Call Member Services
You can call us at 1-844-362-0934 (TTY: 711). We’re here 8 AM to 8 PM, 7 days a week.
What’s covered?
We want to help you live your best life. That’s why we cover services to help you reach your health goals. We have experience that you can count on. And we’re always ready to help you on your path to better health. Check the Summary of Benefits to see an overview of benefits and services offered.
Learn more about your plan
The Evidence of Coverage is a great resource. It has everything you need to know about your health plan. You’ll also find phone numbers, addresses and much more.
More than standard benefits
Living your best life means taking care of the whole you. See all the ways we can support your health, now and in the future. You can enjoy much more than the standard benefits that Medicare and NJ FamilyCare (Medicaid) offers.
For members with a qualifying chronic condition, the plan provides a $240 monthly (up to $2,880 annually) allowance to help pay for every day expenses including:
- Healthy food
- Over-the counter (OTC) items
- Transportation
- Utilities
- Personal care items
Members without a qualifying chronic condition, can use the monthly allowance to purchase OTC items.
The monthly benefit amount will be available on the card the first day of each month. Be sure to use the full benefit each month because any unused amount will not roll over into the next month.
Please see the Evidence of coverage for a listing of chronic conditions.
Important: Plan not responsible for lost or stolen cards or fees associated with late utility payments.
Call Member Services at 1-844-362-0934 (TTY: 711), 8 AM to 8 PM, seven days a week for help in finding a provider.
New for 2024
$305 monthly (up to $3,660 each year) allowance to help pay for everyday expenses, like:
- Over-the-counter (OTC) items
- Healthy food
- Utilities (including internet and cell service)
- Transportation (including public transit, services like Uber or Lyft, and gas at the pump)
- Rent or mortgage
- Personal-care supplies
2024 OTC catalog — English (PDF)
Our plan covers up to 14 home-delivered meals over a 7-day period after being discharged from an Inpatient Acute Hospital, Inpatient Psychiatric Hospital or Skilled Nursing Facility to home. Upon discharge, you will be contacted by NationsBenefits to schedule delivery.
Call Member Services at 1-844-362-0934 (TTY: 711), 8 AM to 8 PM, seven days a week for help in finding a provider.
Our plan covers up to 28 home-delivered meals over a 14-day period after being discharged from an Inpatient Acute Hospital, Inpatient Psychiatric Hospital or Skilled Nursing Facility to home. Upon discharge, you will be contacted by NationsBenefits to schedule delivery.
Call Member Services at 1-844-362-0934 (TTY: 711),), 8 am to 8 pm, seven days a week for help in finding a provider.
Our plan provides you with a $150 allowance every year for purchasing certain clinically appropriate home and bathroom safety devices that can help you manage physical impairments and improve your ability to move safely around your home.
Covered items will be shipped directly to you. You will be responsible for installation and assembly. There is a limit of 3 orders per year, even if you have not exceeded the annual allowance
Call Member Services at 1-844-362-0934 (TTY: 711), 8 AM to 8 PM, seven days a week for help in finding a provider.
New for 2024
Our plan provides you with a $150 allowance every year for purchasing certain clinically appropriate home and bathroom safety devices that can help you manage physical impairments and improve your ability to move safely around your home.
Covered items will be shipped directly to you. You will be responsible for installation and assembly. There is a limit of 3 orders per year, even if you have not exceeded the annual allowance.
Call Member Services at 1-844-362-0934 (TTY: 711),, 8 am to 8 pm, seven days a week for help in finding a provider.
SilverSneakers® is a fitness program. You can use fitness centers and attend classes at no cost. Find a SilverSneakers spot near you.
It’s never too late to get active with healthy exercise. Your fitness benefit can help improve your overall health. You can also learn to make healthier choices. This benefit includes:
- Membership at a fitness club or exercise center through a fitness center network
- Orientation to the fitness center and its equipment
- Access to the SilverSneakers website and a phone number for customer service and support
- At-home fitness kits for members who don’t live near a fitness center that takes part in SilverSneakers or for those who prefer to exercise at home
- Mental Fitness – Topics Include New Skills, Organization, Self Help and Staying Connected
- Health and Wellness – Topics include Cooking, Food & Nutrition, and Proactive Care
- GetSetUp classes on any device by logging in at SilverSneakers
Apple Fitness+℠ subscription
This is an award-winning fitness subscription service designed to help you live healthier. The service encourages you to exercise anytime, anywhere, no matter where you are on your fitness journey. You can choose from the full library of Fitness+ content. This includes workouts and meditations from 5 to 45 minutes with 11 workout types.
Activate your Fitness+ subscription through:
- Your SilverSneakers member account
- The SilverSneakers GO™ mobile app
Once you activate your subscription, you can use Fitness+ on iPhone®, iPad®, Apple TV® or Apple Watch®. With Apple Watch, you can take your motivation to the next level with:
- Personal, real-time metrics that display on iPhone, iPad, and Apple TV
- Access to Time to Walk®, Time to Run℠, and meditations (Apple Watch paired with AirPods or other Bluetooth® headphones)
Call Member Services at 1-844-362-0934 (TTY: 711), 8 am to 8 pm, seven days a week for help in finding a provider.
SilverSneakers® is a fitness program. You can use fitness centers and attend classes at no cost. Find a SilverSneakers spot near you.
It’s never too late to get active with healthy exercise. Your fitness benefit can help improve your overall health. You can also learn to make healthier choices. This benefit includes:
- Membership at a fitness club or exercise center through a fitness center network
- Orientation to the fitness center and its equipment
- Access to the SilverSneakers website and a phone number for customer service and support
- At-home fitness kits for members who don’t live near a fitness center that takes part in SilverSneakers or for those who prefer to exercise at home
- Mental Fitness – Topics Include New Skills, Organization, Self Help and Staying Connected
- Health and Wellness – Topics include Cooking, Food & Nutrition, and Proactive Care
- GetSetUp classes on any device by logging in at SilverSneakers
Apple Fitness+℠ subscription
This is an award-winning fitness subscription service designed to help you live healthier. The service encourages you to exercise anytime, anywhere, no matter where you are on your fitness journey. You can choose from the full library of Fitness+ content. This includes workouts and meditations from 5 to 45 minutes with 11 workout types.
Activate your Fitness+ subscription through:
- Your SilverSneakers member account
- The SilverSneakers GO™ mobile app
Once you activate your subscription, you can use Fitness+ on iPhone®, iPad®, Apple TV® or Apple Watch®. With Apple Watch, you can take your motivation to the next level with:
- Personal, real-time metrics that display on iPhone, iPad, and Apple TV
- Access to Time to Walk®, Time to Run℠, and meditations (Apple Watch paired with AirPods or other Bluetooth® headphones)
Call Member Services at 1-844-362-0934 (TTY: 711), 8 am to 8 pm, seven days a week for help in finding a provider.
Need help with non-urgent illnesses and conditions, like allergies, minor injuries or flu? Members have the option to schedule a telehealth visit 24 hours a day, 7 days a week via Teladoc, MinuteClinic Video Visit, or other provider that offers telehealth services covered under your plan.
Members can access Teladoc at Teladoc.com/Aetna or by calling 1-855-TELADOC (1-855-835-2362) (TTY: 711).
Members can find out if MinuteClinic Video Visits are available in their area at CVS.com/MinuteClinic/virtual-care/videovisit.
Need help with non-urgent illnesses and conditions, like allergies, minor injuries or flu? Members have the option to schedule a telehealth visit 24 hours a day, 7 days a week via Teladoc, MinuteClinic Video Visit, or other provider that offers telehealth services covered under your plan.
Members can access Teladoc at Teladoc.com/Aetna or by calling 1-855-TELADOC (1-855-835-2362) (TTY: 711).
Members can find out if MinuteClinic Video Visits are available in their area at CVS.com/MinuteClinic/virtual-care/videovisit.
Do you have questions about your health? Skip the crowded waiting rooms. You can talk to a nurse 24 hours a day, 7 days a week, at no cost to you. They can help you find local providers, understand your medicine and much more. To reach a registered nurse, you can call 1-844-362-0934 (TTY: 711), 24 hours a day, 7 days a week.
You’ll have a supplemental benefit for hair loss that happens as a result of chemotherapy. This benefit isn’t for any other purpose.
You can get coverage for up to $400 each calendar year toward the purchase of a wig. You’ll need to cover any amount above this limit.
Need help finding a wig? You can find a provider in our network that supplies wigs. Under “Search for a specialty,” choose “DME (Durable Medical Equipment).”
Call Member Services at 1-844-362-0934 (TTY: 711), 8 am to 8 pm, seven days a week for help in finding a provider.
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We cover emergency and urgent care worldwide.
You may go to any emergency room if you reasonably believe you need emergency care. You do not need prior authorization and you do not have to be in‑network.
Urgently needed care includes treatment for a health condition that is necessary within 24 hours to prevent the condition from getting worse. You do not need prior authorization and you do not have to be in‑network.
Standard benefits in your plan
Your benefits give you all the support you need to reach your health goals.
Need to see a specialist or have an emergency? You’re covered. You can also get vaccinations and services for preventive care.
We also cover Early and Periodic Screening, Diagnosis and Treatment (EPSDT) for members under 21 years of age. EPSDT covers services such as well-child care, preventive screenings, medical examinations, vision and hearing screenings and services, immunizations, lead screening, and private duty nursing services.
Need help finding a provider? You can find a provider online. Or call us at 1-844-362-0934 (TTY: 711). We’re here 8 AM to 8 PM, 7 days a week.
Your behavioral health needs are important to us. Mental illnesses are medical conditions that can disrupt your thinking, feeling, mood and daily functioning. The use of alcohol, some prescription medicines or other drugs may affect your health. So we offer coverage for a variety of services, such as:
Inpatient and outpatient mental health services and substance use disorder treatments
Short-term substance use disorder residential services
Mental health rehabilitation
Need to learn more? Just visit our page on behavioral health.
Under certain circumstances, there may be coverage for limited medically necessary emergency transportation needs.
Your provider may need to send medical orders or help coordinate your rides.
Need help setting up your ride? Just call us at 1-844-362-0934 (TTY: 711). We’re here from 8 AM to 8 PM, 7 days a week.
Getting routine eye exams is an easy way to keep your eyes healthy. You don’t need a referral when you see a provider in our network.
MARCH Vision manages your vision benefits, including:
Routine and diagnostic exams
Eyeglasses
Contact lenses
Need help finding a provider? You can find one on the MARCH Vision website. Or call us at 1-844-362-0934 (TTY: 711). We're here from 8 AM to 8 PM, seven days a week.
LIBERTY Dental manages your dental benefits. As a member, you’ll get routine and comprehensive coverage for services, like:
Exams
X-rays
Cleanings
Fluoride treatments
Dentures (artificial teeth and gums)
Periodontal (gum disease) services
Fillings
Crowns
We also have providers that can help children who are members of the plan maintain good oral health habits and dental safety. These providers can also treat dental emergencies.
Need help finding a dentist? You can find a dentist online. Or call us at 1-844-362-0934 (TTY: 711). We're here from 8 AM to 8 PM, seven days a week.
As a member, you’ll get coverage for:
Routine and diagnostic exams
Hearing aids, fittings and accessories
Need help finding a provider? You can find a provider online. Or call us at 1-844-362-0934 (TTY: 711). We’re here 8 AM to 8 PM, 7 days a week.
Some conditions call for a little extra care. We can help you manage your condition and live a healthier life. You can get care for chronic conditions like these and others:
Diabetes
Chronic obstructive pulmonary disease (COPD)
Congestive heart failure (CHF)
You can learn more about caring for chronic conditions. Just visit our page on chronic disease management.
Do you need help getting care? Through our care management program, we’ll work with you to help you get the care you need. Care Managers are Nurses and Social Workers who understand your health conditions and help connect you to the right care. A Care Manager can teach you more about your health, help you find a ride to your appointments and more.
Need help or have questions? You can call your Care Manager directly. Or call us at 1-844-362-0934 (TTY: 711). We’re here 8 AM to 5 PM, 7 days a week.
Need help finding a provider? Just call us at 1-844-362-0934 (TTY: 711). We’re here 8 AM to 8 PM, 7 days a week.
As a member, you’ll get coverage for:
Routine exams
Medically necessary foot care
Therapeutic shoes or inserts for those with severe diabetic foot disease, plus exams for fittings
Need help finding a provider? Just call us at 1-844-362-0934 (TTY: 711). We’re here 8 AM to 8 PM, 7 days a week.
Do you have questions about your health? Skip the crowded waiting rooms. You can talk to a nurse 24 hours a day, 7 days a week, at no cost to you. They can help you find local providers, understand your medicine and much more. To reach a registered nurse, you can call 1-844-362-0934 (TTY: 711), 24 hours a day, 7 days a week.
Need help finding a provider? Just call us at 1-844-362-0934 (TTY: 711). We’re here 8 AM to 8 PM, 7 days a week.
We make it easy to get the medicine you need to feel better. There are no copays or deductibles when your medicine is on our List of Covered Drugs (Formulary), also known as the Drug List. This is a list of the medicines we cover.
If you don’t see your medicine on the list, your Provider will help you find one that’s similar. You can fill your prescription at any pharmacy in our network. To learn more, just call us at 1-844-362-0934 (TTY: 711). We’re here 8 AM to 8 PM, 7 days a week.
Learn more about your pharmacy benefits
Download the list of medicines we cover
Need help finding a provider? Just call us at 1-844-362-0934 (TTY: 711). We’re here 8 AM to 8 PM, 7 days a week.
Managed Long Term Services and Supports (MLTSS)
Sometimes, you need extra care to feel healthy. If you meet certain clinical and financial requirements, you may be eligible for MLTSS. Get assistance with everyday tasks like taking a bath, getting dressed, making food and taking medicine. Get care where and when you need it.
Need help with your options? You can get help.
Call the state
Just call your State Health Insurance Assistance Program (SHIP) at 1‐800‐792-8820.
Call Medicare
You can also call Medicare at 1‐800‐633‐4227 (TTY: 1-877-486-2048). Someone can help you 24 hours a day, 7 days a week. Or visit Medicare.gov to learn more.
When joining this plan:
- You must use in-network providers, DME (Durable Medical Equipment) suppliers, and pharmacies.
- You will be enrolled automatically into Medicaid (NJ FamilyCare) coverage under our plan, and disenrolled from any Medicaid (NJ FamilyCare) plan you are currently enrolled in. All of your Medicaid-covered services, items, and medications will then be covered under our plan, and you must get them from in-network providers.
- You will be enrolled automatically into Part D coverage under our plan, and you will be automatically disenrolled from any other Medicare Part D or creditable coverage plan in which you are currently enrolled.
- You must understand and follow our plan’s rules on referrals.
SilverSneakers is a registered trademark of Tivity Health, Inc. SilverSneakers GO is a trademark of Tivity Health, Inc, © 2023 Tivity Health, Inc. All rights reserved.
iPhone, iPad, Apple TV, Apple Watch and Time to Walk are registered trademarks of Apple Inc., registered in the U.S. and other countries. Apple Fitness+ and Time to Run are service marks of Apple Inc.
Bluetooth is a registered trademark of Bluetooth SIG, Inc.