Member Forms
Forms for Members
Authorization for Release of Protected Health Information (PHI) (third party) (PDF)
Autorización para divulgar información protegida de salud (PDF)
Request for Protected Health Information (PHI) (PDF)
Formulario de solicitud de acceso a la informacion medica protegida (PHI) (PDF)
Revocation of Authorization previously given to Aetna (Third party) (PDF)
Member Complaint and Appeal (PDF)
Vision Claim Form - Benefit as part of your medical plan (PDF)
Vision Claim Form - Benefit through Aetna Vision Preferred (PDF)
Effective solutions that fit a variety of needs
Our health coverage solutions bring together local expertise with the experience of a leading national insurance brand. We provide plans that deliver the services members value with the type of cost clarity that gives peace of mind.