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
01/01/2020 Download
Employer Application 1.20
01/01/2020 Download
FTE Certification Form
01/01/2020 Download
Small Group ACA Banking Consent Form
01/01/2020 Download
In Force Group Forms
Employer Verification Form
01/01/2020 Download
Administration
Employer Administrative Handbook
01/01/2020 Download
New Customer Quick Start Guide
01/01/2020 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Employee Enrollment Change Form 1.20
01/01/2020 Download
Request for Continuation of Coverage for Disabled Child
01/01/2020 Download
Handicapped Child Attending Physician Statement
01/01/2020 Download
Mail Order Rx Delivery-Registration Form
01/01/2020 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
01/01/2020 Download
Medical Claim Form
01/01/2020 Download
Pharmacy Claim Form
01/01/2020 Download
Dental Claim Form
01/01/2020 Download
Vision Claim Form
01/01/2020 Download
Form Name Effective Date Download Form
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
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
Form Name Effective Date Download Form
Aetna CA Small Group Plan Guide - Benefits Toolkit
01/01/2020 Download
Aetna Small Group Product & Services Update For Q3 2019
07/01/2019 Download
Attain by Aetna Fact Sheet
01/01/2020 Download
Attain by Aetna Member Flyer
01/01/2020 Download
Aetna Discount Program
01/01/2020 Download
Aetna Heal Flyer for PPO Members
01/01/2019 Download
Aetna HMO Network Guide
01/01/2020 Download
Aetna Member Website Flyer
01/01/2019 Download
Aetna Mobile App Flyer
01/01/2020 Download
Aetna Provider Search Instructions
01/01/2019 Download
Aetna Teladoc Flyer
01/01/2019 Download
Aetna Underwriting Guidelines 1.20
01/01/2020 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