A department in a health insurance/health benefits company that helps members with questions about plan benefits and exclusions and, if part of a plan, choosing or changing a primary care physician (PCP). It is reached by calling the toll-free phone number on the member ID card.

A group life insurance feature that lets a member or spouse who is diagnosed with a terminal illness or life-limiting medical condition get a percentage of the life benefits as an early payment.

A benefit that is payable to a beneficiary for loss of life or to a member for an accidental injury, as specified in a policy.

Covers the same losses as AD&D, but also pays a benefit for unexpected events that result in the loss of sight, speech and hearing; paralysis; coma; and third-degree burns. In case of loss of life, benefits may also be available for education, child care and return of remains. An additional benefit may be available if the member dies while prop [..]

An employee who works on a regular basis in the usual course of the employer's business. An employee must work at least the number of hours in the employer's normal workweek or the number of hours as shown in the plan's Schedule of Insurance.

The determination by an insurer or health plan of the availability of health insurance or health benefits for a claim and the level of benefit to be paid.

A designation by Aetna for certain specialists who have met certain levels of clinical performance and efficiency.

A federal law that bans unfair and discriminatory treatment in employment on the basis of age.

The maximum benefit that will be paid under the Policy for all Covered Medical Expenses incurred by a Covered Person that accumulate from one year to the next.

Any limit on length of benefits for disabilities related to alcoholism and/or drug addiction.