Helpful Tips for Aetna Plan Members

** The HealthWorks website is a one-stop shop where all of Aetna's many websites and extensive online services are collected and organized in one location. The site is a gateway for all McClatchy employees who have joined –- or are considering joining –- one of the three Aetna medical plans offered.

** Diabetic strips and other diabetic supplies are covered as prescription drugs. Test strips will be covered as brand non-formulary (Tier 3) unless you use the recommended One Touch or Precision brand test strips. For more information, refer to page 20 of the Aetna Preferred Drug Guide, which employees can access from the HealthWorks website. Click on the "Prescription Drug Formulary" link at the top of the menu bar.

** Check the Aetna Preferred Drug Guide to determine if your current medication requires pre-certification or step therapy before you need a refill. Pre-certification means the drug requires prior approval, and your doctor must call Aetna and provide appropriate clinical information to get the drug approved for coverage. Step therapy means you must try other drug alternatives before the drug will be approved. If you have already gone through step therapy with either Blue Shield or Kaiser, and your drug requires step therapy under Aetna, you may not necessarily have to complete the process again. Have your doctor contact Aetna’s pharmacy services at (800) 414-2386 to provide the necessary clinical information for approval.

** Employees can take steps to reduce prescription drug costs. Check the Aetna Preferred Drug Guide for less costly alternative medications, and ask your doctor about them. Employees can also use the Aetna Rx Home Delivery program to fill maintenance drugs. Maintenance drugs are drugs taken for chronic conditions. Through Aetna RX Home Delivery, members can receive up to three months of drugs for only two months of co-pays. To use the mail-order program, send the prescription order form and co-pay to the Aetna Rx Home Delivery. Check if your drug requires pre-certification or step therapy and that appropriate approval has been obtained before sending in your prescription.

** The Aetna Navigator website is now available to all Aetna members. Members will need to register to use this secure site and will need to select a username and password. Human resources personnel recommend that you use your e-mail address as the username. The password has to contain both numbers and letters and must contain at least six characters. On the Aetna Navigator website, you can research the price of a drug and identify less-costly alternatives, contact Aetna Member Services, request a temporary ID card, change a Primary Care Physician and check the status of a claim. Aetna enrollees should register for the website now. Only those claims incurred after registration will be accessible online. The Aetna Navigator link is available from the HealthWorks website.

** Another useful Aetna website is the "Simple Steps To A Healthier Life." This site, too, is available from the HealthWorks website under the link "Health Risk Assessment."

Simple Steps To A Healthier Life is an interactive health and wellness program that can help improve and maintain your health in ways that best fit your lifestyle. A health risk assessment survey is available on this site. Once you complete the survey, you will receive tailored Health Reports and a one-page Health Summary report. Additionally, the website will provide links to articles specific to your health issues.

** To access mental health benefits, employees must call the Aetna Behavioral Health group for authorization. The phone number, which is printed on the back of your ID card, is (800) 424-4047. If you are in the Aetna Select plan, you do not need a referral from your Primary Care Physician, but you must use an in-network provider and get pre-approval from the Aetna Behavior Health group for your services to be covered. If you belong to the Aetna Choice or Aetna Routine Care plan, you must call the Aetna Behavioral Health group for pre-approval for in-network coverage. If you use an out-of-network provider, you do not need to call.

** The Summary of Coverage booklets, also called the Summary Plan Descriptions, for all three Aetna plans are available online at the HealthWorks website in PDF format. These booklets describe benefits in detail and also specify any plan requirements pertaining to coverage. Click on the binoculars icon on the PDF toolbar to search by topic.