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 1.21
01/01/2021 Download
Employer Application 4.21
04/01/2021 Download
Small Group ACA Banking Consent Form
01/01/2021 Download
In Force Group Forms
Cal-COBRA Employer Notice of Qualifying Event Form
01/01/2021 Download
Employer Verification Form
01/01/2021 Download
Small Employer Certification Form (FTE Certification)
01/01/2021 Download
Administration
Employer Administrative Handbook
01/01/2021 Download
New Customer Quick Start Guide
01/01/2021 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Employee Enrollment Change Form 7.21
07/01/2021 Download
Request for Continuation of Coverage for Disabled Child
04/01/2021 Download
Handicapped Child Attending Physician Statement
01/01/2021 Download
Mail Order Rx Delivery-Registration Form
01/01/2021 Download
Transition of Care Form (HMO)
01/01/2020 Download
Transition of Care Form (PPO)
01/01/2020 Download
Claim Forms
Authorization to Release Protected Health Information Form
01/01/2021 Download
Medical Claim Form
01/01/2021 Download
Pharmacy Claim Form
01/01/2021 Download
Dental Claim Form
01/01/2021 Download
Vision Claim Form
01/01/2021 Download
Form Name Effective Date Download Form
2021 Medical HMO
Full HMO Network
HMO Platinum CA $20/30 0 Ded
01/01/2021 Summary SBC
HMO Platinum CA $20/30 0 Ded noINF (without Infertility)
02/01/2021 Summary SBC
HMO Gold CA $30/60 0 Ded
01/01/2021 Summary SBC
HMO Gold CA $35/55 250 Ded
01/01/2021 Summary SBC
HMO Gold CA $35/55 250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
HMO Gold CA $25/50 500 Ded
01/01/2021 Summary SBC
HMO Silver CA $55/90 2250 Ded
01/01/2021 Summary SBC
HMO Silver CA $55/90 2250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
HMO Silver CA $50/75 2550 Ded
01/01/2021 Summary SBC
HMO Bronze CA $75/125 7900 Ded
01/01/2021 Summary SBC
HMO Deductible Network
HMO Deductible Platinum CA $20/30 0 Ded
01/01/2021 Summary SBC
HMO Deductible Platinum CA $20/30 0 Ded noINF (without Infertility)
02/01/2021 Summary SBC
HMO Deductible Gold CA $30/60 0 Ded
01/01/2021 Summary SBC
HMO Deductible Gold CA $35/55 250 Ded
01/01/2021 Summary SBC
HMO Deductible Gold CA $35/55 250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
HMO Deductible Gold CA $25/50 500 Ded
01/01/2021 Summary SBC
HMO Deductible Silver CA $55/90 2250 Ded
01/01/2021 Summary SBC
HMO Deductible Silver CA $55/90 2250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
HMO Deductible Silver CA $50/75 2550 Ded
01/01/2021 Summary SBC
HMO Deductible Bronze CA $75/125 7900 Ded
01/01/2021 Summary SBC
Aetna Value Network
Aetna Value Network HMO Platinum CA $20/30 0 Ded
01/01/2021 Summary SBC
Aetna Value Network HMO Platinum CA $20/30 0 Ded noINF (without Infertility)
02/01/2021 Summary SBC
Aetna Value Network HMO Gold CA $30/60 0 Ded
01/01/2021 Summary SBC
Aetna Value Network HMO Gold CA $35/55 250 Ded
01/01/2021 Summary SBC
Aetna Value Network HMO Gold CA $35/55 250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
Aetna Value Network HMO Gold CA $25/50 500 Ded
01/01/2021 Summary SBC
Aetna Value Network HMO Silver CA $55/90 2250 Ded
01/01/2021 Summary SBC
Aetna Value Network HMO Silver CA $55/90 2250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
Aetna Value Network HMO Silver CA $50/75 2550 Ded
01/01/2021 Summary SBC
Aetna Value Network HMO Bronze CA $75/125 7900 Ded
01/01/2021 Summary SBC
Basic Network
HMO Basic Platinum CA $20/30 0 Ded
01/01/2021 Summary SBC
HMO Basic Platinum CA $20/30 0 Ded noINF (without Infertility)
02/01/2021 Summary SBC
HMO Basic Gold CA $30/60 0 Ded
01/01/2021 Summary SBC
HMO Basic Gold CA $35/55 250 Ded
01/01/2021 Summary SBC
HMO Basic Gold CA $35/55 250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
HMO Basic Gold CA $25/50 500 Ded
01/01/2021 Summary SBC
HMO Basic Silver CA $55/90 2250 Ded
01/01/2021 Summary SBC
HMO Basic Silver CA $55/90 2250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
HMO Basic Silver CA $50/75 2550 Ded
01/01/2021 Summary SBC
HMO Basic Bronze CA $75/125 7900 Ded
01/01/2021 Summary SBC
HMO Basic Bronze CA $65/95 6300 Ded - Mandated coverage CA exchange plan (contact RBG for plan availability and rates)
01/01/2021 Summary SBC
HMO Basic Bronze CA $65/95 6300 Ded noINF (without Infertility) - Mandated coverage CA exchange plan (contact RBG for plan availability and rates)
02/01/2021 Summary SBC
Aetna Whole Health Network Southern CA
AWH Southern CA HMO Platinum CA $20/30 0 Ded
01/01/2021 Summary SBC
AWH Southern CA HMO Platinum CA $20/30 0 Ded noINF (without Infertility)
02/01/2021 Summary SBC
AWH Southern CA HMO Gold CA $30/60 0 Ded
01/01/2021 Summary SBC
AWH Southern CA HMO Gold CA $35/55 250 Ded
01/01/2021 Summary SBC
AWH Southern CA HMO Gold CA $35/55 250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
AWH Southern CA HMO Gold CA $25/50 500 Ded
01/01/2021 Summary SBC
AWH Southern CA HMO Silver CA $55/90 2250 Ded
01/01/2021 Summary SBC
AWH Southern CA HMO Silver CA $55/90 2250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
AWH Southern CA HMO Silver CA $50/75 2550 Ded
01/01/2021 Summary SBC
AWH Southern CA HMO Bronze CA $75/125 7900 Ded
01/01/2021 Summary SBC
2021 Medical EPO
Elect Choice EPO Network
OA Elect Choice EPO Silver CA 60 2000 Ded
01/01/2021 Summary SBC
Aetna Whole Health Network Southern CA Elect Choice EPO
AWH Southern CA OA Elect Choice EPO Silver CA 60 2000 Ded
01/01/2021 Summary SBC
2021 Medical PPO
Managed Choice POS Network
OA Managed Choice POS Platinum CA 90/50 0 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Gold CA 80/50 350 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Gold CA 80/50 750 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Gold CA 80/50 1250 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Gold CA 80/50 1500 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Silver CA 60/50 2000 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Silver CA Copay Plan 70/50 2250 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Silver CA 60/50 2550 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Bronze CA 60/50 6300 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Bronze CA 50/50 8300 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Bronze HDHP CA 100 7000 Ded HSA
01/01/2021 Summary SBC
Savings Plus Managed Choice POS Network
Savings Plus OA Managed Choice POS Platinum CA 90/50 0 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 350 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 750 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 1250 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 1500 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Silver CA 60/50 2000 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Silver CA Copay Plan 70/50 2250 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Silver CA 60/50 2550 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Bronze CA 60/50 6300 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Bronze CA 50/50 8300 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Bronze HDHP CA 100 7000 Ded HSA
01/01/2021 Summary SBC
Aetna Whole Health Network Southern CA Managed Choice POS Network
AWH Southern CA OA Managed Choice POS Platinum CA 90/50 0 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 80/50 350 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 80/50 750 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 80/50 1250 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 80/50 1500 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA 60/50 2000 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA Copay Plan 70/50 2250 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA 60/50 2550 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze CA 60/50 6300 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze CA 50/50 8300 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze HDHP CA 100 7000 Ded HSA
01/01/2021 Summary SBC
PPO Network (available to out-of-state employees only)
Open Choice PPO Gold CA 80/50 1000 Ded
01/01/2021 Summary SBC
2020 Medical HMO
Full HMO Network
HMO Platinum CA $15/30 0 Ded
01/01/2020 Summary SBC
HMO Gold CA $25/50 250 Ded
01/01/2020 Summary SBC
HMO Deductible Network
HMO Deductible Platinum CA $15/30 0 Ded
01/01/2020 Summary SBC
HMO Deductible Gold CA $25/50 250 Ded
01/01/2020 Summary SBC
HMO Deductible Gold CA $25/50 500 Ded
01/01/2020 Summary SBC
HMO Deductible Silver CA $50/85 2250 Ded
01/01/2020 Summary SBC
HMO Deductible Silver CA $50/75 2550 Ded
01/01/2020 Summary SBC
HMO Deductible Bronze CA $75/125 7900 Ded
01/01/2020 Summary SBC
Aetna Value Network
Aetna Value Network HMO Platinum CA $15/30 0 Ded
01/01/2020 Summary SBC
Aetna Value Network HMO Gold CA $25/50 250 Ded
01/01/2020 Summary SBC
Aetna Value Network HMO Gold CA $25/50 500 Ded
01/01/2020 Summary SBC
Aetna Value Network HMO Silver CA $50/85 2250 Ded
01/01/2020 Summary SBC
Aetna Value Network HMO Silver CA $50/75 2550 Ded
01/01/2020 Summary SBC
Aetna Value Network HMO Bronze CA $75/125 7900 Ded
01/01/2020 Summary SBC
Basic Network
HMO Basic Platinum CA $15/30 0 Ded
01/01/2020 Summary SBC
HMO Basic Gold CA $25/50 250 Ded
01/01/2020 Summary SBC
HMO Basic Gold CA $25/50 500 Ded
01/01/2020 Summary SBC
HMO Basic Silver CA $50/85 2250 Ded
01/01/2020 Summary SBC
HMO Basic Silver CA $50/75 2550 Ded
01/01/2020 Summary SBC
HMO Basic Bronze CA $75/125 7900 Ded
01/01/2020 Summary SBC
HMO Basic Bronze CA $65/95 6300 Ded - Mandated coverage CA exchange plan. Contact RBG for plan availability and rates.
01/01/2020 Summary SBC
Aetna Whole Health Network Southern CA HMO
AWH Southern CA HMO Platinum CA $15/30 0 Ded
01/01/2020 Summary SBC
AWH Southern CA HMO Gold CA $25/50 250 Ded
01/01/2020 Summary SBC
AWH Southern CA HMO Gold CA $25/50 500 Ded
01/01/2020 Summary SBC
AWH Southern CA HMO Silver CA $50/85 2250 Ded
01/01/2020 Summary SBC
AWH Southern CA HMO Silver CA $50/75 2550 Ded
01/01/2020 Summary SBC
AWH Southern CA HMO Bronze CA $75/125 7900 Ded
01/01/2020 Summary SBC
2020 Medical EPO
Elect Choice EPO Network
OA Elect Choice EPO Gold CA 80 750 Ded
01/01/2020 Summary SBC
OA Elect Choice EPO Gold CA 80 1250 Ded
01/01/2020 Summary SBC
OA Elect Choice EPO Silver CA 60 2000 Ded
01/01/2020 Summary SBC
OA Elect Choice EPO Silver CA 60 2550 Ded
01/01/2020 Summary SBC
OA Elect Choice EPO Bronze CA 50 7300 Ded
01/01/2020 Summary SBC
Aetna Whole Health Network Southern CA Elect Choice EPO
AWH Southern CA OA Elect Choice EPO Gold CA 80 750 Ded
01/01/2020 Summary SBC
AWH Southern CA OA Elect Choice EPO Gold CA 80 1250 Ded
01/01/2020 Summary SBC
AWH Southern CA OA Elect Choice EPO Silver CA 60 2000 Ded
01/01/2020 Summary SBC
AWH Southern CA OA Elect Choice EPO Silver CA 60 2550 Ded
01/01/2020 Summary SBC
AWH Southern CA OA Elect Choice EPO Bronze CA 50 7300 Ded
01/01/2020 Summary SBC
2020 Medical PPO
Managed Choice POS Network
OA Managed Choice POS Platinum CA 90/50 0 Ded
01/01/2020 Summary SBC
OA Managed Choice POS Gold CA 80/50 250 Ded
01/01/2020 Summary SBC
OA Managed Choice POS Gold CA 80/50 750 Ded
01/01/2020 Summary SBC
OA Managed Choice POS Gold CA 80/50 1250 Ded
01/01/2020 Summary SBC
OA Managed Choice POS Silver CA 60/50 2000 Ded
01/01/2020 Summary SBC
OA Managed Choice POS Silver CA Copay Plan 80/50 2250 Ded
01/01/2020 Summary SBC
OA Managed Choice POS Silver CA 60/50 2550 Ded
01/01/2020 Summary SBC
OA Managed Choice POS Bronze CA 50/50 7300 Ded
01/01/2020 Summary SBC
OA Managed Choice POS Bronze HDHP CA 100/50 6900 Ded HSA
01/01/2020 Summary SBC
Savings Plus Managed Choice POS Network
Savings Plus OA Managed Choice POS Platinum CA 90/50 0 Ded
01/01/2020 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 250 Ded
01/01/2020 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 750 Ded
01/01/2020 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 1250 Ded
01/01/2020 Summary SBC
Savings Plus OA Managed Choice POS Silver CA 60/50 2000 Ded
01/01/2020 Summary SBC
Savings Plus OA Managed Choice POS Silver CA Copay Plan 80/50 2250 Ded
01/01/2020 Summary SBC
Savings Plus OA Managed Choice POS Silver CA 60/50 2550 Ded
01/01/2020 Summary SBC
Savings Plus OA Managed Choice POS Bronze CA 50/50 7300 Ded
01/01/2020 Summary SBC
Savings Plus OA Managed Choice POS Bronze HDHP CA 100/50 6900 Ded HSA
01/01/2020 Summary SBC
Aetna Whole Health Network Southern CA Managed Choice POS
AWH Southern CA OA Managed Choice POS Platinum CA 90/50 0 Ded
01/01/2020 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 80/50 250 Ded
01/01/2020 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 80/50 750 Ded
01/01/2020 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 80/50 1250 Ded
01/01/2020 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA 60/50 2000 Ded
01/01/2020 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA Copay Plan 80/50 2250 Ded
01/01/2020 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA 60/50 2550 Ded
01/01/2020 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze CA 50/50 7300 Ded
01/01/2020 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze HDHP CA 100/50 6900 Ded HSA
01/01/2020 Summary SBC
PPO Network (available to out-of-state employees only)
Open Choice PPO Gold CA 80/50 1000 Ded
01/01/2020 Summary SBC
Form Name Effective Date Download Form
General Information
CA Small Group Plan Guide - Benefits Toolkit 1.21
01/01/2021 Download
Underwriting Guidelines 1.21
01/01/2021 Download
Attain by Aetna Fact Sheet
01/01/2020 Download
Attain by Aetna FAQ
03/01/2020 Download
Attain by Aetna Member Flyer
07/01/2020 Download
CVS HealthHUB Broker Sell Sheet
01/01/2021 Download
Discount Program Brochure
01/01/2020 Download
Heal Flyer for PPO Members
01/01/2020 Download
HMO Network Guide - Southern California
03/01/2021 Download
HMO Network Guide - Northern California
01/01/2021 Download
Member Website Flyer
01/01/2020 Download
Mobile App Flyer
01/01/2021 Download
Online Provider Search Instructions
01/01/2020 Download
Small Group Prescription Drug Formulary Guide 2021
01/01/2021 Download
Teladoc Flyer
12/01/2020 Download
Vision Preferred Flyer
01/01/2021 Download
Form Name Effective Date Download Form
Contact Information
01/01/2020 Download