Health Plan (Aetna)
For questions about claims or benefits call Aetna at 877-602-3862. For claim form submissions, fax Aetna at 859-455-8650. To register for online services through the Aetna website.
To contact the health plan administrator for the City of Portland, send correspondence to:
Health Plan Administrator for City of Portland
P.O. Box 981106
El Paso, TX 79998-1106
Custom link to search for doctors
All permanent employees working 20 (18.75 if working a standard 37.5 hour work week) hours or more per week and their eligible dependent(s) may participate in the City of Portland’s health insurance plan. Employees have 60 days from their date of hire or qualifying event to enroll. Examples of qualifying life events include but are not limited to losing or obtaining other coverage, marriage, formation of a domestic partnership, birth, adoption or placement of adoption.
Summary of Benefits & Coverage
View the Summary of Benefits and Coverage for the City of Portland. This is only a summary. If you want more detail about your coverage and costs, read both the Plan Booklet and Schedule of Benefits together.
Health Plan Rates
Current weekly rates for full-time permanent employment, (contact your payroll clerk or the Benefits Division for proration schedule of costs) are $0.00 for employee plan, $53.16 for employee and children, $75.91 for employee and adult and $129.05 for employee, adult and children. Open enrollment is held during June each year with an effective date of coverage for July 1. Payroll deductions are on a pretax federal, state, and Medicare basis.
Value-Based Health Plan
Value-based health plan: The health plan requires each covered member to select a primary care physician (PCP). To receive the highest level of benefits, use high-value network providers for primary care, preference-sensitive and supply-sensitive care and in-network Aetna providers for all other services. The health plan is administered by Aetna. Please call important telephone numbers on the back of the health plan ID card as necessary.
Find high-value network and Aetna network doctors and providers, visit www.portlandmaine.gov. Choose Departments>HumanResources>Benefits> Health Plan. Doctors and providers in the high-value network are denoted with a “P Employer Preferred Network” in blue under the column Plan Information. If you have registered for online services, log into your secure member website (Aetna Navigator), at www.aetna.com. On the left hand “I want to” menu, click “Find a Doctor, Dentist or Facility” down menu.
Visit Aetna and register for online services to check the status of a claim, change a PCP, search the online provider directory for network physicians, update your address or order a new ID card.
To find high-value network and Aetna network doctors, Click here.
Maine Health Management Coalition
The City of Portland is a member of the Maine Health Management Coalition (MHMC). The Coalition is made up of employers, hospitals, health plans and doctors working together to provide you with patient safety and qualify information. Better quality healthcare not only can save lives, it can make a difference in how fast your health improves. Visit the MHMC website to view physician and hospital data collected.
- 2016 Aetna Healthy Actions Rx Savings Drug Class for January 1, 2017 Implementation
- Aetna Premier Plus Three Tier Open Formulary effective January 1, 2017
- Aetna Walk In and Urgent Care Centers
- August 2016 Medicare D Certificate of Creditable Coverage
- Benefits at a Glance for Value-Based Health Plan for January 1, 2017
- Health Enrollment Change Form
- Health Plan Claim Forms
- Non Emergent ER list provided by Aetna December 2016
- Notice of Privacy Practices
- 2017 Aetna Non-Discrimination Notice
- Plan Booklet
- Prescription Drug Claim Form
- Schedule of Benefits
- Summary of Benefits and Coverage