Polk County

OPEN ENROLLMENT 

 Benefits Information

•  Employee Health Plan Handbook - Overview of all benefits and premium information.

Medical Plan

Benefit Summary:

For any questions / concerns you can contact Aetna at: 1-800-942-7154

•  Aetna Open Access Select Choice
•  Aetna OA Select Schedule of Benefits 
•  Aetna Choice POS II 
•  Aetna Choice POS II Schedule of Benefits 
•  Aetna Comprehensive Medical Plan - Retirees 
•  Aetna Complaint Appeals Amendment 

Member:

• Access Aetna Navigator  (Your Personalized Website)

Register your password for:

• Health Information
• Insurance Information
• Manage Personal Health
• Personalized Tools
• Financial Tools

Forms:

•  Medical, Life, & LTD Enrollment Form 
•  Aetna Claim Form 
•  Transition Coverage Request 

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Prescription Drug Plan

Benefit Summary:

For any questions contact PharmaCare at: 1-888-645-9303

•  PharmaCare Benefit Summary 

 

 

 

Member:

• Access Your Personalized Website  

Register your password in Member Services for:

• Plan benefit summary
• Formulary and Non-Formulary alpha listings
• Detailed information about specific medications
• Utilization/Claims history

Forms:

•  PharmaCare Mail Order Service Request Form 
•  PharmaCare Physician Prior Authorization Request Form 

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Employee / Dependent Life

Benefit Summary:

For any questions please call: 1-800-523-2233

•  Hartford Life Benefits Highlight Sheet 
•  Hartford Life Insurance Certificate 
•  Hartford LTD Benefits Highligh Sheet 
•  Hartford LTD Insurance Certificate 
• Basic Life and Supplemental Life
• Accidental Death & Dismemberment
• Supplemental Dependent Life
• Long Term Disability

Member:

Access The Hartford at Work website  for assistance in assessing your life insurance needs, claim filing, claim status updates, and benefits overviews.

Forms:

•  Life & LTD Enrollment Form 
•  Beneficiary Change Form 
•  Personal Health Application Form 
•  Proof of Death Portability Life Insurance Form 
•  Children with Disabilities Eligibility Form 

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Dental Plan

Benefit Summary:

For any questions or concerns please call: 1-800-GETMET8 (1-800-438-6388)

•  High Plan Certificate of Coverage 
•  Low Plan Certifcate of Coverage
•  MetLife PDP Providers By City (Polk County Only)

  A listing of providers outside of Polk County are available via the MetLife  website. 

Member:

Visit the www.Metlife.com  website for online information and an updated provider directory (Company Name: Polk County Government).

Forms:

•  METLIFE Enrollment Form 
•  METLIFE Eligibility Change Form 
•  METLIFE Dental Expense Claim Form 

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Vision Plan

Benefit Summary:

For any questions or concerns please call: 1-800-638-3120

•  Spectera Benefit Summary 

 

 

Member:

Access www.spectera.com  for your program design or information.

The following services are available without an identifications number:

• Provider Locator (with door-to-door directions)
• FAQs
• Vision Care topics (i.e. Laser Surgery Discount)

The following services are available with an identifications number:

• Claim history
• Program design
• Order discounted contacts (after initial benefit received)

Forms:

•  Spectera Vision Enrollment Form 

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Employee Assistance Program / Mental Health & Substance Abuse

Benefit Summary:

For any question or concerns you can contact Aetna EAP at: 1-888-AETNA-EAP (1-888-238-6232)

Member:

To access service or information online, log on to the www.aetnaEAP.com  site using the company ID code: POLKSEAP 

Flexible Spending Accounts

 FSA Approved Over-The-Counter Items 

Forms:

•  Flexible Spending Account Enrollment Form 
•  Flexible Spending Account Direct Deposit Form 
•  Aetna FSA Reimbursement Claim Form 

MetLaw Hyatt Legal Plan

•  MetLaw Custom Services - For Polk Government Employees
•  MetLaw Custom Plan Savings - Calculate total savings
•  MetLaw Intranet Links - Links to information center prior to enrollment
•  Hyatt Legal Plan Video - Watch video to review plan benefits

Forms:

•  MetLaw Enrollment Form 

Have Questions ?

If you have additional questions about employee group benefits please contact the Risk Management Division at 863-534-5275.