Special Notes for Filling out Aetna Application If YOU ALREADY HAVE INSURANCE Waiver (Mandatory) – if you currently have insurance through Shared Market Plan or your spousal insurance plan you may waive out of our group plan. Please sign section B on the application form and provide your insurance information. Return to Debbie DeMarco at 223 Pine Cliff Dr., Wilmington, DE 19810 or fax to 302-397-2698. Please remember to Xerox a copy of your insurance card and send it with the waiver.
Be specific when filling out the Waiver in identifying why you choice to Waive out of MNS Group Insurance Plan. Examples: Spousal Coverage, Shared Market Plan, No Coverage etc...
IF YOU ARE APPLYING FOR INSURANCE FOLLOW THE GUIDELINES BELOW
See Monthly Premium Fees section below. ALL applications must be submitted with a check made out to Mortgage Network Solutions, LLC in the amount of 3 months premium. See note below.
Section C – check mark Medical - check mark Health Network Option. In the Plan Option write in the provided line 3.4. Dental - Plan Number: Option 4. Plan Name: DE PPO Max 1000.
Section D – Please be sure to fill out information for yourself and any other person you are including for coverage. Be sure to provide the PCP Provide ID and Dental ID numbers. These can be found on Aetna's website under Doc Find (more information below).
Section F - Dependent Information
Section G – J – Do Not fill In
Sign page 4 of the application and mail the original to Debbie DeMarco at MNS, 223 Pine Cliff Drive, Wilmington, DE 19810. You can fax me a copy to 302-397-2698. It is important that I have a clear copy to process your application. Be sure to keep a copy for yourself.
HOW TO ACCESS AETNA WEBSITE TO OBTAIN PROVIDERS AND ID#’S
Physician/Hospital/Services - Under Aetna Open Access Plans choice: Aetna Health Network Option (Open Access)
Dental Providers - Under Dental PPO/PDN with PPO II Network choice: Aetna Health Fund/Aetna Dental Fund with PPO II Network
Monthly Premium Fee IMPORTANT Note: MNS will hold 2 months premium in reserve – each application must be accompanied with a check made out to Mortgage Network Solutions in the amount of 3 months premium (1 month for current months coverage, 2 months to be held in reserve). MNS must receive a check by the first of each month to cover the monthly premium. If you have a closing we can deduct your premium from that payroll but you must communicate this to Corporate Office.
Effective: 8/1/15 Medical/RX- Premiums are calculated per enrolled member - See Attached Chart
DE Silver HNOption 2000 100/50
How to calculate Premium for Medical/RX: each enrolled member 21 and over will calculate their individual premium. Rates apply to the oldest 3 children under 21 per family.
Employee age 50 – 651.77