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Find the forms and documents you need

If you can't find the form you need below, please log on to your secure member website. Here you will find other forms, specific forms from your employer and general information.

Medical, Dental and Vision Claim Forms 

Health care professionals in our network should file claims for you. (Some who are not in the network may also submit claims for you.) Ask your doctor or other health care professional if you need to submit a claim.

If you get a bill or receive care from a health care professional who is not in the network, and you need to submit a claim, please complete and mail one of the forms below to the address on your ID card.

Medical Claim Form   (PDF)
Dental Claim Form   (PDF)
Spanish Dental Claim Form   (PDF)
Vision Claim Form  (PDF) 

Pharmacy Forms 
During an emergency or when traveling, you may have to use a pharmacy that is not in our network. In this case, you must file a paper claim  (PDF). Mail the completed form to the address on your ID card.

Aetna Rx Home Delivery® Brochures & Order Forms
Save time and money. Order your prescriptions through Aetna Rx Home Delivery. To download a brochure or order form, log-in to your secure member website. Choose "Pharmacy Benefits" under Related Shortcuts. Then click on "Order prescriptions or check order status online" to find brochures and order forms.

Flexible Spending Account Forms 
Before submitting a Health Care Reimbursement  (PDF) request, please read about health care expenses.

Flexible Spending Account Over-the-Counter Health Care Reimbursement  (PDF)
Use this form to request reimbursement for over-the-counter drugs and products if your plan allows for over-the-counter medical expense reimbursements.

Before submitting a Dependent Care Reimbursement  (PDF) request, please read about dependent care expenses.

Before submitting a Limited FSA Reimbursement  (PDF) request, please read about our Limited FSA expenses.

Use this form to submit a request for reimbursement of Limited FSA over-the-counter medications and products  (PDF).

For more Flexible Spending Account forms, employer-specific forms, your account status, and payment information, visit your secure member website.

Aetna Quick Charge Billing Plan
If you have an Aetna Golden Medicare Plan®, Aetna Golden ChoiceTM Plan, or Aetna Medicare RxSM Plan, you may be able to have your premiums automatically deducted from your bank account or credit card. Use this form to apply for the Aetna Quick Charge Billing Plan  (PDF).

Aetna Group Life Insurance Forms
To file a claim or make a change, complete the forms and submit them to your employer or Aetna. If a section does not apply, or the information is not available, write "NA" in the space so we know you did not overlook the question.

Alaska Travel Benefits for groups 2-50

• Travel Benefits Flyer  (2 Pages)