Aetna Deductible Credit Submission Process
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General Information
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Author: |
Katie Marsh |
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Stakeholders: |
Internal and External |
Benefit Consultants, Client Success Managers, Employees (WSEs), Aetna Member Services |
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Purpose/Scope: |
To ensure consistent, accurate guidance for employees (WSEs) on how to request deductible credit when joining Aetna from another carrier or transferring from one Aetna plan to another within the same calendar year. |
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Systems: |
Aetna Member Portal |
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Effective Date: |
08/01/2025 |
Revision Number: |
1.0 |
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Frequency: |
Annually |
Revision Date |
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Process Overview |
This SOP outlines the options for employees to request deductible credit transfers to their new Aetna medical plan, including submission instructions and common corrections to outdated or conflicting guidance. Out-of-pocket (OOP) maximum credit is not available under Aetna’s policy.
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Process Steps |
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Step |
Task |
Owner |
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1.0 |
Determine eligibility for deductible credit. Must have: (a) switched to Aetna from another carrier within the same calendar year or (b) transferred from one Aetna plan to another. |
Employee |
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2.0 |
Collect required documents: final Explanation of Benefits (EOB) from prior carrier OR (if Aetna-to-Aetna) gather both Aetna member IDs. |
Employee |
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3.0 |
Choose a submission method: Secure Message Portal (preferred), Fax, or Mail. |
Employee |
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4.0 |
Via Secure Message (Preferred for ALL carriers):• Login at https://www.aetna.com/about-us/login.html• Click envelope icon → Messages → Take Me There → New Message• Topic: A claim• Subject line: Deductible Credit Request• Include member ID and explanation in comments• Upload documents (EOB and PEO Deductible Credit Form) |
Employee |
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4.1 |
Fax Option: Fax completed PEO Deductible Credit Form and EOB to: 859-455-8650Include subject line: Deductible Credit Request |
Employee |
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5.0 |
For Aetna-to-Aetna transfers only: call Member Services and provide both member IDs to request rollover. No form or EOB needed. |
Employee |
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6.0 |
Group Name on form should be: Aspen HR (not the client name) |
Employee |
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7.0 |
Allow 7–10 business days for processing. Monitor deductible updates in Aetna portal. |
Employee |
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Additional Information |
PEO Deductible Credit Form: Deductible credit does not apply to Individual (IFP) plans. - Prescription deductibles may be credited if both plans have one. - COBRA participants can request deductible credit. - Credits apply only for claims in the current calendar year (Jan 1–effective date). - Out-of-Pocket Maximum (OOP) credit is NOT available. - Contact for spreadsheet submission:
Wilson, Kishma A WilsonK11@aetna.com
FAQs
Q: Can employees use the portal even if their previous plan was not Aetna? A: Yes. All deductible credit requests, regardless of prior carrier, can be submitted via the secure member portal.
Q: What should be written in the subject line of the portal message? A: “Deductible Credit Request”
Q: What should the Group Name field list on the form? A: Aspen HR
Q: Where is the mailing address found? A: On the front of the ID card (not back).
Q: Are Out-of-Pocket Maximums credited? A: No. Aetna does not apply OOP maximum credits.
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Audit Checklist |
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Confirm EOB is from current calendar year |
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Confirm Aspen HR is listed as Group Name |
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Confirm correct subject line used: “Deductible Credit Request” |
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Ensure all pages have member ID |
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Confirm EOB and form were submitted together (if not Aetna-to-Aetna) |
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If faxed, confirm correct number (859-455-8650) |
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If mailed, confirm address from front of card used |
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If portal used, verify message was sent under “A claim” topic |
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Confirm confirmation of receipt or portal update within 10 days |