Medical Services Claim Form (PDF)
You will need this form only when:

• You have other health plan coverage that is primary and the provider won't bill Aetna as secondary insurance.
• You receive emergency care outside the U.S.
• You receive non-network emergency care inside the U.S. Most non-network providers in the U.S. can bill Aetna directly. So this will rarely happen.

Prescription Drug Coverage Claim Form (PDF)
Use this form when you have purchased prescriptions at a non-network pharmacy, failed to show your subscriber ID card when you purchase prescriptions, or when Aetna pays secondary to another health plan.

Mail-Order Pharmacy Form (PDF)
Use this form to order drugs from the Wellpartner mail-order pharmacy.

Vision Hardware Form (PDF)
Use this form to get reimbursed for eyeglasses or contact lenses you purchased from a non-network provider.

Transition of Care Form (PDF)
Use this form if you currently receive care from a non-network provider for an ongoing course of treatment (such as for a pregnancy or cancer treatment) that began in 2008 and continues in 2009.