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Find a health insurance form

Not all forms are for every plan.To find forms for your health plan, the first step is to log in to your member account.

 

Not sure which form you need? Call us at the toll-free number on the back of your Aetna® ID card. We’re happy to help.

Choose a topic to find the form you need

Be sure to ask your doctor if you need to file a claim at the time of service. Providers in our network file should file claims for you. Some providers outside our network will, too. But if you get a bill from a provider who isn’t in the Aetna network, you’ll need to file a claim. To do so, fill out one of these forms and mail it to the address on your ID card.

 

 

Permission to share protected health info

 

Use this form to give us permission to share your info, or your dependent’s info, with another person or company. You choose exactly what we can share.

 

 

Use this form if you no longer want us to share your info, or your dependent’s info, with another person or company.

 

Need to order a blood glucose monitor?

Diabetes supply order order form (PDF)

 

Already using mail-order delivery?

Log in to your member account to refill your medicine.

 

New to mail-order delivery?

Fill out this form. Be sure to include your new prescription when you send it in.

 

 

In case of an emergency, or when traveling, you may need to use a pharmacy that is not in our network. In that case, complete the claim form and mail it to the address on the claim form.

 

Have an Inspira Financial™ account? You can use your Aetna member website to get reimbursed or find a form. Eligible accounts include:

 

  • Health care flexible spending account (FSA)
  • Dependent care FSA
  • Limited purpose FSA
  • Health savings account (HSA)
  • Health reimbursement arrangement (HRA)
  • Retiree reimbursement account (RRA)

Here’s what you need to do

  1. Log in to your member account to connect to the Inspira website.
  2. From your Inspira account dashboard, you can file a claim, request funds and find forms.

When health challenges arise, we’re here to support you. Learn how to file a claim or get the forms you need.

 

Get forms or file a claim

Are you a Massachusetts resident? Are you 18 or older? Can you afford health insurance? If you answered yes to all three questions, Massachusetts law is that you have health coverage. If you don't get coverage, you'll have to pay a penalty through your tax return.

 

Learn about Massachusetts coverage requirements

You have the right to make your voice heard about your health care experience with your HMO plan. Aetna Health of California HMO has steps to make filing a complaint a little easier.

 

Grievance and appeals for California members

Depending on how you got your health coverage, you may receive one or more versions of Form 1095. Here’s what each one means, how to request a copy, and when you might need it for your taxes.

 

Form 1095-A: Comes from the federal government’s exchange marketplace or state-based exchange marketplace.

 

Form 1095-B: Comes from your insurance company. 

 

The IRS announced in 2019 that you no longer need Form 1095-B to file your federal taxes. That means Aetna won’t mail form 1095-B for the reporting tax year. Check state exceptions.*

 

Want a copy of Form 1095-B for your records? You can:

 

 

Questions? Call 1-855-532-6837 ${tty}. We’re here to help.

 

Form 1095-C: Comes from your employer.

 

Most people receive only one version, though some may get both a 1095-B and a 1095-C.

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