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Aetna Voluntary Forms


Non-Discrimination Notice
Non-Discrimination Notice - Spanish

Submit your claims your way. You can choose from one of the two options below:

     1. Use the online claims process. Just click the links below.

     2. Click on the PDF links, complete the form and submit it by fax or postal service.

Please remember to include all required supporting documentation.

Aetna Accident Plan

Online claims process

Accident claim form - English | Spanish

Health screening benefit form - English | Spanish

Hospital care due to sickness form - English | Spanish

Aetna Critical Illness Plan

Online claims process

Critical Illness claim form - English | Spanish

Health screening benefit form - English | Spanish

Aetna Hospital Plan

Online claims process

Hospital claim form - English | Spanish


Portability form for Accident, Critical Illness, and Hospital- English | Spanish

Aetna Fixed Benefits Plan

Fixed Benefits claim form - English | Spanish


Dental benefits request - English | Spanish


Vision benefits request - English | Spanish

Short-term Disability

Disability employee request - English | Spanish

Aetna Life

Proof of death form - English | Spanish


Affidavit of Sole Survivors

Affidavit of sole survivors form - English | Spanish

Protected Health Information

Authorization for release of protected health information form - English | Spanish


Transition of Care   

Transition coverage request form - English | Spanish

Transition coverage request form - CA traditional fully insured members only - English | Spanish

Member Request for Estimates - Massachusetts and Rhode Island Only

Member request for estimate form - English | Spanish


Helpful Resources

Find a doctor or pharmacy, answer health questions, and more.

Insurance Benefit Plans

Vision, dental, disability, and term life.

Consider These Stories

"I continued to make my mortgage payments when I got sick."

Tools for Employees