If you cannot find the form you need or are not sure if you need to file a claim, log on to your secure Aetna Navigator^® member website for additional forms, employer-specific forms and information.

Medical, Dental and Vision Claim Forms
Health care professionals and facilities that participate in Aetna plans (in-network providers and facilities) should file claims on your behalf. Some out-of-network providers may also submit claims on your behalf. Check with your doctor or other health care provider to verify if you need to submit a claim. If you receive a bill or if you received care from an out-of-network provider for covered services and need to submit a claim, please complete and mail the applicable form to the address on your ID card.

Medical Claim Form  (2 pages)
Dental Claim Form  (2 pages)
Vision Claim Form  (2 pages)

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Pharmacy Forms
During travel or emergencies, you may have to use a non-network pharmacy and file a paper claim  (2 pages). Mail the completed form to the address on your ID card.

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Aetna Rx Home Delivery® Brochures & Order Forms
Save time and money by ordering your prescriptions through Aetna's mail-order prescription medication service, Aetna Rx Home Delivery. To download a brochure or order form, please log-in to the Member Secure website and select "Pharmacy Benefits" under the Related Shortcuts. Then click on "Order prescriptions or check order status online" for brochures and order forms available for download.

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Flexible Spending Account Forms

Health Care Reimbursement  (2 pages)
Before submitting a Health Care Reimbursement request, please read about eligible health care expenses.

Flexible Spending Account OTC (Over-the-Counter) Health Care Reimbursement  (2 pages)
Use this form to submit a request for reimbursement for over-the-counter medications and products (if your plan allows over-the-counter medical expense reimbursements).

Dependent Care Reimbursement  (2 pages)
Before submitting a Dependent Care Reimbursement request, please read about eligible dependent care expenses.

Limited FSA Reimbursement (2 pages)
Before submitting a Limited FSA Reimbursement request, please read about Aetna Limited FSA expenses (if your plan offers a Limited FSA).

Limited FSA over-the-counter medications and products (2 pages)
Use this form to submit a request for reimbursement of Limited FSA over-the-counter medications and products (if your plan allows over-the-counter medical expense reimbursements).

More Information
For additional Flexible Spending Account forms, employer-specific forms, your account status, and payment information visit Aetna Navigator.

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Aetna Quick Charge Billing Plan
If you have an Aetna Golden Medicare Plan^®, Aetna Golden Choice^TM Plan, or Aetna Medicare Rx^SM Plan, you may be able to have premiums automatically deducted from your bank account or credit card. Use this form to apply for the Aetna Quick Charge Billing Plan  (2 pages).