Choose a topic to find the form you need
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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.
- Medical claim form - English (PDF)
- Medical claim form - Spanish (PDF)
- Dental claim form - English (PDF)
- Dental claim form - Spanish (PDF)
- Vision benefits with medical plan claim form (PDF)
- Vision benefits through Aetna Vision Preferred claim form - English (PDF)
- Vision benefits through Aetna Vision Preferred claim form - Spanish (PDF)
- Complaint and appeal form (PDF)
- Infertility donor, surrogate or gestational carrier expense reimbursement form (PDF)
Permission to share protected health information (PHI)
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.
- Permission to share protected health info form - English (PDF)
- Permission to share protected health info form - Spanish (PDF)
Use this form if you no longer want us to share your info, or your dependent’s info, with another person or company.
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Need a blood glucose meter?
Learn about available meters and get the right one for you.
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.
- Prescription mail-service order form - English (PDF)
- Prescription mail-service order form - Spanish (PDF)
In case of an emergency, or when traveling, you may need to use a pharmacy that’s not in our network. If so, fill out the claim form and mail it to the address on the form.
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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
- Log in to your member account to connect to the Inspira website.
- From your Inspira account dashboard, you can file a claim, request funds and find forms.
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When health challenges arise, we’re here to support you. Learn how to file a claim or get the forms you need.
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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.
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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.
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You may get a tax form called a 1095 that shows what kind of health insurance you had during the year. Not everyone gets the same one, and some people may get more than one. Here’s what each form means and when you might need it.
Form 1095-A
Who sends it: The federal Health Insurance Marketplace (HealthCare.gov) or your state’s marketplace.
Who usually gets it: People who bought their own insurance through the Marketplace.
Why it matters: You need this form if you got financial help (a tax credit) for your insurance. It helps you file your taxes correctly.
Form 1095-B
Who sends it: Your insurance company (for example, Aetna), when it applies to your employer group plan. Form 1095-B does not apply to all employer plans.
Who usually gets it: People with insurance through a private plan, Medicaid, Children’s Health Insurance Plan (CHIP) or certain employer plans (i.e., a fully insured employer plan).
Important:
The IRS announced in 2019 that you do not need Form 1095-B to file your federal taxes. Because of this, Aetna does not automatically mail this form. Some states may still require Form 1095-B for state tax filing. Be sure to check your state’s specific tax rules.
If your employer’s health plan qualifies, a digital copy of Form 1095-B may be available in your Aetna member account. Note that not all employer plans are eligible for a digital copy.
If you want a copy for your records and form 1095-B is applicable to your employer plan, there are three ways to get one:
Log into your Aetna member account to find documents.
Call 1-855-531-6837 ${tty} and speak with a tax agent.
Form 1095-C
Who sends it: Your employer.
Who usually gets it: People who receive insurance through their job where the employer is considered a self-insured or applicable large employer (ALE).
Quick summary
- Bought insurance on the marketplace? You’ll get 1095-A.
- Have insurance with Aetna through an applicable employer plan or another insurer? You may get a Form 1095-B, but you don’t need it to file your federal taxes.
- Have insurance through your employer who’s self-insured or an applicable large employer (ALE)? You’ll get Form 1095-C.
- Some people may receive both a 1095-B and a 1095-C, depending on their insurance type and employment situation.
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You have the right to have your confidential health information be sent to you instead of the person who pays for your health plan. Use this request form to share how you’d like to receive this information.
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You have the right to have your confidential health information be sent to you instead of the person who pays for your health plan. Use this request form to share how you’d like to receive this information.
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If your employer has chosen not to include contraceptive coverage in their health plan, you can use this form to elect this coverage.
Legal notices
Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).
Health benefits and health insurance plans contain exclusions and limitations.