Review the Aetna provider directory or Aetna pharmacy directory*, based on the providers, clinics, facilities and pharmacies that are contracted with Aetna.

To search for your provider, facility or clinic, go to the Aetna provider directory.

To search for your pharmacy, go to the Aetna pharmacy directory.

All Providence-employed providers and facilities are in-network, even if you do not see them in the provider directory.

Some Providence and affiliated providers may not be listed in the provider directory as they are in the process of contracting with Aetna and will be added to the provider directory as they are contracted.

If you do not find your provider in the directory, we recommend that you call the Aetna Service Advocate team to double-check if the provider is in-network. For assistance with a provider or pharmacy directory search, call the Aetna Service Advocate team at 833-529-1661 (TTY: 711), weekdays, 8 a.m. to 6 p.m. Pacific Time through Dec. 31, 2024, then 24/7 beginning Jan. 1, 2025.

*Important: The provider and pharmacy directories are subject to change at any time.

If you or your enrolled family member are receiving active medical treatment that will continue into 2025 for health conditions such as cancer, transplant or the third trimester of pregnancy and your provider is not in-network with Aetna for 2025, you may be eligible for a transition of care. The Transition of Care Request form and frequently asked questions will be available at the end of November.

You can also ask your provider if they are interested in joining the Aetna network. If the provider is interested, call the Aetna Service Advocate team at 833-529-1661 (TTY: 711) to request that Aetna reach out to your provider.

The Aetna Service Advocate team will not have access to your personal information or 2025 benefits enrollment data until December 2024. However, we are able to answer plan coverage questions for the plans that will be administered by Aetna beginning Jan. 1, 2025.

A prescription drug formulary is a list of medications that are eligible for coverage under a prescription drug plan, subject to the plan’s provisions.

You can use the Aetna prescription drug formulary tool to find out if your medication is covered on the Aetna prescription drug formulary.*

*Important: The prescription drug formulary is subject to change at any time.

In the Aetna formulary, there is an icon next to each medication name. Click on the icon by your medication and dosage, and you will see the list of status definitions (pictured below) to identify the one associated with your medication. This can be used to review the coverage level available under your plan’s provisions.*

*Important: The prescription drug formulary is subject to change at any time.

Specialty medications, including Specialty-Preferred (SP-P) and Specialty-Non-Preferred (SP-NP), require a prior authorization. If the drug has an SP-P or SP-NP icon in the prescription drug formulary*, then a prior authorization will be needed. You will receive a personalized letter from Aetna regarding where you can fill your specialty medications beginning Jan. 1, 2025. There is no form to complete for a prior authorization—your provider should initiate a prior authorization request directly with Aetna CVS for pharmacy.

*Important: The prescription drug formulary is subject to change at any time.

2025 ID cards have been sent to caregiver homes. Aetna issues a family ID card listing all covered family members (up to five names per card, families of six or more will be issued additional cards).

If you need to request the separate ID card to use for the 100% coverage of certain women’s reproductive health services mandated by the Affordable Care Act, contact the Aetna Service Advocates 24/7 at 833-529-1661.

To access your electronic ID cards immediately, you can set up your member portal at Health.Aetna.com. Once you set up your Aetna member portal, you’ll have access to your digital ID cards (regular ID card and the reproductive health services ID card).

Bring your ID card to each of your first provider* and pharmacy visits in 2025 and let your provider’s office or pharmacy staff know that you have a new ID card. Additionally, you can set up your Aetna Health account at Health.Aetna.com using your member number on your ID card.

*Caregivers enrolled in the Blue Shield HMOs in Southern California will use their Aetna ID card for prescription drug benefits beginning Jan. 1, 2025. You will use your Blue Shield ID card for medical benefits in 2025

You can register at Health.Aetna.com after you receive your new member ID card in late December. Or you can register via the free Aetna Health app—it’s available to download for Apple and Android products.

We recommend that you register on or after Jan. 1, 2025, so that you have access to the full range of Aetna resources that will be available to you beginning Jan. 1.

If you register prior to Jan. 1, you will not yet have access to most of the information and resources but will have access to the digital medical/prescription drug ID card.*

*Caregivers enrolled in the Blue Shield HMOs in Southern California will have access to their prescription drug benefits and digital prescription drug ID card and will be able to get help finding a pharmacy and comparing medication costs. Your medical plan information will continue to be available through Blue Shield of California.

Beginning Jan. 1, 2025, you will have full access to Health.Aetna.com (or the Aetna Health app) and can:

• Review information about your medical/pharmacy benefits*
• View and submit claims and review electronic copies of your Explanation of Benefits (once the claim is processed)
• View your digital medical/prescription ID card*
• View the provider/pharmacy directories, as well as the ability to compare costs*
• View your prior authorizations
• Access health & wellness information, tools and resources

*Caregivers enrolled in the Blue Shield HMOs in Southern California will have access to their prescription drug benefits and digital prescription drug ID card and will be able to get help finding a pharmacy and comparing medication costs. Your medical plan information will continue to be available through Blue Shield of California.

If they are currently enrolled in your medical plan and you had certified their disability with the current medical plan administrator, no action is needed by you at this time—they will transition to Aetna as a disabled dependent. You may be asked to provide documentation on the dependent’s disability in the future.