Health care professionals in our network should file claims for you. (Some out-of-network health care professionals also may submit claims for you.) Ask your doctor or other health care professional if you need to submit a claim.
If you get a bill or receive care from a health care professional who is not in the Aetna network, and you need to submit a claim, please complete and mail one of the forms below to the address on your ID card.
Medical Claim Form (English - PDF)
Medical Claim Form (Spanish - PDF)
Dental Claim Form (English - PDF)
Dental Claim Form (Spanish - PDF)
Vision Claim Form for vision benefits within a medical plan (PDF)
Vision Claim Form for vision benefits through the Aetna Vision Preferred plan (PDF)
Spanish vision claim form for vision benefits through the Aetna Vision Preferred Plan (PDF)
Complaint and Appeal Form (PDF)
Use this form to give us permission to share information about you (or a dependent) with another person or company. You can also choose the types of coverage for which the permission applies.
Authorization to Release Protected Health Information (English - PDF)
Authorization to Release Protected Health Information (Spanish - PDF)
Use this form to remove permission previously given to share information about you (or a dependent) with another person or company.
Revocation of Authorization (English - PDF)
Instructions for ordering a blood glucose monitor Diabetic Supply Order Form (PDF)
To refill a medication through mail-order delivery, log in to your member account. If you have a new prescription and want to start mail-order delivery, fill out the form below and send it to us with your prescription.
Prescription mail-order delivery form for CVS Caremark Mail Service Pharmacy (English - PDF)
Prescription mail-order delivery form for CVS Caremark Mail Service Pharmacy (Spanish - PDF)
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.
Prescription drug claim form (English - PDF)
If you have any of these PayFlex® accounts, you can get your forms or request reimbursement online.
Here’s what you need to do
Are you a Massachusetts resident? Are you 18 or older? Can you afford health insurance? If you answered yes to all three questions, you must have health coverage according to Massachusetts laws. If you do not, you must pay a penalty through your tax return.
Aetna Health of California HMO has procedures for Members to use if they are dissatisfied with a decision that the HMO has made or with the operation of the HMO.
View more information on how California members can get help
1095-A comes from the federal government Federal Exchange Marketplace or state-based Exchange Marketplace.
1095-B comes from your insurance company.
1095-C comes from your employer.
People generally receive only one version, though some may get both a 1095-B and a 1095-C.
The Internal Revenue Service (IRS) recently issued a Notice related to information reporting requirements that were added by the Affordable Care Act (ACA). Because the tax penalty for filing to meet the “individual mandate” has now been reduced by Congress to zero, the IRS indicated in its Notice that “an individual does not need the information on Form 1095-B in order to compute his or her federal tax liability or file an income tax return with the Service.” As a result, Aetna will not be mailing Form 1095-B for the reporting tax year. For those that previously received their Form 1095-B in the mail, you can receive a copy of your Form 1095-B by going out to the Aetna Member Website in the “Message Center” under the “Letters and Communications” tab or by sending us a request at Aetna PO BOX 981206, El Paso, TX 79998-1206. We will continue to provide the 1095-B form to members who live in the States that have passed their own individual mandate i.e. New Jersey, Washington, D.C., Vermont, Rhode Island, and California.
If you have an interest in receiving this form, please follow the steps above, email us at AetnaMemberServices@aetna.com or call1-855-531-6837with any questions.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites.
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Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
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Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers. This search will use the five-tier subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Do you want to continue?
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The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical Necessity Guide does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.
Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.
The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.
Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change.
Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law.
