FREQUENTLY ASKED QUESTIONS (FAQs)

 

On January 1, 2027, Aetna and CVS will become the administrator for Suffolk School Employees Health Plan’s Medical and Pharmacy benefits.

 

Q1:Will I receive a new ID Card?

 

A1:Yes, all members will receive an Aetna/CVS ID card. A family ID card reflecting information for you and each of your covered dependents will be mailed to you prior to the start of the plan. You can expect to receive your new ID card late December.

 

Q2:How can I see if my current provider participates in the Aetna plan?

 

A2:The Aetna Choice POS II network provides a wide network of providers. To look up your providers:

•log onto www.aetnaresource.com/p/SSEHP

•Scroll to the Find Your Provider section

•Click “Choice POS II”

•Enter your zip code

•Then you can enter your providers names, or search our list of providers

 

Q3:What if my Provider does not participate in the Aetna network

 

A3:You may continue to see your provider; however, the plan will reimburse at the out-of-network level of benefits.

 

Your doctor can choose to apply to participate in the Aetna network. You can share the following link to get them started. www.aetna.com/health-care-professionals.html

 

Alternatively, you can select a new provider who participates in the Aetna network to continue to enjoy in-network level of reimbursement.

 

Q4:What if I’m currently in a prescribed course of treatment with a provider not in the Aetna network?

 

A4:You may be eligible for transition of care if you are currently undergoing an active course of treatment. Aetna will help guide you through the process. More information to be shared in the coming weeks.

 

Q5: What do I do if I have a doctor’s appointment planned in January?

 

A5:If your provider participates in the Aetna network, for most procedures you will simply need to present your new Aetna ID card at the time of your visit.

 

Q6:What if I have surgery, or other medical, planned in January?

 

A6:You should inform your provider that your coverage is changing effective January 1. If your procedure requires precertification, you will need to obtain an updated precertification from Aetna. More information about this process will be communicated in the coming weeks.

 

Q7:Will my Copays change under Aetna?

 

A7:Yes, there will be a positive change to your in-network copays. Beginning January 1st 2027, the copay for all in-network PCPs will be $20, and the copay for all in-network specialists will be $25. There will no longer be a differential between designated and non-designated providers. The same copay will apply to all in-network providers.

 

Q8:Will my Out of Network Deductible or Out of Pocket Maximum change under Aetna?

 

A8:No, there is no change to your Out-of-Network Deductible or Out-of-Pocket maximum.

 

Q9:Will my Pharmacy benefits change under Aetna CVS?

 

A9:No, your Pharmacy benefits and Copays will remain at their current levels with Aetna CVS

 

Q10:Will I need to update prescriptions on file at my retail pharmacy?

 

A10:No. You will only need to provide the pharmacy with your new Aetna CVS ID card on your first visit after January 1.