Aetna

Founded in 1853 in Hartford, CT, Aetna is committed to providing individuals, employers, health care professionals, producers and others with innovative benefits, products and services.

Provider Finder

Form Name Effective Date Download Form
New Group Submission
New Business Submission Checklist
01/01/2018 Download
Employer Application 1.18 Effective
01/01/2018 Download
FTE Certification Form
01/01/2018 Download
ACH Form
01/01/2018 Download
Attestation Form for Special Open Enrollment Groups
01/01/2018 Download
In Force Group Forms
Employer Verification Form
01/01/2018 Download
Administration
Employer Administrative Handbook
01/01/2018 Download
New Customer Quick Start Guide
01/01/2018 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Employee Enrollment Change Form
01/01/2018 Download
Request for Continuation of Coverage for Disabled Child
01/01/2018 Download
Handicapped Child Attending Physician Statement
01/01/2018 Download
Evidence of Insurability - Group Life Above Guarantee Issue
01/01/2018 Download
Mail Order Rx Delivery-Registration Form
01/01/2018 Download
Transition of Care Form (HMO)
01/01/2018 Download
Transition of Care Form (PPO)
01/01/2018 Download
Claim Forms
Authorization to Release Protected Health Information Form
01/01/2018 Download
Authorization to Release Protected Health Information Form (Spanish)
01/01/2018 Download
Medical Claim Form
01/01/2018 Download
Medical Claim Form (Spanish)
01/01/2018 Download
Pharmacy Claim Form
01/01/2018 Download
Dental Claim Form
01/01/2018 Download
Vision Claim Form
01/01/2018 Download
Group Term Life Claim Form
01/01/2018 Download
Form Name Effective Date Download Form
2018 Medical HMO
Full HMO Network
CA Gold HMO $25/55 0 Ded
01/01/2018 Summary SBC
HMO Deductible Network
CA Platinum HMO Ded Net $15/30 0 Ded
01/01/2018 Summary SBC
CA Gold HMO Ded Net $25/55 0 Ded
01/01/2018 Summary SBC
CA Gold HMO Ded Net $20/50 250 Ded
01/01/2018 Summary SBC
CA Silver HMO Ded Net $35/75 0 Ded
01/01/2018 Summary SBC
CA Silver HMO Ded Net $45/75 2000 Ded
01/01/2018 Summary SBC
CA Bronze HMO Ded Net $70/115 5500 Ded
01/01/2018 Summary SBC
Aetna Value Network
CA Platinum HMO AV Net $15/30 0 Ded
01/01/2018 Summary SBC
CA Gold HMO AV Net $25/55 0 Ded
01/01/2018 Summary SBC
CA Gold HMO AV Net $20/50 250 Ded
01/01/2018 Summary SBC
CA Silver HMO AV Net $35/75 0 Ded
01/01/2018 Summary SBC
CA Silver HMO AV Net $45/75 2000 Ded
01/01/2018 Summary SBC
CA Bronze HMO AV Net $70/115 5500 Ded
01/01/2018 Summary SBC
Basic Network
CA Platinum HMO Basic Net $15/30 0 Ded
01/01/2018 Summary SBC
CA Gold HMO Basic Net $25/55 0 Ded
01/01/2018 Summary SBC
CA Gold HMO Basic Net $20/50 250 Ded
01/01/2018 Summary SBC
CA Silver HMO Basic Net $35/75 0 Ded
01/01/2018 Summary SBC
CA Silver HMO Basic Net $45/75 2000 Ded
01/01/2018 Summary SBC
CA Bronze HMO Basic Net $70/115 5500 Ded
01/01/2018 Summary SBC
CA Bronze HMO Basic Net $75/105 6300 Ded - Mandated coverage California exchange plan. Contact RBG for plan availability and rates.
01/01/2018 Summary SBC
Aetna Whole Health HMO - PrimeCare Network
CA Gold HMO PrimeCare $20/50 250 Ded
01/01/2018 Summary SBC
CA Silver HMO PrimeCare $35/75 0 Ded
01/01/2018 Summary SBC
CA Bronze HMO PrimeCare $70/115 5500 Ded
01/01/2018 Summary SBC
2018 Medical Aetna Whole Health EPO
MemorialCare EPO Network
CA Gold MemorialCare EPO 750 80%
01/01/2018 Summary SBC
CA Silver MemorialCare EPO 2000 60%
01/01/2018 Summary SBC
CA Bronze MemorialCare EPO 6800 50%
01/01/2018 Summary SBC
PrimeCare EPO Network
CA Gold PrimeCare EPO 750 80%
01/01/2018 Summary SBC
CA Silver PrimeCare EPO 2000 60%
01/01/2018 Summary SBC
CA Bronze PrimeCare EPO 6800 50%
01/01/2018 Summary SBC
Providence EPO Network
CA Gold Providence EPO 750 80%
01/01/2018 Summary SBC
CA Silver Providence EPO 2000 60%
01/01/2018 Summary SBC
CA Bronze Providence EPO 6800 50%
01/01/2018 Summary SBC
2018 Medical PPO
MC Network
CA Gold MC 0 80/50
01/01/2018 Summary SBC
CA Gold MC 750 80/50
01/01/2018 Summary SBC
CA Silver MC 1250 60/50
01/01/2018 Summary SBC
CA Silver MC 2000 Copay
01/01/2018 Summary SBC
CA Bronze MC 6800 50/50
01/01/2018 Summary SBC
CA Bronze MC 4800 60/50 HSA
01/01/2018 Summary SBC
CA Bronze MC 6550 100/50 HSA
01/01/2018 Summary SBC
Savings Plus Network
CA Platinum Savings Plus 0 90/50
01/01/2018 Summary SBC
CA Gold Savings Plus 0 80/50
01/01/2018 Summary SBC
CA Gold Savings Plus 750 80/50
01/01/2018 Summary SBC
CA Silver Savings Plus 1250 60/50
01/01/2018 Summary SBC
CA Silver Savings Plus 2000 Copay
01/01/2018 Summary SBC
CA Bronze Savings Plus 6800 50/50
01/01/2018 Summary SBC
CA Bronze Savings Plus 4800 60/50 HSA
01/01/2018 Summary SBC
CA Bronze Savings Plus 6550 100/50 HSA
01/01/2018 Summary SBC
PPO Network
CA Gold PPO 750 80/50 - This plan is available for employees located outside the MC service area. Contact RBG for availability and rates.
01/01/2018 Summary SBC
Aetna Whole Health MC - MemorialCare Network
CA Silver MemorialCare MC 1250 60/50
01/01/2018 Summary SBC
CA Bronze MemorialCare MC 4800 60/50 HSA
01/01/2018 Summary SBC
Aetna Whole Health MC - PrimeCare Network
CA Silver PrimeCare MC 1250 60/50
01/01/2018 Summary SBC
CA Bronze PrimeCare MC 4800 60/50 HSA
01/01/2018 Summary SBC
Aetna Whole Health MC - Providence Network
CA Silver Providence MC 1250 60/50
01/01/2018 Summary SBC
CA Bronze Providence MC 4800 60/50 HSA
01/01/2018 Summary SBC
2017 Medical HMO
Full HMO Network
CA Gold HMO 20
01/01/2017 Summary SBC
CA Gold HMO 45
01/01/2017 Summary SBC
HMO Deductible Network
CA Gold HMO Deductible 250
01/01/2017 Summary SBC
CA Silver HMO Deductible 1500
01/01/2017 Summary SBC
CA Silver HMO Deductible 2000
01/01/2017 Summary SBC
CA Silver HMO Deductible 2000 Copay Plan
01/01/2017 Summary SBC
CA Bronze HMO Deductible 6500
01/01/2017 Summary SBC
Aetna Value Network
CA Platinum AVN HMO 15 Copay Plan
01/01/2017 Summary SBC
CA Gold AVN HMO 20
01/01/2017 Summary SBC
CA Gold AVN HMO 30 Copay Plan
01/01/2017 Summary SBC
CA Gold AVN HMO 45
01/01/2017 Summary SBC
Basic Network
CA Platinum Basic HMO 15 Copay Plan
01/01/2017 Summary SBC
CA Gold Basic HMO 20
01/01/2017 Summary SBC
CA Gold Basic HMO 30 Copay Plan
01/01/2017 Summary SBC
CA Gold Basic HMO 45
01/01/2017 Summary SBC
CA Gold Basic HMO 250
01/01/2017 Summary SBC
CA Silver Basic HMO 1500
01/01/2017 Summary SBC
CA Silver Basic HMO 2000
01/01/2017 Summary SBC
CA Silver Basic HMO 2000 Copay Plan
01/01/2017 Summary SBC
CA Bronze Basic HMO 6300 Plan
01/01/2017 Summary SBC
CA Bronze Basic HMO 6500
01/01/2017 Summary SBC
Aetna Whole Health HMO - PrimeCare Network
CA Gold PrimeCare HMO 30 Copay Plan
01/01/2017 Summary SBC
CA Gold PrimeCare HMO 45
01/01/2017 Summary SBC
CA Silver PrimeCare HMO Deductible 1500
01/01/2017 Summary SBC
CA Bronze PrimeCare HMO Deductible 6500
01/01/2017 Summary SBC
2017 Medical Aetna Whole Health EPO
MemorialCare EPO Network
CA Gold MemorialCare EPO 750 80 (01 17)
01/01/2017 Summary SBC
CA Silver MemorialCare EPO 2000 Copay (01 17)
01/01/2017 Summary SBC
CA Bronze MemorialCare EPO 4000 Copay (01 17)
01/01/2017 Summary SBC
Providence EPO Network
CA Gold Providence EPO 750 80 (01 17)
01/01/2017 Summary SBC
CA Silver Providence EPO 2000 Copay (01 17)
01/01/2017 Summary SBC
CA Bronze Providence EPO 4000 Copay (01 17)
01/01/2017 Summary SBC
2017 Medical PPO
MC Network
CA Gold MC 0 Copay Plan
01/01/2017 Summary SBC
CA Gold MC 750 80 50
01/01/2017 Summary SBC
CA Silver MC 1000 70 50
01/01/2017 Summary SBC
CA Silver MC 2000 60 50
01/01/2017 Summary SBC
CA Silver MC 2000 80 50 HDHP Plan
01/01/2017 Summary SBC
CA Silver MC 2000 Copay
01/01/2017 Summary SBC
CA Bronze MC 4000 Copay
01/01/2017 Summary SBC
CA Bronze MC 6500 Copay
01/01/2017 Summary SBC
CA Bronze MC HDHP 4800 60 50 HSA Plan
01/01/2017 Summary SBC
CA Bronze MC 6550 100 50 HSA
01/01/2017 Summary SBC
Savings Plus Network
CA Platinum Savings Plus 0 Copay Plan
01/01/2017 Summary SBC
CA Gold Savings Plus 0 Copay Plan
01/01/2017 Summary SBC
CA Gold Savings Plus 750 80 50
01/01/2017 Summary SBC
CA Silver Savings Plus 1000 70 50
01/01/2017 Summary SBC
CA Silver Savings Plus 2000 60 50
01/01/2017 Summary SBC
CA Silver Savings Plus 2000 80 50 HDHP Plan
01/01/2017 Summary SBC
CA Silver Savings Plus 2000 Copay
01/01/2017 Summary SBC
CA Bronze Savings Plus 4000 Copay
01/01/2017 Summary SBC
CA Bronze Savings Plus 6500 Copay
01/01/2017 Summary SBC
CA Bronze Savings Plus HDHP 4800 60 50 HSA Plan
01/01/2017 Summary SBC
CA Bronze Savings Plus 6550 100 50 HSA
01/01/2017 Summary SBC
Aetna Whole Health MC -MemorialCare Network
CA Silver MemorialCare MC 2000 60 50
01/01/2017 Summary SBC
CA Bronze MemorialCare MC 6500 Copay
01/01/2017 Summary SBC
Aetna Whole Health MC - PrimeCare Network
CA Gold PrimeCare MC 750 80 50
01/01/2017 Summary SBC
CA Silver PrimeCare MC 2000 60 50
01/01/2017 Summary SBC
CA Bronze PrimeCare MC 4000 Copay
01/01/2017 Summary SBC
Aetna Whole Health MC - Providence Network
CA Silver Providence MC 2000 60 50
01/01/2017 Summary SBC
CA Bronze Providence MC 6500 Copay
01/01/2017 Summary SBC
Aetna Whole Health MC - SCIPPA Network
CA Silver SCCIPA MC 2000 60 50
01/01/2017 Summary SBC
CA Bronze SCCIPA MC 6500 Copay
01/01/2017 Summary SBC
Form Name Effective Date Download Form
Aetna CA Small Group Plan Guide - Benefits Toolkit
01/01/2018 Download
Aetna CA Underwriting Guidelines
01/01/2018 Download
Aetna CA Underwriting Addendum (01-18)
01/01/2018 Download
Aetna Provider Search Instructions
Download
Aetna Heal Flyer
04/01/2017 Download
Form Name Effective Date Download Form
Aetna Broker Alert - No More Outside Sales
01/01/2018 Download
Contact Information
01/01/2017 Download