Aetna Claim Forms

For use when you have paid for out-of-network expenses.  No Claim Form is needed for in-network expenses.

You will need Adobe Acrobat Reader to download the following files.

Open Access Managed Choice Claim Form
(for all services beginning September 1, 2010)
For claims prior to September 1, 2010:
Managed Choice Claim Form (page 1)
Managed Choice Claim Form (page 2)

(For California, Washington D.C., Maine, and Oregon)  
QPOS Claim Form
(For states not mentioned above)
Complete Claim Form above and send to: 
Aetna Health Inc.
P.O. Box 981107
El Paso, TX 79998-1107
Aetna Dental Claim Form
For Use with our Traditional and PPO Dental Plans. You do not need a claim form for services under the DMO Plan (For all states)

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