91Ô­´´

Resources for non-emergency care for the treatment of colds, flu, rashes, back pain, etc.

• Primary Care ProviderÌýÌý
  • Aetna HMO Plan: Having a PCP is important as he or she will assist you in managing your care with your other health care providers. With access to your complete medical history, he or she knows you best. You are required to have a designated Aetna PCP and obtain a referral from your PCP to see a specialist (with the exception of urgent care, OB/GYN, emergency room and behavioral health visits). The PCP that you selected, or was assigned to you or your family members, is listed on the front of your Aetna ID card.
  • Want to select a different PCP for you or your family members?Ìý
    Log in to or register for your . Or, call Aetna at 1-877-542-3862. Prior to selecting a new PCP, it is important that you check to make sure they participate in Aetna's HMO network and that they are accepting new patients. If you change your PCP, Aetna will send you a new ID card. Be sure to change your PCP with Aetna before visiting a new PCP not listed on your ID card, in order to prevent claims from being denied.
  • Aetna CDH Gold Plan: You are encouraged to have a PCP. With access to your complete medical history, he or she knows you best. Having a PCP is important as he or she will assist you in managing your care with your other health care providers.

• 24-Hour Nurse Line: 1-800-556-1555
• Telemedicine (Virtual Medicine)
  • Customer Service: 1-855-835-2362
  • If you can’t get a quick appointment with your Primary Care Provider (PCP), consider using telemedicine instead of going to an urgent care center or ED. Telemedicine is a service that allows you to have an online video consultation with a doctor whether you are at home or on the go, by using your computer, tablet or smartphone. You can use telemedicine services and speak with a doctor to receive a diagnosis and get recommended treatment for minor illnesses, such as a sore throat, runny nose, or headache. The doctor can even prescribe medications when appropriate.

• Urgent Care - (Medical Aid Units) - For symptoms that are not life threatening, an in-network urgent care facility is an appropriate option if you cannot get a same day appointment with your Primary Care Provider (PCP).

Emergency Room - Use the Emergency Room (ER) only for emergencies. For example, when you have chest pain; severe shortness of breath; fainting, sudden dizziness, weakness; sudden confusion; and uncontrolled bleeding.Ìý

Not sure if you should go to the ER? Contact the 24/7 Nurse Line atÌý800-556-1555.

Lab Work (Blood Work) Services -ÌýSave time and money by having your outpatient lab work (blood work) services completed at in-network non-hospital affiliated preferred labs. Quest Diagnostics and LabCorp are Aetna’s only preferred labs for 91Ô­´´â€¯Aetna members.

Imaging/Radiology Services -ÌýSave time and money by having your outpatient imaging/radiology services completed at in-network non-hospital affiliated freestanding facilities. These facilities provide similar quality as hospital affiliated locations and are often more convenient.

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Lab Services

• HMO Plan - Cost-share for services rendered at Quest or LabCorp typically results in a reduced member cost-share of a $10 copay.
• CDH Gold Plan w/HRA Fund - Member responsibility for lab services is determined after claim processing and may vary based on plan coverage and available HRA funds.

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What to Expect: Requests for Payment

• Quest Diagnostics - Some locations may ask you to place a card on file for any cost share owed. ThisÌýis optional and can be declined at the time of service.
• LabCorp - Some locations may ask you to place a card on file for any cost-share owed. TheÌýinformation provided serves as advanced authorization to charge the amount owed once your claimÌýhas finished processing and a final member cost-share amount has been determined.

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Note: Members should confirm any payment arrangements with the lab at the time of service. Final memberÌýcost-share amounts depend on claim processing and plan details and will be reflected in your Explanation ofÌýBenefits (EOB) once your claim has finished processing. You can view claim details by logging into yourÌýmember website or app or contact your Aetna Concierge Services team at (833) 821-0849.

Outpatient Surgery Services -ÌýSave time and money by having your outpatient surgery services completed at in-network non-hospital affiliated Ambulatory Surgery Centers (ASCs). These facilities provide similar quality as hospital affiliated locations and are often more convenient.

To save you money, please consider Lantern for non-emergency, planned surgeries.

The Lantern benefit is a comprehensive surgical program that provides a personalized concierge experience from dedicated Care Advocates and access to excellent health care through a network of credentialed Surgeons of Excellence for planned, non-emergent surgeries. Enrollment in the Lantern benefit is automatic for individuals enrolled in a 91Ô­´´ Aetna or Highmark Delaware non-Medicare health plan.

Their goal, in partnership with the 91Ô­´´, is to simplify the surgical process from start to finish - from helping schedule appointments to eliminating medical bills related to your care. The credentialed surgeons undergo a rigorous evaluation process to assure that you receive high-quality care from specialists who excel in the area related to your needs. Lantern negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings for the 91Ô­´´.

Using the Lantern benefit for your planned, non-emergent surgeries saves you money by reducing your financial responsibility and removing deductibles, copays, and coinsurance amounts. Some surgeries and procedures may even include a financial incentive and travel benefits, when applicable.

High-quality facilities with better outcomes, fewer complications and readmissions for specific procedures – Orthopedic, Spine, Bariatric and Transplants

Aetna has designated certain health care facilities within their provider network as Centers of Excellence, or simply COE Facilities. COE Facilities have been identified as delivering high quality services and superior outcomes for specific procedures or conditions. This means improved outcomes and reduced cost, which includes delivering surgery and post-operative care more efficiently and with lower risk of complications and readmissions. Get the quality of care you and your family deserve!

Aetna Institutes Gene-Based, Cellular and Other Innovative Therapies (GCIT) Designated Network

The GCIT Designated Network is the Aetna participating network for certain gene therapy services. Providers that offer GCIT services and have met criteria are designated to participate in the Aetna Institutes® GCIT designated network. The GCIT network helps members who have been diagnosed with certain genetic conditions that may be treated with the use of innovative-FDA-approved GCIT products.

GCIT services must be provided by a Ìýto be covered through your Aetna HMO or CDH Gold plans. This means that providers who do not contract to be part of the GCIT designated networks for specific GCIT services are out of network and there is no coverage under your State of Delaware Group Health Insurance Plan (GHIP) medical plans administered by Aetna.

These services require precertification. Current GCIT designated services include Luxturna, Spinraza and Zolgensma. This list of GCIT designated services is subject to change.

If you have questions about GCIT services and participating providers, please contact Aetna One Advisor at 1-877-542-3862.

Perimenopause and Menopause

Midi Health has a national network of licensed clinicians specializing in women's midlife hormonal changes. They provide expert virtual care for perimenopause and menopause. Clinicians are licensed nurse practitioners, doctors, nurse midwives and naturopathic doctors who specialize in midlife health. Each patient receives a personalized care plan to help them manage symptoms and overall health.

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Learn more