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Date: NOTE: INCOMPLETE CLAIM FORMS WILL BE RETURNED TO YOU FOR MISSING INFORMATION. THIS WILL DELAY THE PROCESSING OF THE CLAIM. FOR FASTER, EASIER SUBMISSION OF CLAIMS, THE PROVIDER MAY CONTACT THE AETNA CLAIM PROCESSING CENTER FOR INFORMATION REGARDING ELECTRONIC CLAIM SUBMISSIONS. TO THE EMPLOYEE.
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Find the insurance documents you need, including claims,...
- Find a Form
Claim Form for Medical Treatment Reimbursements. Aetna International. Please complete clearly in BLOCK CAPITALS. One form must be completed for each patient, for each medical condition treated.
Find the insurance documents you need, including claims, tax, reimbursement and other health care forms. Also learn how to find forms customized specifically for your Aetna benefits as well as how to determine which forms are meant for your use if you are unsure.
Aetna International Claim Form. Please submit this completed claim form with itemized bills and receipts. A separate claim form is needed for each family member. Please tape small receipts on a full size sheet of paper.
Claim Form for Dental Treatment Reimbursements. For the quickest way of submitting your claim, log into Health Hub at www.aetnainternational.com and submit your claim online.
Fill out this form if you’re asking for reimbursement of a covered a medical service, dental service, eyewear, hearing aid, vaccine or fitness reimbursement you paid a doctor, healthcare professional, or service provider who did not bill us directly.
You are authorized to provide Aetna Life Insurance Company or one of its affiliated companies (“Aetna”), and any independent claim administrators and consulting health professionals
