Aetna Medical Benefits Request Form
El active el retired 7. Patents name 10. Claim Form Aetna 15 Advantages Of Claim Form Aetna And How You Can Make Full Use Of It Medical Claims Shocking Facts United Healthcare Please complete this form if you are interested in joining the aetna s network. Aetna medical benefits request form . If you wish to have your benefits for this claim paid directly to your physician or supplier sign block twenty eight 28. Request a hard copy. Employees daytime telephone number date of retirement 9. You fill out this section. Employees birthdate mm dd yyyy 6. Medical benefits request refer to your digital id card for claim mailing address note. Request a hard copy through the aetna service center that services your employer. Employees aetna id number 4. Instructions are on the back of this form. Include the reason for the change and the affected service address es. This information can be obtained from the claim form. Aetna medical benefits request to be completed by