Already a member?
If you are already a member, you can log in to your member account to manage everything. You can file claims for out-of-network care, submit prescription drug claims, get cost estimates, and more.
Claims forms
Health care professionals in our network should file claims for you. Sometimes, health care professionals outside our network do this too.
If you get a bill or receive care from a health care professional who isn’t in the Aetna Student Health® network, you might need to send in a claim yourself.
Use the provided form. Fill it out carefully. Include all required information. Be sure to include copies of any bills or receipts you received. Send to the address or fax number listed on the form. Terms apply*.
- How to submit a medical claim (PDF)
- Aetna Medical Claim Form (PDF)
- Aetna Prescription Drug Claim Form (PDF)
- Aetna Accident Death and Dismemberment Claim Form (NY only) (PDF)
- California State University Health Center Claim Form (CSU only) (PDF)
- Exercise Facility Reimbursement Request Form (NY only) (PDF)
Other forms you might need
All these forms are fillable. They also have digital signature capabilities when opened in Adobe Reader. Send the completed form to the address or fax number listed on the form.
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Out-of-network dental claims
If you choose to use an out-of-network provider for your dental needs, you can submit a claims form.
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Out-of-network vision claims
If you choose to use an out-of-network provider for your vision needs, submitting a claim is easy. You can submit a claims form electronically or print and mail a claim form.
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CVS Caremark® Mail Service
Save time and money by ordering your prescriptions through Aetna’s mail-order prescription service, CVS Caremark Mail Services.
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Complaint or appeal
If you have a complaint about your health plan, or want to appeal a decision about your care, submit this form with any related bills or communications.
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Estimate for service costs
You can get an estimate for what a service will cost by completing the Member Request for Estimate form. We’ll review your request and get you an estimate within 2 business days.
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Travel and lodging reimbursement
If you must travel over 100 miles from your home address for expenses related to an abortion, you can request reimbursement. Terms apply*.
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Personal health information request
These forms help you control your health information with Aetna. You can use them to give permission to share your health information, take back permission if you change your mind, and ask for detailed reports about your health information. This way, you can keep track of who sees your health information.
Connect with us
Need more help? Our team is here for you. If you need assistance filling out any of the forms, our team can guide you through the process.
Legal notices
Student health insurance plans are insured by Aetna Life Insurance Company. Self-funded plans are funded by the school and administered by Aetna Life Insurance Company. Aetna Student HealthSM is the brand name for products and services provided by Aetna Life Insurance Company and its affiliates (Aetna).
Health benefits and health insurance plans contain exclusions and limitations.