Removal of Annual/Lifetime Limits:

• CardiacRehabilitation: Currently limited to 36 days per calendar year.
• Hospice: Currently limited to 360 days per lifetime.
• Residential Treatment: Currently limited to 60 days per calendar year.
• Habilitative Services: Currently limited to 100 visits in combination of other services.
• ABA and Autism: Currently limited to 100 visits in combination of other services per year.
• Respiratory Rehabilitation: Currently included with short term rehab 60 visit limits per calendar year.
• Nutritional Counseling: Currently included with a visit limit of 3 outpatient visits per year.

Modified Benefits effective January 1, 2026:

Maternity Benefit (Advantage HMO/POS)

• Currently, first visit $50 copay. Reduction in copay, will follow specialist copay $40.

Imaging: CT/PET Scans, MRIs, etc.

• $750 copay/visit at Hospital setting. (No charge at Jackson Health System Provider)

Durable Medical Equipment (DME)

• Currently $50 copay per episode of illness or orthotic supplies.
• To be administered at $5 copay for DME and orthotic supplies.

Others

• Infusion Therapy Outpatient Facility: Current copay $0, will follow a $15.
• Gene, Cellular and Innovative Therapies: Current copay $0, will follow a $15

You’ll now have access to value added benefit programs, a broader network of providers, and improved member services, all designed to support your health and well-being. Aetna’s offerings are well-positioned to deliver a high-quality health care experience now and into the future.

How to get Aetna Resources and Support:

Need Help? Ask Aetna Miami-Dade Aetna Onsite Representatives

• Phone: (305) 375-5306
• Email: askaetnamdc@aetna.com
• Hours: Monday–Friday, 8:00 AM – 5:00 PM
• Where: SPCC 23rd Floor

More Helpful AETNA Tools

• Aetna Concierge: 833-704-0009
• Miami-Dade County’s Aetna dedicated landing page Resource Hub: https://mdc.aetna.com/home
• Member Website: Health Insurance Plans | Aetna

What should I DO BEFORE receiving treatment?

• Check coverage and benefits
• Find in-network providers
• Understand copays and deductibles
• Get assistance with the Aetna Health app 

You have access to preventive care, treatment for medical conditions, surgeries, and prescription drug coverage. You also have access to added programs designed to improve your well-being. These include:

• Additional care management programs
  Personalized support from a clinical team to help you reach your health goals, with guidance to local resources when needed.
• Enhanced digital tools
  Convenient access to your health information, providers, and wellness resources through web and mobile platforms.
• CVS® ExtraCare Plus® program
  Enjoy a $10 monthly reward to use at CVS locations, plus benefits like no-cost prescription delivery, 20% off CVS Health® brand products, and discounts on everyday items. Contact number: 1-833-704-0009
• MinuteClinic® visits
  Get low-cost access to covered services for minor illnesses, injuries, skin conditions, women’s health needs, vaccines, and preventive care, often at a lower cost than urgent or emergency care.
• CVS Virtual Primary Care®
  Available at select locations, this service offers full primary care at the same cost as in-person visits under your plan, with the convenience of virtual access.
• Lifestyle and Condition Coaching
  If you want to eat better, be more active or take charge of your health, we can help. Our program offers clear, reliable health information to help you make healthy changes. And you can access our program, at your convenience, through our wellness app or online. This program is in addition to the health and wellness coaching services available today.

  • 24/7 web and mobile access
  • Live group-coaching session online
  • One-on-one phone support
• Personal health solutions and virtual solutions
  Programs to help you lose weight, reduce joint pain, support mental well-being, enhance women’s health, physical therapy, manage high blood pressure and stop smoking.

Two family-style ID cards will be mailed to each family.

• If any family member needs an additional ID card, please follow the instructions below to register and print an Aetna ID card.

We understand that especially during the holidays, mail delivery can sometimes be delayed. The good news is you do not have to wait—Aetna makes it easy to access your ID card online and print additional copies whenever you need them.

Aetna makes it easy to access your ID card online and print additional copies whenever you need them.

• Go to the Aetna Member Website:

  • Visit www.aetna.com and log in to your secure member account. If you haven’t registered yet, you can create an account using your Aetna member ID number or the last 4 digits of your Social Security Number.
• Access Your ID Card:

  • On your homepage, look for the “ID Card” option at the top of the page, or
  • Click the “Account” option, then select “ID Cards” from the dropdown, or
  • Under “Plan Overview,” click “ID Cards” under Medical Coverage, or
  • Hover over the “Benefits” tab and select “View ID Cards.”
• View and Print:

  • Your ID card will display on the screen.
  • Click to view the front and back of your card.
  • Select the print option to print a physical copy for your records or immediate use.
• Mobile Access:

  • You can also access your digital ID card on the go using the Aetna HealthSM app, available for download from the App Store or Google Play.

Go to the Aetna Member Website

• Visit www.aetna.com

• Start Registration

  • Click the “Login” button at the top of the page.
  • If you do not have an account, select “Register” or “Register for my account.”
• Enter Your Information

  • Enter your Aetna Member ID number (found on your ID card).
  • If you do not have your Member ID, you may use the last 4 digits of your Social Security Number.
  • Enter your full first name (as it appears on your ID card), last name, date of birth, and home zip code.
• Verify Your Identity

  • Complete the verification steps as prompted.
  • Create security questions and answers for account protection.
• Create Your Account

  • Choose a username (at least 6 characters, including one letter and one number; no spaces or SSN/employee IDs).
  • Set a password and select a security question.
• Agree to Terms

  • Review and accept the website’s terms and conditions.
• Finish Registration

  • Click “Continue” to complete your registration.
  • You can now log in using your new username and password.

How to Find a Provider

• Visit www.aetna.com and and select “Find a Doctor.”
• Under “Don’t have a member account?” Select “Plan from an employer”
• Under “Continue as a Guest,” enter your home location (ZIP code, city, county, or state) to view providers specific to your plan. You can also set a search radius of up to 100 miles.
• Select the appropriate plan option under “Aetna Open Access Plans” using the chart below:

• You can search by provider name, provider type, or category.  Categories include:

  • Medical Doctors & Specialists
  • Hospitals & Facilities
  • Urgent Care & Walk-In Clinics
  • Pharmacies
  • Behavioral Health
  • Labs & Testing
  • Alternative Medicine
  • Durable Medical Equipment
  • Common Procedures & Conditions
  • Institutes of Quality/Excellence

Participating laboratories

• What stand-alone labs can I use Under Aetna? 

  • Both LabCorp and Quest Diagnostics are participating laboratories under the Aetna network.  
• Do I need an appointment for lab work 

  • Quest Diagnostics: Appointments are recommended, but some locations accept walk-ins. 
  • LabCorp: Appointments are strongly encouraged; walk-ins may be limited depending on location 
• Do I need a doctor’s order? 

  • Yes.  Most lab tests require a valid order from your provider. 
• What if I receive a bill? 

  • If you receive a bill, contact the Aetna Dedicated Onsite Team at 305-375-5306, or the Aetna Concierge at 833-704-0009 for assistance regarding your lab bill. 

View results in either list view or map view to explore your options.

Please send an email with the following information to NominateYourMDCProvider@aetna.com

• Your doctor’s name
• The provider’s address
• The provider’s telephone number

Once we receive your email, our team will reach out directly to the provider to begin the nomination process.

If you choose a plan with a national network (not included on the First Choice Advantage HMO plan), you and your family will have access to care across Florida and throughout the country. Whether you're traveling, or have a student living out of the area, you’ll be able to receive care just like you would at home using your Aetna member ID card, with no extra paperwork or special steps required.

Aetna’s network has a 99% provider match, so most members will find that their current doctors are already in the network. In the rare case that your provider isn’t in the network and you’re pregnant or receiving ongoing treatment, you may be eligible for Transition of Care (TOC) coverage.

TOC is temporary coverage designed to help you continue care without interruption while you transition to Aetna. If approved, your provider must use a health care facility, durable medical equipment (DME) vendor, or pharmacy vendor that’s part of the Aetna network.

We’re here to make sure your care continues smoothly, with no gaps. TOC forms are available in English and Spanish to help get the process started.

An active course of treatment is when you have begun a program of planned services with your doctor to correct or treat a diagnosed condition. The start date is the first date of service or treatment. An active course of treatment covers a certain number of services or period of treatment for special situations. Some active course of treatment examples may include, but are not limited to:

• Members who enroll with Aetna beyond 20 weeks of pregnancy, unless there are specific state or plan requirements (Members less than 20 weeks pregnant whom Aetna confirms as high risk are reviewed on a case-by-case basis.)
• Members in an ongoing treatment, such as chemotherapy or radiation therapy
• Members with a terminal illness who are expected to live six months or less
• Members who need more than one surgery, such as cleft palate repair
• Members who have recently had surgery
• Members who receive outpatient treatment for a mental illness or for substance abuse (The member must have had at least one treatment session within 30 days before the effective date on January 1, 2026.)
• Members with an ongoing or disabling condition that suddenly gets worse
• Members who may need or have had an organ or bone marrow transplant  

To be considered for TOC coverage, the course of treatment must have started before your enrollment with Aetna on January 1, 2026.

If you are prescribed a new medication by your physician during the plan year, you will need to check for coverage on the Aetna Standard Formulary. If there is a change to a medication on the formulary you are currently utilizing, you will not be impacted.

Yes. You will be able to fill a 90-day supply of your maintenance medication at any participating retail network pharmacy or through the CVS mail order pharmacy.

Call the Aetna Concierge Team at 833.704.0009 for personalized assistance. You can also call the pharmacy number listed on the back of your Aetna ID card.

Aetna’s network includes over 66,000 pharmacies nationwide, including:

• CVS Pharmacy® (9,800+ locations)
• Major chains like Walgreens, Publix, Walmart
• Most independent pharmacies

For actively employed individuals, you will continue to have access to the plan options you’re familiar with. Plan eligibility is determined by Miami-Dade County.

As outlined by the County, the Advantage plans apply to:

Medical Plan Eligibility by Date of Hire & Bargaining Unit

**POS Advantage is available only to PBA Rank & File/Supervisory employees hired prior to January 1, 2019

The Advantage plans are:

• First Choice Advantage HMO
• Select Advantage HMO
• HMO Advantage
• POS Advantage

For non-bargaining and bargaining employees in GSAF Professional, GSAF Supervisory, and IAFF hired on or after January 1, 2019, and for bargaining employees in AFSCME Aviation, AFSCME Solid Waste, and AFSCME General hired on or after January 1, 2020, Transport Workers Union employees hired on or after January 1, 2021, AFSCME Water & Sewer employees hired on or after July 1, 2021, and PBA Rank & File/Supervisory employees hired on or after January 1, 2022, the following options are available:

• First Choice Advantage HMO
• Select Advantage HMO

Please note: If you select Aetna First Choice Advantage HMO plan, the service area includes Miami-Dade and Broward counties, and care is provided through Jackson Health System and University of Miami facilities. For emergencies that occur outside the service area, you may seek medical services at an emergency room or participating urgent care.

Yes, both Jackson Health System and the University of Miami are participating in the Aetna network.

• Visit the RetireeFirst Miami-Dade County dedicated website: retireefirst.com/miamidadecounty
• For Miami-Dade County Group Plans, call 305.420.5858 or toll-free 833.212.9891, Monday–Friday, 9:00 AM – 5:00 PM EST
• For Individual Medicare Advantage Plans, call 786.640.3292 or toll-free 888.517.6373, Monday–Friday, 9:00 AM – 5:00 PM EST

We are here to help every step of the way. You have access to:

• Aetna MDC Member Microsite https://mdc.aetna.com
• Aetna Concierge Team at 833.704.0009, available Monday–Friday, 8:00 AM – 8:00 PM.

Aetna team members will be available at the Stephen P. Clark Government Center Building. You can visit them Monday through Friday, from 8:00 AM to 4:30 PM for answers to your questions and personalized support.