;
  • use the same character no more than 2 times; and
  • differ from your answer to the security question.

Examples of strong passwords are:

  • 2be1validpassword;
  • Pass1word


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What can I do if I forget my user name or password?
This help option will permit you to create and verify a new user name or password.  You will need to fill out an online form and correctly answer the security questions you chose when you registered.  You will then be allowed to create a new user name or password by doing the following:

  • Select Forgot your user name? or Forgot your password? from the login box.
  • Enter the information requested on the displayed form.
  • If your answers exactly match what you entered when you registered for Aetna's Consumer Portal, your user name will display instantly or you will be able to enter and verify a new password, depending on which question you chose.  You can then proceed to the secure website.


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I am entering the correct user name and password, but I receive a message saying I am not an authorized user. What can I do?

  • The password is case-sensitive.  So check to be sure that your Caps Lock key is not on.
  • If you have a separate number key pad, check your Num Lock key on your number key pad to be sure it is on when you are entering numbers.
  • If you do not have a separate number key pad, be sure your Num Lock key is not on as it turns some of the letters on your keyboard into numbers.
  • If you kept a record of your user name and password, consult it to make sure that you are entering your information correctly.


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Who can I contact if I still have problems entering my user name or password?
If Forgot your user name? or Forgot your password? do not work for you, call the Help Desk Monday through Friday, 7 a.m. to 9 p.m. Eastern Time. The Help Desk toll-free number is 1-800-225-3375.  Choose option 1 for assistance. NOTE:  If you have a problem with Forgot your password?, the Help Desk will not be able to reset your password. The Help Desk will be able to guide you through the password reset online form.

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BENEFITS

What type benefits are covered under the AARP® Essential Premier Health Insurance Plans?
Please visit the product website at www.aarphealthcare.com/aetna.  Choose Compare Plans on the right side of the screen.  Once you’ve added your state information and birth date and click Submit, you can download a brochure that compares the benefits for all plans available in your state.  To see the cost differences for plans, choose Get A Quote.  The Get A Quote section gives a summary of plan benefits and shows the basic monthly premium.

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Do the AARP® Essential Premier Health Insurance Plans offer dental coverage?
The AARP Essential Premier Health Insurance Plans, insured by Aetna, do not offer Dental insurance plans. Please visit https://www.aarphealthcare.com/education/50-64/basic-info and click on Dental Insurance under Other Offerings on the left side of the page for Dental insurance options.

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What is the difference between a Primary Care Physician (PCP) and a Specialist?
A Primary Care Physician (PCP) is trained to manage your entire health care needs. Your PCP plays many roles:
• primary caregiver;
• health care advisor and consultant;
• coordinator of specialty care; and
• patient advocate.

PCP's can include:
• Family/General Practitioners (Doctors who treat patients of all ages);
• Internists (Doctors who treat adults and may have a subspecialty); and
• Pediatricians (Doctors who treat children – babies through teens).

Specialists are physicians who have specialized in a generally accepted sub-specialty area such as:
• women’s health (Obstetrician/Gynecologist);
• heart problems (Cardiologist); and
• skin problems (Dermatologist).
There are medical specialists who provide medical care for conditions and surgical specialists who perform surgery when needed.  Your PCP will generally refer you to a specialist if you need specialty care.  However, a referral from your PCP is not needed to request care from a specialist.



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PRESCRIPTIONS

Does my AARP® Essential Premier Health Insurance Plan include coverage for prescription drugs?
Benefit plans differ depending on the product you choose.  Please visit the product website at www.aarphealthcare.com/aetna.  Choose Compare Plans on the right side of the screen.  Once you’ve added your state information and birth date and click Submit, you can download a brochure that compares the benefits (including pharmacy benefits) for all plans available in your state.  To see the cost differences for plans, choose Get A Quote.  The Get A Quote section gives a summary of plan benefits and shows the basic monthly premium.

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What is a Formulary?
A formulary is a list of prescription drugs the health plan covers. It is also called a preferred drug list.  The formulary can include drugs that are brand-name and generic. Drugs on this list may cost less than drugs not on the list. How much a plan covers may vary from drug to drug. Many of AARP® Essential Premier Health Insurance Plan prescription drug benefit plans use a preferred drug list (formulary). The preferred drug list (formulary) is available on www.aetna.com.

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What is a Generic drug?
A generic drug is a copy of a brand-name drug that no longer has a patent.  It is the same as a brand-name drug in safety, dosage and strength.  The generic drug has met the standards set by the Food and Drug Administration (FDA) to assure it performs the same as the original patented brand name drug. Generic drugs cost less than the original brand name drug.

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What is a Brand Name drug?
A brand name drug is a prescription drug that has been patented by the drug maker.  It is sold under a trademarked name and is only available through one manufacturer.  An equivalent generic drug may be available at a lower cost once the patent has expired.

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RATES

Are the AARP® Essential Premier Health Insurance Plans guaranteed issue plans?
No, the AARP Essential Premier Health Insurance Plans are not guaranteed issue plans. This means that people who apply will have to go through the medical underwriting* process. 

*Medical Underwriters assess the risk of those who apply through a review of all information submitted on the:
• Application;
• Health questionnaire; and
• Medical records.

This underwriting determines if each person is eligible.  Each person is placed within a risk category. Various risk categories are used based on the known and predicted medical risk factors of each person applying.

Following the completion of medical underwriting, applicants may be:
1. accepted into their selected plan at the standard premium charge; or
2. accepted into their selected plan at a higher rate, based on medical findings; or
3. turned down based on significant medical risk factors.
Starting on October 1, 2010, coverage cannot be declined based on medical risk factors for children under the age of 19 years.



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ADDRESSES / PHONE NUMBERS

How do I obtain AARP® Essential Premier Health Insurance Plan enrollment materials?
AARP members can obtain information:
• at www.aarphealthcare.com/aetna; or
• by calling 1-866-660-4081.

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Where do I mail my enrollment form?
If you are working with an agent who is authorized to offer the AARP Essential Premier Health Insurance plans:
• submit your enrollment form to your agent.

If you are not working with an agent who is authorized to offer the AARP Essential Premier Health Insurance plans:
• mail your enrollment form and first premium check to:

Aetna
AARP-Branded Plans
PO BOX 14015
Lexington, KY 40512-4015



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If I am currently covered under an AARP® Essential Premier Health Insurance Plan, who do I contact for questions about billing or benefit clarification?
For questions about billing, members should contact Aetna using the telephone number provided on their:
• Medical ID card, or
• most recent premium billing invoice.

For questions about benefit clarification, members should contact Aetna by:
• calling the telephone number shown on their Medical ID card, or
• using email through the secure member website, Aetna Navigator. The website address is www.aetna.com/essentialpremier.



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If I am denied coverage through Medical Underwriting, how do I obtain information and enrollment materials for other insurance options?
AARP® members can get HIPAA eligibility information and packets by calling:
1-866-660-4119.

Also check the federal government’s health care reform website (http://finder.healthcare.gov/) to see what other plans are available in your area.



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BILLING

What are my premium payment options?
If applying for coverage online:
• you may pay your first month’s premium with a credit card. For your ongoing monthly premium payments, you may pay monthly by check or sign up for EasyPay; OR
• you may set up EasyPay for your first month’s premium and ongoing payments. Your monthly premium will be automatically deducted from your checking account.

If applying for coverage using a paper application:
• you may pay your first month’s premium by check. For ongoing monthly premium payments, you may pay monthly by check or sign up for EasyPay; OR
• you may set up EasyPay for your first month’s premium and ongoing payments. Your monthly premium will be automatically deducted from your checking account; OR
• you may pay your first month’s premium with a credit card. For your ongoing monthly premium payments, you may pay monthly by check or sign up for EasyPay.



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When is the premium due?
Your first premium payment must be made when you enroll.  After that, your full premium payment must be received by Aetna no later that the first of each month.

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If I am denied coverage, will my premium be refunded?
When you apply for coverage, you must pay your first month’s premium either by check, credit card or EasyPay.  If you are denied coverage, you will receive a refund either by check (if you paid by check) or directly to your credit card account.

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How will I be billed if my rate changes because of a change due to underwriting?
Any rate change made as a result of the underwriting process will be handled as follows:
• automatically charged to your EasyPay or credit card account if you use either of these methods to pay your premium.
• billed on the next billing statement if you pay your premium by check.

You will be notified at least 30 days prior to any rate changes.  Such rate changes may result in an increase of 10% to 100% of the standard rate.



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APPLYING

Do I need to be an AARP® member to apply?
Yes, the person applying must be an AARP member.  If you are age 50 or over, you can join AARP by going to this website – www.aarphealthcare.com/aetna.  Click on Join AARP in the upper right corner.

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Does AARP® Essential Premier Health Insurance Plan offer coverage for dependents (spouse and/or children/grandchildren)?
Yes, dependents including your children up to age 26 years and/or your spouse can be covered under the family plan.  As of October 1, 2010, the AARP Essential Premier Health Insurance Plan no longer offers child only/grandchild only coverage for children under the age of 19 years.  Dependent child coverage for children up to age 19 years is offered only as part of a family plan.  Adult dependent children who are at least 19 years old but less than 26 years may apply for a policy on an individual basis (not part of a family plan) subject to medical underwriting.

If Aetna requests you to verify that the child is your dependent, one of the following is required:
• A copy of the child’s birth certificate; or
• Adoption decree; or
• Legal documentation of responsibility.



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I am applying with a dependent (spouse or child). Whose age should I use to check for our rate?
Each person’s rate is based on their own age.

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What ages are eligible to apply?
To qualify for enrollment, all applicants must be within the following ages:

1. The applicant must be at least 50 years old and an AARP® member.
2. Applicant and enrolling spouse must be under age 64 and 9 months.
3. Eligible children must be under age 26 years.

State Specific Exception
Ohio: Eligible children can be up to age 28 years.



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Should I cancel my existing coverage?
You should not cancel your current plan until Aetna lets you know that your application is approved.  Once you are approved, you must cancel your current health plan either before or on the day your AARP® Essential Premier Health Insurance Plan goes into effect.

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How long will it take to process the enrollment form?
Processing your enrollment form may take as long as three to four weeks. Aetna must underwrite and approve the enrollment form.  Please note that coverage does not begin under any circumstances until the approval is granted.

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Are my medical records requested during the underwriting process?
During the review of your application, Aetna may need to review your medical records. You are responsible for getting the records within 30 calendar days when asked by Aetna to do so.  You may also be asked to take part in a telephone interview which must occur within 15 calendar days of request.

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When is the last day of the month that I can submit my enrollment form to be effective the first of the next month?
Aetna must receive your signed enrollment form by the last day of the month before the month of your effective date. For example, if Aetna receives your signed enrollment form on June 30 and the signature is on or before June 30, then you are eligible for a July 1 effective date.

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When will my coverage be effective?
If you do not ask for an effective date, Aetna will assign an effective date of the 1st of the month following the date the enrollment form is approved.  A requested effective date will not be honored prior to the signature date on the form.  For example, if you request an effective date of July 1, 2010, the signature on the enrollment must be dated before July 1, 2010.  If the signature is dated July 2, 2010, the July 1 effective date will not be approved.

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Do I need to send my premium payment with the enrollment form?
Your first premium payment must be made when you enroll.  You can pay using one of three ways:
• You may set up EasyPay for your first month’s premium and ongoing payments. Your monthly premium will be automatically deducted from your checking account;
• If applying for coverage online you may pay your first month’s premium with a credit card; OR
• If applying for coverage using a paper application you may pay your first month’s premium by check, credit card or via EasyPay.

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What would cause my enrollment to be delayed?
Your enrollment could be delayed for a number of reasons:

  • Your application is not signed and dated.  Please make sure to sign and date your application.
  • All dependents age 18 and older did not sign the application.  Please make sure all dependents 18 and over sign the application.
  • All questions are not answered.  Please make sure all fields on the enrollment form are completed.
  • Detail to questions answered "yes" in the medical history section, is incomplete or not answered.  Please provide detail to all questions answered “yes.”
  • Medical records were requested and not yet received.
  • Other information was requested and not yet received.
  • Your first month’s premium has not been paid.  Please make sure to pay your premium when you apply.


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I am a current group member. Can I convert to an individual AARP® Essential Premier Health Insurance Plan?
Acceptance into the AARP Essential Premier Health Insurance Plan is not guaranteed. Plans are medically underwritten. All applicants must submit a completed enrollment form.  You also need to be an AARP member.  You can join AARP by going to this website – www.aarphealthcare.com/aetna.  Click on Join AARP in the upper right corner.  You must be 50 years old or more to join AARP.

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How do I choose a Primary Care Physician (PCP)?
 Please visit our website at http://www.aetna.com/docfind/aarp to find a doctor in your area.   You are not required to choose a Primary Care Physician (PCP) to enroll in these plans.

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What is Aetna Navigator?
Aetna Navigator is a secure member website.  This website allows members to print a copy of their medical ID cards, review benefits, check claims and much more. To enroll in Aetna Navigator, please visit www.aetna.com/essentialpremier

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What is a pre-existing condition and does this impact my eligibility requirements?
A pre-existing condition is an illness or injury that was diagnosed or treated within six months before the date the health plan’s coverage began.  Pre-existing condition exclusions do not apply to children younger than 19 years of age.

When you and your dependents apply for coverage, each applicant will go through a medical underwriting process.  Some pre-existing conditions may result in a decline of coverage.  If approved for coverage, some pre-existing conditions may result in a higher premium.



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What is Creditable Coverage?
Creditable Coverage is a person’s prior medical coverage as defined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Prior creditable coverage does not guarantee acceptance into an AARP® Essential Premier Health Insurance Plan. Plans are medically underwritten and all who apply must submit a completed enrollment form and medical questionnaire.

If the applicant has prior creditable coverage within 63 days* immediately before the signature date on the application, then the pre-existing condition exclusions of the plan will be waived for members age 19 years and older.  Pre-existing condition exclusions do not apply to children younger than 19 years of age.
*(90 days for Alaska, Colorado and Wyoming; 120 days for Connecticut)


Such coverage includes:

• Health coverage issued on a group or individual basis;
• Medicare;
• Medicaid;
• Health care for members of the uniformed services (e.g. CHAMPUS);
• A program of the Indian Health Service;
• A state health benefits risk pool;
• The Federal Employees’ Health Benefit Plan (FEHBP);
• A public health plan (any plan established by a State, the government of the United States, or any subdivision of a State or of the government of the United States, or a foreign country);
• Any health benefit plan under section 5(e) of the Peace Corps Act;
• The State Children’s Health Insurance Program (S-CHIP).

Such coverage does not include:

• Dental or vision only policies;
• Specified disease policy (e.g., cancer policies);
• Medical coverage under auto or homeowners insurance policy;
• Medical coverage under worker’s compensation;
• Hospital indemnity or other fixed indemnity plans.



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