Our FAQ page is divided into three sections. Click the section below that relates to you and you’ll be taken directly to the corresponding questions and answers.
Q: Are there any restrictions on what Aetna group medical plans can be paired together?
A: No, there is no matrix and there is no load to the rates. Pick 5 allows employers to offer any combination of up to five Aetna medical plans.
Q: What is the deadline for my new group insurance submission?
A: Aetna requires new group paperwork to be submitted ten business days prior to the requested effective date. If you have a group coming in past this timeframe, then please contact us for details on how to proceed.
Q: What size groups does TBS quote and write?
A: We quote and write business in three different states: Washington, Alaska, and Idaho. In Washington, we can quote and write groups with 1-50 total average employees on payroll. In Alaska, we can quote and write groups from 2-100 total average employees on payroll. In Idaho, we quote and write groups with 2-100 eligible, total average employees on payroll. Mid-market (51-100) Alaska and Idaho groups are underwritten by Aetna.
Q: Does Aetna offer COBRA administration services?
A: COBRA administration is available through Aetna with Ameriflex. Please contact our office for more information.
Q: Can employees receive credit for deductible met with their prior carrier when enrolling with Aetna?
A: Yes, Aetna will allow new groups to offer their existing employees the ability to credit deductible met in that calendar year to their new Aetna plan. For more information see the Deductible Credit Form.
Q: Can we do a census enrollment for our group?
A: Yes! Please utilize the TBS Enrollment Census template which is available on our forms page for each state.
Q: I have a group wanting to enroll with VSP and LifeMap, do we need separate forms?
A: Yes, each carrier has specific forms that would be required. Please see the carrier specific area or contact our New Business Team for further information.
Q: When can we expect to see medical renewals for our groups?
A: Generally, renewals are released 45-60 days prior to the group’s anniversary date. For additional information, please contact our Renewal Team at email@example.com.
Q: How do I get appointed with Aetna?
A: To start the online appointment process, please visit this link.
Q: I am looking for help with my small group book of business renewals and marketing. Does TBS have a solution that can help me?
A: TBS has a division called Broker Services. Broker Services is set up to maximize your time by helping you with things like pre-renewal data collection, marketing, and other tasks. We complete these tasks for you so that you have more time to spend with your clients. Contact us today to learn more about how we can help.
Q: Where can we access the Summary of Benefits and Coverage (SBCs) for our Aetna group medical plan?
A: SBCs are group effective date specific and can be downloaded via the public Aetna website here.
Q: We just received our group invoice from Total Benefit Solutions and have a question, who should we contact?
A: You may contact our Billing and Enrollment department by calling 1-855-246-8873 or via email at firstname.lastname@example.org.
Q: We have an employee whose enrollment was processed mid-month. Will Aetna prorate the premium?
A: Aetna does not prorate charges. That is, while enrollments may be processed mid-month, the effective date and premium date will be the 1st of the month.
Q: When will we receive our benefit books and contracts?
A: Aetna has gone green and no longer sends hard copies of benefit booklets out. You will receive an email with these documents and each of your employees will receive a mailed notification on how and where they can access copies of their booklets.
Q: Our renewal doesn’t take place for several more months; however, we are interested in adding other lines of coverage before then. Do we have to wait until renewal to make these additions?
A: No, absolutely not! We are more than happy to work with you and your broker to explore options for ancillary lines of coverage at any time of the year. We offer a wide range of dental, vision, life, and disability products from several trusted carriers. Have your broker contact us and request your customized quote today!
Q: When do Aetna enrollments or terminations need to be submitted by?
A: Enrollments need to be submitted within 30 days of the member’s effective date/qualifying event date, and terminations must be submitted within 60 days. Late applicants without a qualifying event are not allowed and must wait for the group’s next open enrollment period/renewal date to enroll.
Q: Does TBS offer reoccurring payment options?
A: As many of our groups have fluctuating premium amounts due to enrollments and terminations, we do not offer reoccurring payments at this time. Groups can pay online through our Online Billing System (OBS), with a check, or with an ACH. Groups may, however, set up reoccurring payments privately through their banking institution.
Q: One of my employees recently terminated. Can we deduct the premium for that employee from the total due of our monthly Total Benefit Solutions invoice?
A: We advise groups to pay their monthly invoices as billed. Adjustments for eligibility changes will appear on the group’s next month invoice. Groups are also welcome to utilize our Online Billing System to manage their eligibility and pay their invoices online. And of course, groups can call us at 1-855-246-8873 for live assistance.
Q: What is the 365 day rehire provision?
A: It is an industry standard to waive the probationary period for an employee who is rehired within 365 days of their termination date, and to come on first of the month following their re-hire date. Rehired employees must be insured at least one day on the group’s policy prior to termination, in order to qualify for the rehire provision. If the group would rather an employee re-satisfy their probationary period they may do so, but the rule must apply to all employees going forward.
Q: Where can I get another Aetna ID card?
A: You may log on to your Aetna Navigator account at www.aetna.com (accessible 24 hours a day, seven days a week) and print an ID card.
Q: I am using the Aetna DocFind feature to locate an in-network medical provider but I don’t know what plan name to select.
A: When asked to select a medical plan name you will want to choose “Open Choice PPO.”
Q: I met my deductible in December, do you allow for 4th quarter carry over?
A: The deductible is applicable for the calendar year and does not allow for any portion to be carried over into the following year regardless of when it was satisfied.
Q: What is an EOB?
A: An “EOB” is an Explanation of Benefits. These are generated once a claim is processed and are either mailed or delivered electronically to you. If you have signed up for Aetna Navigator then you can access and print or save your EOB online.
Q: I received a paper ID card from Aetna. Is it valid? When should I expect a plastic ID card?
A: Effective 04/01/17 Aetna will change the material ID cards are printed on from plastic to durable paper. Paper ID cards will be sent to all new members. Existing members will receive paper ID cards as replacements when critical card changes occur. The ID card size and content printed on the cards will not change.
Q: How do I enroll my newborn?
A: Congratulations on the new addition! For WA, newborns are covered for a 60 day period, (in AK and ID it is for a 31 day period) from the date of birth during which time the parent can choose to add the baby to the plan permanently or not. If the member wishes to permanently add the newborn to their plan they need to complete and return an enrollment form to TBS. Please note newborn enrollments cannot be completed through the Online Billing System, a manual application will be required. We advise that the newborn enrollment form be submitted within 30 days from the date of birth to permanently add the newborn onto the plan.
Q: How do I find a contracted flu shot provider?
A: You can log in to the secure Aetna member website at http://www.aetna.com to locate a provider. Click on “Find a Doctor, Dentist, or Facility” and then search for “Find a Flu Shot/Vaccine Provider.” You can also call the number on your ID card for Member Services for assistance.
Didn’t find the answer you were looking for? Please contact us with any questions about insurance and we’ll be happy to help you out.