![]() In-Network providers can update their Tax ID by clicking on Contact and then selecting Practice changes/Provider termination from the list. If you’re already in our network, you can’t use this form to update your Tax ID.If you have multiple Tax ID’s, you only need to complete this form once for your primary service location to initiate your contracting and credentialing process.Midwife, Nurse Practitioner, Physician Assistant. Under the “specialty” question on the form, please refer to the instructions for non-physicians to select their “provider type” from the pull down menu e.g. If you are a midlevel provider complete the “medical request for participation” form.Helpful Tips to consider before completing request for participation: Note – not all plans and offers available in all markets.Please complete this form if you’re interested in joining Aetna's network and you are a medical health care professional, physician or non-physician. Special promotions including, but not limited to, additional months free are not available to California residents or on Fully Insured Plans. Note – not all Aetna dental plans and offers available in all markets. We encourage you to check with your participating provider prior to beginning treatment. You will receive the discount off the provider’s usual and customary fees when you pay. Since there is no paperwork or reimbursement, you must pay for the service at the time it’s provided. To check that your provider participates, visit our website or call us. The dental discounts are available through participating healthcare providers only. Please consult with the respective plan detail page for additional plan terms. Aetna dental plans are not considered to be qualified health plans under the Affordable Care Act. Website to obtain participating providers: .Īetna Dental Savings Plans are NOT dental insurance and the dental savings will vary by provider, plan and zip code. Discount Plan Organization: New Benefits, Ltd., Attn: Compliance Department, PO Box 803475, Dallas, TX 75380-3475, 80. MD Residents: The membership fee and one-time application fee (minus $5.00) will be refunded if cancelled within the first 30 days and upon return of the discount card. ![]() UT, AR and TN residents: A refund of all fees will be issued if membership is cancelled within the first 30 days. Member shall receive a reimbursement of all periodic membership fees if membership is cancelled within the first 30 days after the effective date. The range of discounts for medical or ancillary services provided under the plan will vary depending on the type of provider and medical or ancillary service received. This discount card program contains a 30 day cancellation period, provides discounts only at the offices of contracted health care providers, and each member is obligated to pay the discounted medical charges in full at the point of service. The plan member is obligated to pay for all healthcare services but will receive a discount from those healthcare providers who have contracted with the discount plan organization. This plan does not make payments directly to the providers of medical services. ![]() This plan provides discounts at certain healthcare providers for medical services. The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under the Affordable Care Act or Massachusetts M.G.L. ALIC does not provide dental care or treatment and is not responsible for outcomes. Dental providers are independent contractors and not employees or agents of ALIC or its affiliates. Neither ALIC nor any of its affiliates is an affiliate, agent, representative or employee of discount program. Neither ALIC nor any of its affiliates offers or administers the discount program. This network is administered by Aetna Life Insurance Company (ALIC). ![]() The discount program provides access to the Aetna Dental Access® network. * Actual costs and savings may vary by provider, service and geographic location. ** According to the Aetna Enterprise Provider Database as of September 2012. ![]()
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