Aetna Voluntary Forms

Non-Discrimination Notice
Non-Discrimination Notice - Spanish

Submit your claims your way. You can choose from one of the two options below:

     1. Use the online claims process. Just click the links below.

     2. Click on the PDF links, complete the form and submit it by fax or postal service.

Please remember to include all required supporting documentation.



Aetna Accident Plan

Online claims process

Accident claim form - English | Spanish

Health screening benefit form - English | Spanish

Hospital care due to sickness form - English | Spanish


Aetna Critical Illness Plan

Online claims process

Critical Illness claim form - English | Spanish

Health screening benefit form - English | Spanish


Aetna Hospital Plan

Online claims process

Hospital claim form - English | Spanish

 

Portability form for Accident, Critical Illness, and Hospital- English | Spanish

 
Aetna Fixed Benefits Plan

Fixed Benefits claim form - English | Spanish


Dental

Dental benefits request - English | Spanish
 

Vision

Vision benefits request - English | Spanish

 
Short-term Disability

Disability employee request - English | Spanish
 

Aetna Life 

Proof of death form - English | Spanish

 

Affidavit of Sole Survivors

Affidavit of sole survivors form - English | Spanish
 

Protected Health Information

Authorization for release of protected health information form - English | Spanish

 

Transition of Care   

Transition coverage request form - English | Spanish

Transition coverage request form - CA traditional fully insured members only - English | Spanish

Member Request for Estimates - Massachusetts and Rhode Island Only

Member request for estimate form - English | Spanish