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)
Beneficio Médicos – Instrucciones para la presentación de reclamos (PDF)
Vision Claim Form - Benefit as part of your medical plan (PDF)
Vision Claim Form - Benefit through Aetna Vision Preferred (PDF)
Now that’s innovation
Innovation Health is transforming the health care journey. Through innovative programs, coordinated care, and convenient access, our health plans are personalized to fit our members’ needs. Discover how we are helping members achieve their health ambitions right in their community.