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Resources and Forms

Contact us

All customer service inquiries, including Provider network questions, should be directed to Aetna Student Health. Visit the Contact Us page to call or email.

Claim forms

If the Provider does not file the claim directly with Aetna Student Health, then you can file the claim by submitting an Aetna Claim Form along with an itemized bill and proof of payment (if you paid for the service) immediately after treatment to us. Always retain copies for your records.

The documents listed below are in PDF format.

Print an Aetna Claim Form

For prescription drug claims, to receive reimbursement, you will need to submit a claim form and the prescription receipt to Aetna.

Print an Aetna Prescription Drug Claim Form

Fax your completed Aetna Prescription Drug Claim Form and receipts to 1-888-472-1128 or mail it to:

Aetna Pharmacy Management
P.O. Box 52444
Phoenix, AZ 85072-2444

Personal health information requests

We need your permission to release your Personal Health Information.

Print out the PHI Request 67902 Form

You also can fax the form to (860) 907-3017 or mail it to:

Aetna Legal Support Services
151 Farmington Avenue, RT65
Hartford, CT 06156-9998

We need your permission to release your personal health information to your providers.

Print out the PHI Request 67938 Form

You also can fax the form to (859) 455-8650 or mail it to:

Aetna Legal Support Services
PO Box 14079
Lexington, KY 40512-4079


Accessibility Services: 
If you are a person with a disability who needs assistance using our websites (or mobile apps) our Customer Service representatives can assist you. Please call them at 877-480-4161. Relay services for individuals with a hearing disability are available by dialing 711.

If you need a PDF document in an accessible format, you can request it directly by completing this online form.

77 South Bedford Street Burlington, MA 01803. Aetna Student Health Agency Inc. is a duly licensed broker for student accident and health insurance in the Commonwealth of Massachusetts. Massachusetts license number: 10041444. California license number: OB84599.

Fully insured student health insurance plans are underwritten by Aetna Life Insurance Company. Self-insured plans are funded by the applicable school, with claims administered on services provided by Aetna Life Insurance Company. Aetna Student HealthSM is the brand name for products and services provided by Aetna Life Insurance Company and its applicable affiliated companies (Aetna).

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Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.

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