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Aetna Voluntary Forms

 

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 PDF

Health screening benefit PDF

Hospital care due to sickness PDF

Portability form PDF - COMING SOON


Aetna Critical Illness Plan

Online claims process

Critical Illness claim form PDF


Health screening benefit PDF

Portability form PDF - COMING SOON


Aetna Hospital Plan

Online claims process

Hospital claim form PDF




Aetna Fixed Benefits Plan

Fixed Benefits claim form PDF

Fixed Benefits claim form PDF - Spanish



Dental Claim

Dental benefits request PDF 

Dental benefits request PDF - Spanish

 


Vision Claim

Vision benefits request PDF

Vision benefits request PDF - Spanish


 
Short Term Disability Claim

Disability employee request PDF 


Disability employee request PDF - Spanish
 


Life Claim
 

Proof of death PDF

Proof of death PDF - Spanish

 

Affidavit of Sole Survivors


Affidavit of sole survivors PDF

Affidavit of sole survivors PDF - Spanish
 


Protected Health Information

Authorization for release of protected health information PDF

Authorization for release of protected health information PDF - Spanish

 

Transition of Care
   

Transition coverage request PDF

Transition coverage request PDF - Spanish

Transition coverage request PDF - For CA traditional fully insured members only

Transition coverage request PDF - Spanish - For CA traditional fully insured members only



Member Request for Estimates form - Massachusetts and Rhode Island Only

Member request for estimate PDF

Member request for estimate PDF - Spanish

 

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