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Health Survey

Let’s get started

 

This health survey will help your personal care team better understand your everyday life and health needs. Your care team will then work with you to design a personalized care plan for your needs. Your care plan helps you take full advantage of Aetna® health and wellness benefits and services.

 

Important:

  1. Your answers will stay confidential. And they will not affect your coverage.
  2. Once you start this survey, you must complete it. There’s no option to save the survey in the middle.
  3. All fields are required unless marked optional.
  4. This survey is only for members who are in certain Medicare and Medicaid plans (D-SNPs) or who are in plans designed for their Chronic Conditions (C-SNPs).

When you’re done, you’ll get a confirmation page that you can print to keep. It’ll include the next steps for your personal care plan.

 

Verify your identity 

 

To begin, we need two pieces of information:

  • An Aetna member ID number or Medicare beneficiary ID number
  • Your date of birth
MM/DD/YYYY

Acknowledgement

  • I am submitting my HRA responses to Aetna® for individual care plan purposes.
  • The information I provided is true and accurate.

Thank you for your time! 

Your health survey has been successfully submitted.

Confirmation Number:
Member ID:
Date of submission:

 

A care team member will follow up with you to design a personal care plan based on your needs.

 

For questions about your health survey or the next steps with the care team, call 1-866-409-1221 ${tty}

Monday through Friday from 8:30 AM to 5:00 PM ET.

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