Claims and reimbursement (ask us to pay you back)
Aetna® Medicare forms: claims and reimbursement, Appointment of Representative and more
Forms to give a caregiver permission to help with your care |
Choose PDF language |
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Let someone talk to us about your health or coverage
Call us with a caregiver or someone else on the line to give them permission to speak with us (just one time, on that call). Or, mail us a completed PHI (protected health information) form to give them permission more often. |
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Let someone make requests for you
Give a caregiver or someone else permission to act on your behalf. They will be able to:
Just have this person sign your completed Appointment of Representative form and send it to us. This person is then your appointed representative for one year from the date that you both sign the form. |
Forms to give a caregiver permission to help with your care |
Let someone talk to us about your health or coverage
Call us with a caregiver or someone else on the line to give them permission to speak with us (just one time, on that call). Or, mail us a completed PHI (protected health information) form to give them permission more often. |
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Choose PDF language |
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Forms to give a caregiver permission to help with your care |
Let someone make requests for you
Give a caregiver or someone else permission to act on your behalf. They will be able to:
Just have this person sign your completed Appointment of Representative form and send it to us. This person is then your appointed representative for one year from the date that you both sign the form. |
Choose PDF language |
Exceptions, appeals and grievances |
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File Medicare complaints and coverage requests
Have a concern about your coverage or care? Our Member Services team is here to help. Just give us a call at the number on your Aetna member ID card. |
Exceptions, appeals and grievances |
File Medicare complaints and coverage requests
Have a concern about your coverage or care? Our Member Services team is here to help. Just give us a call at the number on your Aetna member ID card. |
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Disenrollment (leaving or canceling a plan) |
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Leave or cancel your Medicare Advantage (MA) or Medicare Advantage Prescription Drug (MAPD) plan
Call us at the number on your ID card if you want to leave or cancel your current plan and not join another one. Or select your current plan and find its phone number on our Contact Member Services page. We’ll let you know your options. Like joining a plan, there are only certain times when you can disenroll.* You may also download, complete and submit a disenrollment form. Use the PDF link for your plan below to print its form.
Please complete the relevant form and mail it to: Aetna
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Leave or cancel your prescription drug plan (PDP)
If you want to cancel or switch your Medicare Part D plan (PDP), find out what your options are. Learn all about how and when to disenroll. |
Disenrollment (leaving or canceling a plan) |
Leave or cancel your Medicare Advantage (MA) or Medicare Advantage Prescription Drug (MAPD) plan
Call us at the number on your ID card if you want to leave or cancel your current plan and not join another one. Or select your current plan and find its phone number on our Contact Member Services page. We’ll let you know your options. Like joining a plan, there are only certain times when you can disenroll.* You may also download, complete and submit a disenrollment form. Use the PDF link for your plan below to print its form.
Please complete the relevant form and mail it to: Aetna
|
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Disenrollment (leaving or canceling a plan) |
Leave or cancel your prescription drug plan (PDP)
If you want to cancel or switch your Medicare Part D plan (PDP), find out what your options are. Learn all about how and when to disenroll. |
*For times you can disenroll
If you don't have creditable coverage for 63 days or more, you may have to pay a late enrollment penalty. For example, creditable coverage from an employer or union is expected to pay, on average, at least as much as Medicare's standard prescription drug coverage. You can generally keep your coverage without paying a penalty if you decide to enroll in Medicare prescription drug coverage later.