Summary of Benefits and Coverage (SBCs)

SBCs are group effective date specific and can be downloaded via the public Aetna website at: https://www.aetna.com/sbcsearch/home

Benefit Grids

2023

• Benefit Grid PPO and PPO Plus (1-50)
• Benefit Grid PPO Matsu (1-50)

2022

• Benefit Grid PPO Plus (1-50)
• Benefit Grid PPO Matsu (1-50)
• Aetna Medicare Creditable List for 2022

Plan Summaries

The following summaries are listed for your convenience. For the most up-to-date information please visit https://www.aetna.com/sbcsearch/home and click on the tab labeled "PDD Search."

Small Group Plan Summaries Effective 1/1/23 and Later

• AK Bronze PPO 6350 80 50 HSA-E
• AK Bronze PPO 6850 70 50
• AK Bronze PPO 8550 70 50
• AK Bronze PPO Matsu 6850 70 50
• AK Bronze PPO Matsu 8550 70 50
• AK Bronze PPO Plus 6850 70 50 40
• AK Gold PPO 750 70 50
• AK Gold PPO Matsu 750 70 50
• AK Gold PPO Plus 750 70 50 40
• AK Silver PPO 1250 70 50
• AK Silver PPO 1850 70 50 HSA-T
• AK Silver PPO 3500 80 50 HSA-E
• AK Silver PPO 3500 80 50
• AK Silver PPO 5500 70 50
• AK Silver PPO Matsu 2500 70 50
• AK Silver PPO Matsu 3500 80 50 HSA-E
• AK Silver PPO Matsu 3500 80 50
• AK Silver PPO Matsu 5500 70 50
• AK Silver PPO Plus 2500 70 50 40

Small Group Plan Summaries Effective 1/1/22 and Later

• AK Gold PPO 750 70/50
• AK Gold PPO Matsu 750 70/50
• AK Gold PPO Plus 750 70/50/40
• AK Silver PPO 1250 70/50
• AK Silver PPO 1800 70/50 HSA-T
• AK Silver PPO Matsu 2250 70/50
• AK Silver PPO Plus 2250 70/50/40
• AK Silver PPO 3000 70/50
• AK Silver PPO 3500 80/50
• AK Silver PPO 3500 80/50 HSA-E
• AK Silver PPO Matsu 3500 80/50 HSA-E
• AK Bronze PPO 6350 80/50 HSA-E
• AK Bronze PPO 6850 70/50
• AK Bronze PPO Matsu 6850 70/50
• AK Bronze PPO Plus 6850 70/50/40
• AK Bronze PPO 8550 70/50
• AK Bronze PPO Matsu 8550 70/50

Plan summaries for groups of 51+ are provided to the group at installation and/or upon renewal.

• Alaska Employee Application (1-50)
• Alaska Employer Application (1-50)
• New Group Enrollment Checklist (1-50)
• New Group Enrollment Checklist (51-100)
• AK Enrollment Census (1-50)
• ACH- New Group
• Deductible Credit form

• AK SG Renewal Submission Checklist
• Alaska Employee Application (1-50)
• TBS Renewal Census

• Aetna HealthFund One-to-One Overview
• Aetna HealthFund One-to-One HSA Flyer
• Aetna HealthFund One-to-One HRA Flyer
• Aetna HealthFund One-to-One FSA Flyer

• AmeriFlex COBRA FAQ
• AmeriFlex COBRA Pricing Sheet

• 2021 Aetna Pharmacy Drug Guide For the most up-to-date formulary and Rx information we recommend you visit https://www.aetna.com/individuals-families/find-a-medication.html. For small group select the “Small Group ACA plans,” or for AK 51-100 select the “Value Plus plans,” and then select the state to view the drug guide or any recent changes.
• Aetna Discount Programs
• Aetna DocFind
• Aetna Health App and Member Website
• Aetna International Travel Flyer
• Aetna Mail Order Rx
• Aetna Member Auth for Release of Protected Health Info (PHI)
• Aetna Member Health Assessment (available to small groups)
• Alaska Medical Travel Reimbursement Program
• Alaska  Network Flyer
• Attain by Aetna app
• Deductible Credit Form
• Domestic Partnership Affidavit
• Medical Claim Form
• Paperless EOB (Explanation of Benefits) Letter
• Preventive Care Flyer
• Retail Flu Shot Providers
• Rx Claim Form
• Rx Precertification form
• Teladoc 2022
• Teladoc FAQs
• Teladoc- Getting Started
• Transition of Coverage
• Womens Preventive Care Flyer

• ACH Premium Withdraw (Month to Month)

Middle Market Forms and Flyers (51+ employees)

• Anchorage Mat-Su Community Plan Member Flyer
• Anchorage Mat-Su Broker Flyer

Aetna – Helping people achieve health and financial security

Aetna is one of the nation’s leaders in health care, dental, pharmacy, group life, and disability insurance, and employee benefits. Dedicated to helping people achieve health and financial security, Aetna offers a broad range of insurance and employee benefits products plus vast resources for producers and employers to help them make the right choices.

The Aetna health care network has:

• More than 1 million health care professionals
• More than 575,000 primary care doctors and specialists
• More than 5,400 hospitals
• A network of specialist physicians, recognized with Aexcel® designation, based on clinical performance and cost efficiency.

Aetna provides benefits through employers in the United States and internationally, with products and services targeted specifically to small, mid-sized and large multi-site national employers, as well as global health insurance for employees on temporary or permanent foreign assignments.

Ask us about Aetna’s health insurance products including Medical, Dental, Life and Global insurance.

Producer Appointment

If you or your firm is not yet appointed with Aetna, please apply online:

https://pangea.geninfo.com/Aetna/Apply

Benefit Grid

• AK Dental Grid

The following summaries are listed for your convenience. For the most up-to-date information and additional plans please visit Aetna's Producer World at: https://www.aetna.com/producer/Login.do. Other dental plan design documents, including more voluntary plan designs are available by request. 

Effective 2021

Groups of 2-9*

*Voluntary dental plans are available to groups with 3+ eligible employees.

• Alaska Option 1
• Alaska Option 2
• Alaska Option 3
• Alaska Option 4
• Alaska Voluntary Option 1

Groups of 10+

• Alaska Opt 1A
• Alaska Opt 1A Ortho
• Alaska Opt 2A
• Alaska Opt 2A Ortho
• Alaska Opt 3A
• Alaska Opt 3A Ortho
• Alaska Opt 4A
• Alaska Opt 4A Ortho
• Alaska Opt 5A
• Alaska Opt 5A Ortho
• Alaska Opt 6A
• Alaska Opt 6A Ortho
• Alaska Opt 7A
• Alaska Opt 7A Ortho
• Alaska Opt 8A
• Alaska Opt 8A Ortho
• Alaska Opt 9A
• Alaska Opt 9A Ortho
  
  

Effective 2020

Small Groups of 2-9*

*Voluntary dental plans are available to groups with 3+ eligible employees.

• Opt 1: Indemnity 1500
• Opt 2: PPO 1000
• Opt 3: PPO 1500
• Opt 4: PPO 2000
• Vol Opt 1: PPO 1000

Groups of 10+

• Opt 1a: PPO 80/80/50
• Opt 1a: PPO 80/80/50 ortho
• Opt 2a: PPO 80/80/50 Plus
• Opt 2a: PPO 80/80/50 Plus ortho
• Opt 3a: PPO 1000
• Opt 3a: PPO 1000 ortho
• Opt 4a: PPO 1000 Plus
• Opt 4a: PPO 1000 Plus ortho
• Opt 5a: PPO 1500
• Opt 5a: PPO 1500 ortho
• Opt 6a: PPO 1500 Plus
• Opt 6a: PPO 1500 Plus ortho
• Opt 7a: PPO 2000
• Opt 7a: PPO 2000 ortho
• Opt 8a: PPO 2000 Plus
• Opt 8a: PPO 2000 Plus ortho
• Opt 9a: indemnity 1500
• Opt 9a: indemnity 1500 ortho
• Vol Opt 2a: PPO 80/80/50 Plus ortho
• Vol Opt 4a: PPO 1000 Plus
• Vol Opt 5a: PPO 1500
• Vol Opt 7a: PPO 2000
• Vol Opt 8a: PPO 2000 Plus ortho

New Business

• Alaska Employee Application (1-50)
• Alaska Employer Application (1-50)

Member Forms

• Dental Claim Form
• Aetna Dental Coverage for EXPAREL
• Aetna Dental/Medical Integration

The following summaries are listed for your convenience. Upon implementation benefit summaries will be generated for the group, and  groups should review their Policy and Certificate for complete details. If you'd like to request a summary not seen below then please contact us.

• $1000 Max Dental Plan Summary
• $1000 Max with Ortho Dental Plan Summary 
• $1500 Max Dental Plan Summary
• $1500 Max with Ortho Dental Plan Summary
• $2000 Max Dental Plan Summary
• $2000 Max with Ortho Dental Plan Summary
• $3000 Max Dental Plan Summary
• $3000 Max with Ortho Dental Plan Summary
• 100-80-50 1K Endo-Pero Basic 90th
• 100-80-50 1.5K Endo-Pero Basic 90th
• 100-80-50 1.5K Endo-Pero Basic 90th Child Ortho 1K
• 100-80-50 1.5K Endo-Pero Basic MAC 1
• 100-80-50 2K Endo-Pero Basic 90th
• 100-80-50 2K Endo-Pero Basic 90th Child Ortho 1K
• 100-80-50 2K Endo-Pero Basic 90th Child Ortho 1.5K
• 100-90-60 - 100-80-50 1.5K Endo-Pero Basic 90th
• 100-90-60 - 100-80-50 2K Endo-Pero Basic 90th
• 100-90-60 - 100-80-50 2K Endo-Pero Basic 90th Child Ortho 1K
• VOLUNTARY 100-80-50 1K Endo-Pero Basic 90th
• VOLUNTARY 100-80-50 1.5K Endo-Pero Basic 90th
• VOLUNTARY 100-80-50 1.5K Endo-Pero Basic 90th Child Ortho 1K
• VOLUNTARY 100-80-50 2K Endo-Pero Basic 90th

New Business

• Coming Soon... in the meantime please contact us for assistance.

Member Forms

• Dental App Employee Flyer
• Dental claim form
• Enrollment and Change Form Note: If you receive a "Please wait..." message then please go ahead and download the PDF and open it with Adobe Acrobat and it will be viewable and fillable.
• Find a Dental Provider
• MyBenefits Registration Flyer

MetLife has been in the business of making and keeping promises for more than 150 years, helping millions of customers protect their future with smart products and targeted services. They apply the same principles to operate responsibly and confidently in more than 40 markets around the world.

Producer Appointment

If you or your firm is not yet appointed with MetLife, then please complete the following and submit as directed on the form:

Broker Appointment Paperwork

To locate a dental provider please visit https://www.metlife.com/ and follow the instructions listed on the Find a Dental Provider brochure.

• Life Summary – $20K

• Beneficiary Change Form
• Proof of Death Form

The following summaries are listed for your convenience. Upon implementation benefit summaries will be generated for the group, and groups should review their Policy and Certificate for complete details. If you'd like to request a summary not seen below then please contact us.

• $25,000 Basic Life Benefit Summary
• $50,000 Basic Life Benefit Summary
• $100,000 Basic Life Benefit Summary
• Supplemental Life Benefit Summary
• Basic Life Summary 1x Salary to $50,000
• Basic Life Summary 1x Salary to $75,000
• Basic Life Summary 1x Salary to $100,000
• Basic Life Summary 2x Salary to $150,000
• Basic Life Summary 2x Salary to $250,000
• Basic Life Summary Flat $20,000

New Business

• Coming Soon... in the meantime please contact us for assistance.

Member Forms

• MyBenefits Registration Flyer

MetLife has been in the business of making and keeping promises for more than 150 years, helping millions of customers protect their future with smart products and targeted services. They apply the same principles to operate responsibly and confidently in more than 40 markets around the world.

Producer Appointment

If you or your firm is not yet appointed with MetLife, then please complete the following and submit as directed on the form:

Broker Appointment Paperwork

The MetLife Life product does not have a provider network.

***As of 01/01/2023 VSP plans are no longer available.***

• VSP Census Form
• VSP AK Master Application

FOR MEMBERS

How do I use my VSP benefit?

Getting started with VSP is easy! After you enroll with your employer during your open enrollment period you can:

1. Create an account on vsp.com, where you can review your personalized plan details and eligibility.
2. Find a doctor who's in network and conveniently located near you.
3. Schedule your appointment! There's no ID card required; however, if you'd like to download or print your Member Vision Card, simply log in to your account on vsp.com.

For additional assistance, members may call VSP Member Services at 1-800-877-7195.

FOR EMPLOYERS

Administration for all of Total Benefit Solutions' VSP policies, including billing, enrollment, and renewals, is handled directly by VSP.  For assistance, employers should reach out to VSP directly online at www.Visionbenefits.vsp.com or by calling VSP Client Support 1-800-216-6248, option 4.

Finding a doctor you love—or keeping your current doctor—is important!

With VSP, most members have access to five VSP network doctors within five miles of where they live or work. When you see an in-network doctor, you’ll get more out of your vision coverage and can count on low out-of-pocket costs and take advantage of exclusive member-only offers on contacts, sunglasses, lens enhancements, and more! Maximize your benefits when you choose to visit a Premier Program location, including private practice doctors and Visionworks retail locations nationwide.

The following summaries are listed for your convenience. Upon implementation benefit summaries will be generated for the group, and  groups should review their Policy and Certificate for complete details. If you'd like to request a summary not seen below then please contact us.

• Vision Plan 1
• Vision Plan 2
• Vision Plan 3
• Vision Plan 4
• Vision Plan 5
• Vision Plan 6

New Business

• Coming Soon... in the meantime please contact us for assistance.

Member Forms

• Eyeconic Flyer
• Find a Vision Provider Flyer

MetLife has been in the business of making and keeping promises for more than 150 years, helping millions of customers protect their future with smart products and targeted services. They apply the same principles to operate responsibly and confidently in more than 40 markets around the world.

Producer Appointment

If you or your firm is not yet appointed with MetLife, then please complete the following and submit as directed on the form:

Broker Appointment Paperwork

To locate a vision provider please visit https://www.metlife.com/ 

The following summaries are listed for your convenience. Upon implementation benefit summaries will be generated for the group, and groups should review their Policy and Certificate for complete details. If you'd like to request a summary not seen below then please contact us.

Short Term Disability 

• STD $1250 12 Week Benefit Summary
• STD $1250 25 Week Benefit Summary
• STD $2500 12 Week Benefit Summary
• STD $2500 25 Week Benefit Summary
• STD Benefit Summary Plan 1 -60% to $1K 0-7-13
• STD Benefit Summary Plan 2 - 60% to $1000 0-7-26
• STD Benefit Summary Plan 3 - 60% to $1000 7-7-12
• STD Benefit Summary Plan 4 - 60% to $1000 7-7-25
• STD Benefit Summary Plan 5 - 60% to $1000 14-14-11
• STD Benefit Summary Plan 6 - 60% to $1000 14-14-24
• STD Benefit Summary Plan 7 - 60% to $1000 30-30-9
• STD Benefit Summary Plan 8 - 60% to $1000 30-30-22

Long Term Disability 

• LTD $3,000 90 EP Plan Summary
• LTD $3,000 180 EP Plan Summary
• LTD $5000 90EP Plan Summary
• LTD $5000 180EP Plan Summary
• LTD $6,000 90 EP Plan Summary
• LTD $6,000 180 EP Plan Summary
• LTD $10,000 90EP Plan Summary
• LTD $10,000 180EP Plan Summary

New Business

• Coming Soon... in the meantime please contact us for assistance.

Member Forms

• MyBenefits Registration Flyer

MetLife has been in the business of making and keeping promises for more than 150 years, helping millions of customers protect their future with smart products and targeted services. They apply the same principles to operate responsibly and confidently in more than 40 markets around the world.

Producer Appointment

If you or your firm is not yet appointed with MetLife, then please complete the following and submit as directed on the form:

Broker Appointment Paperwork

The MetLife Disability products do not have a provider network.