Below are forms that you may need as a member of Aetna Better Health Premier Plan. These forms can help you manage claims, access information and more. If you need a form not listed here, contact us Opens In New Window.

Notice of Privacy Practices  (English PDF Opens In New Window & Español PDF Opens In New Window)

Multi-Language Insert (English PDF Opens In New Window & Español PDF Opens In New Window)

Appointment of Representative Form

Authorization to Release Protected Health Information (PHI) PDF Opens In New Window  (Spanish PDF Opens In New Window/Polish PDF Opens In New Window)

Authorization to Release Psychotherapy Notes PDF Opens In New Window

Prior Authorization Form PDF Opens In New Window

Behavioral Health Prior Authorization Form (coming soon)

IDT Training Brochure PDF Opens In New Window

Prescription Drug Mail Order Form (English PDF Opens In New Window & Español PDF Opens In New Window) PDF Opens In New Window

Coverage Determination Form PDF Opens In New Window

Coverage Redetermination Request Form PDF Opens In New Window

Prescription Reimbursement Request Form (English PDF Opens In New Window & Español PDF Opens In New Window)

Hospice Part D Exception Form PDF Opens In New Window

Advance Directives PDF Opens In New Window