Aetna Dental

Deductible

100

Claim Information:
Charged amount: $150
Deductible already met: $0

Plan Benefit Information:
Deductible: $50

Deductible applied to this claim___                Amount of deductible left ___

Deductible applied to this claim $50              Amount of deductible left $0

200

Claim Information:
Charged amount: $75
Deductible already met: $30

Plan Benefit Information:
Deductible: $100

Deductible applied to this claim___                Amount of deductible left ___

Deductible applied to this claim $70              Amount of deductible left $0

300

Claim Information:
Charged amount: $250
Deductible already met: $50

Plan Benefit Information:
Deductible: $50

Deductible applied to this claim___

Amount of deductible left ___

Deductible applied to this claim $0                Amount of deductible left $0

400

Claim Information:
Charged amount: $1,000
Deductible already met: $50

Plan Benefit Information:
Deductible: $100

Deductible applied to this claim___

Amount of deductible left ___

Deductible applied to this claim $50

Amount of deductible left $0

500

Claim Information:
Charged amount: $25
Deductible already met: $25

Plan Benefit Information:
Deductible: $100

Deductible applied to this claim___

Amount of deductible left ___

Deductible applied to this claim $25

Amount of deductible left $50

Plan Sponsors PSPP

100

GRP 812310 What is the Plan Sponsor Name

State of New Jersey SHBP-SEHBP

200

GRP 863273 What is the phone number for BENEFEDS

BENEFEDS- HR for Federal

877-888-3337

300

What is the group number for Plan Sponsor PSEG? 

101938

400

GRP 812310 What is the Plan Sponsor Name. When is Open Enrollment for the Educators 2027 benefit year.

The New Jersey State Educators Open Enrollment will run from 10/26/26-10/31/26 for the 2027 benefit year.  

500

GRP 101938 Plan PB.. are all payments required to go to the member or can Aetna pay the provider? 

 “This is a direct member reimbursement plan.  There is no deductible and the plan maximum is $XXXX.00 per family.   All eligible charges are covered at 80% after an initial $250 is paid and there are no frequencies.  All benefit payments are issued to the member”     You can also answer any questions they may have.

Dental Plans

100

What plan requires a PCD Assignment? 

DMO

200

This is a PPO plan but has not OON Benefits

EPP

300

This is NOT an insurance plan.

Vital Savings

400

The major differences between a standard dental plan and a pediatric dental plan include:

• Out of pocket maximums rather than annual dental maximums
• Combined deductibles and out of pocket maximums with medical
• When the out-of-pocket maximum is met, the system will automatically pay benefits at 100%.
• Orthodontics limited to medically necessary treatment

Pediatric Dental Plan

500

I need to help a member with the Aetna.com Member portal. Where can I go to view into the members' personalized Aetna Member Website. 

IAM Admin Portal

Call Guidelines

100

What is the correct Greeting? 

Thank you for calling Aetna Dental. My name is ..... I'll be your customer advocate today. How can I help you? 

200

How do I ask a caller for permission to place them on hold.

Can I place you on hold for 2-3 minutes/3-5 minutes while I research this for you? 

300

If a caller asks you to hold for a reason not about fix of the call... what should you do? 

Ask them what the expected hold time is.. 

1-2 mins - tell them you can only hold for a few mins due to high call volume. 

400

What's the correct way to offer the survey at the end of each call? 

(Member Name), do you have a minute to take a brief survey?

If Yes – say -The survey is based on your experience with me on this call, 5 is a good response and shows that I was able to assist and resolve your concerns.

500

What will you do if a caller requests a specific CSR.

CS Toolbar - DT&R (Dental Tools and References) - Workflows 

HIPPA

100

Where on the CS Toolbar can I find more information about Confidentiality. 

CS Toolbar > e.Policies > Confidentiality.

200

Examples of Personally Identifiable Info (PII) include...

Names

Social Security Numbers

Addresses

300

What is PHI? 

Is information about members including demographic information collected from the member, that can reasonably be used to identify a member and that relates to their past, present or future physical or mental health condition. Protected health information is also information about the provision of health care or the payment for that care.

400

There are five components of HIPAA Administration Simplification and Privacy:

1. Standardized Electronic Transactions - Requires adoption of certain EDI transaction standards for eight administrative and financial healthcare transactions (e.g., claims/encounter, payment/remittance, COB, eligibility, etc.). 
2. Standardized Code Sets - Code sets will be standardized for ADA, CPT, HCPCS, ICD-9, etc. 
3. Unique Identifiers - National standardized identifiers for health care providers, employers, etc. (Tax ID, EIN, etc.). 
4. Security - Applies to health information that is stored or transmitted electronically and requires all parties to maintain reasonable and appropriate administrative, technical and physical safeguards for confidentiality and protection of information. 
5. Privacy - Several provisions that focus on the privacy of members' protected health information.

500

Which Act protected an individual's financial and insurance information and addressed the disclosure of individually identifiable information by financial and insurance institutions 

The Gramm-Leach-Bliley Act of 1999