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
07/01/2019 Download
Employer Application
07/01/2019 Download
FTE Certification Form
01/01/2019 Download
ACH Form
01/01/2019 Download
Attestation Form for Special Open Enrollment Groups
01/01/2019 Download
In Force Group Forms
Employer Verification Form
01/01/2019 Download
Administration
Employer Administrative Handbook
01/01/2019 Download
New Customer Quick Start Guide
01/01/2019 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Employee Enrollment Change Form
07/01/2019 Download
Request for Continuation of Coverage for Disabled Child
01/01/2019 Download
Handicapped Child Attending Physician Statement
01/01/2019 Download
Mail Order Rx Delivery-Registration Form
01/01/2019 Download
Transition of Care Form (HMO)
01/01/2019 Download
Transition of Care Form (PPO)
01/01/2019 Download
Claim Forms
Authorization to Release Protected Health Information Form
01/01/2019 Download
Medical Claim Form
01/01/2019 Download
Pharmacy Claim Form
01/01/2019 Download
Dental Claim Form
01/01/2019 Download
Vision Claim Form
01/01/2019 Download
Form Name Effective Date Download Form
2019 Medical HMO
Full HMO Network
HMO Gold CA $30/55 0 Ded
01/01/2019 Summary SBC
HMO Deductible Network
HMO Deductible Platinum CA $15/30 0 Ded
01/01/2019 Summary SBC
HMO Deductible Gold CA $30/55 0 Ded
01/01/2019 Summary SBC
HMO Deductible Silver CA $45/80 2000 Ded
01/01/2019 Summary SBC
HMO Deductible Bronze CA $70/115 6000 Ded
01/01/2019 Summary SBC
Aetna Value Network
Aetna Value Network HMO Platinum CA $15/30 0 Ded
01/01/2019 Summary SBC
Aetna Value Network HMO Gold CA $30/55 0 Ded
01/01/2019 Summary SBC
Aetna Value Network HMO Silver CA $45/80 2000 Ded
01/01/2019 Summary SBC
Aetna Value Network HMO Bronze CA $70/115 6000 Ded
01/01/2019 Summary SBC
Basic Network
HMO Basic Platinum CA $15/30 0 Ded
01/01/2019 Summary SBC
HMO Basic Gold CA $30/55 0 Ded
01/01/2019 Summary SBC
HMO Basic Silver CA $45/80 2000 Ded
01/01/2019 Summary SBC
HMO Basic Bronze CA $70/115 6000 Ded
01/01/2019 Summary SBC
CA Bronze HMO Basic Net $75/105 6300 Ded - Mandated coverage California exchange plan. Contact RBG for plan availability and rates.
01/01/2019 Summary SBC
Aetna Whole Health HMO - PrimeCare Network
AWH PrimeCare HMO Gold CA $30/55 0 Ded
01/01/2019 Summary SBC
AWH PrimeCare HMO Silver CA $45/80 2000 Ded
01/01/2019 Summary SBC
AWH PrimeCare HMO Bronze CA $70/115 6000 Ded
01/01/2019 Summary SBC
2019 Medical Aetna Whole Health EPO
MemorialCare EPO Network
AWH MemorialCare OA Elect Choice EPO Silver CA 60% 2000 Ded
01/01/2019 Summary SBC
AWH MemorialCare OA Elect Choice EPO Bronze HDHP CA 60% 6000 Ded HSA
01/01/2019 Summary SBC
PrimeCare EPO Network
AWH PrimeCare OA Elect Choice EPO Silver CA 60% 2000 Ded
01/01/2019 Summary SBC
AWH PrimeCare OA Elect Choice EPO Bronze CA 60% 6000 Ded HSA
01/01/2019 Summary SBC
Providence EPO Network
AWH Providence OA Elect Choice EPO Silver CA 60% 2000 Ded
01/01/2019 Summary SBC
AWH Providence OA Elect Choice EPO Bronze HDHP CA 60% 6000 Ded HSA
01/01/2019 Summary SBC
2019 Medical PPO
MC Network
OA Managed Choice POS Gold CA 80/50 0 Ded
01/01/2019 Summary SBC
OA Managed Choice POS Gold CA 80/50 750 Ded
01/01/2019 Summary SBC
OA Managed Choice POS Silver CA Copay Plan 2000 Ded
01/01/2019 Summary SBC
OA Managed Choice POS Silver CA 60/50 2000 Ded
01/01/2019 Summary SBC
OA Managed Choice POS Bronze CA 50/50 6800 Ded [NEW 7.19]
07/01/2019 Summary SBC
OA Managed Choice POS Bronze HDHP CA 60/50 6000 Ded HSA
01/01/2019 Summary SBC
OA Managed Choice POS Bronze HDHP CA 100/50 6650 Ded HSA
01/01/2019 Summary SBC
Savings Plus Network
Savings Plus OA Managed Choice POS Platinum CA 90/50 0 Ded
01/01/2019 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 0 Ded
01/01/2019 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 750 Ded
01/01/2019 Summary SBC
Savings Plus OA Managed Choice POS Silver CA Copay Plan 2000 Ded
01/01/2019 Summary SBC
Savings Plus OA Managed Choice POS Silver CA 60/50 2000 Ded
01/01/2019 Summary SBC
Savings Plus OA Managed Choice POS Bronze CA 50/50 6800 Ded [NEW 7.19]
07/01/2019 Summary SBC
Savings Plus OA Managed Choice POS Bronze HDHP CA 60/50 6000 Ded HSA
01/01/2019 Summary SBC
Savings Plus OA Managed Choice POS Bronze HDHP CA 100/50 6650 Ded HSA
01/01/2019 Summary SBC
Aetna Whole Health MC - MemorialCare Network
AWH MemorialCare OA Managed Choice POS Silver CA Copay Plan 2000 Ded
01/01/2019 Summary SBC
AWH MemorialCare OA Managed Choice POS Bronze HDHP CA 60/50 6000 Ded HSA
01/01/2019 Summary SBC
Aetna Whole Health MC - PrimeCare Network
AWH PrimeCare OA Managed Choice POS Silver CA 2000 Copay
01/01/2019 Summary SBC
AWH PrimeCare OA Managed Choice POS Bronze HDHP CA 60/50 6000 Ded HSA
01/01/2019 Summary SBC
Aetna Whole Health MC - Providence Network
AWH Providence OA Managed Choice POS Silver CA Copay Plan 2000 Ded
01/01/2019 Summary SBC
AWH Providence OA Managed Choice POS Bronze HDHP CA 60/50 6000 Ded HSA
01/01/2019 Summary SBC
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
Form Name Effective Date Download Form
Aetna CA Small Group Plan Guide - Benefits Toolkit
01/01/2019 Download
Aetna Small Group Product & Services Update For Q3 2019
07/01/2019 Download
Attain by Aetna Fact Sheet
08/01/2019 Download
Attain by Aetna Member Flyer
08/01/2019 Download
Aetna Discount Program
01/01/2019 Download
Aetna Heal Flyer for PPO Members
01/01/2019 Download
Aetna Member Website Flyer
01/01/2019 Download
Aetna Mobile App Flyer
01/01/2019 Download
Aetna Provider Search Instructions
01/01/2019 Download
Aetna Teladoc Flyer
01/01/2019 Download
Aetna Underwriting Guidelines 1.19
01/01/2019 Download
Aetna Underwriting Guidelines 7.19
07/01/2019 Download
Aetna 2018 MLR Experience Year Rebate Pools
08/15/2019 Download
Form Name Effective Date Download Form
Aetna Broker Alert - No More Outside Sales
01/01/2018 Download
Contact Information
01/01/2017