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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

How to get your 1095-B Tax Form online

The 1095 form is a health insurance tax form which reports the type of coverage you had and the period of coverage for the prior year. This form is used to verify on your tax return that you have had at least minimum qualifying health insurance coverage.

To obtain your 1095 form online from your account please follow the instructions provided below.

PLEASE NOTE: Because Northwestern identifies students with their student ID number and not their social security number (SSN) you will need to follow the instructions below to update your SSN before printing the form.

Step 1: You will need your ID card first, click here get your ID card if you do not have it yet.

Step 2: To get to Your Member Website please go to this link and click on the blue “Register/Login” button at the bottom of the page.

To Register:

1) Scroll down to the “Register/Login” button on the bottom left hand side of the page.

2) Enter your Aetna member ID number found on your member ID card downloaded in Step 1. (the ID number should begin with “W”).

3) Enter your date of birth.

To Update Your SSN (Social Security Number)

1) Click the “Profile” tab at the top of the home page

2) Select “Security Settings” from the subgrouping.

3) Click “Add or update Social Security number” link (Northwestern does not provide Aetna with your SSN)

4) Update your Social Security Number, and click “Save”*

To Find the 1095 Form

1) Log into your account

2) Click “Messages” at the top of the page

3) Select “Letters and Communications”

*If you do not see a link to the 1095 form immediately once you update your SSN, please give the system 24 hours to update your social security number, and try back then.

Personal health information requests

Please note these forms are fillable and have digital signature capabilities when opened in Adobe Reader.

Authorization for Release of Protected Health Information (PHI) (third party authorization)

Use this form to give us permission to share information about you (or a dependent) with another person or company. You can also choose the types of coverage for which the permission applies.

Request for Protected Health Information

Use this form to get a report that included the Protected Health Information Aetna used to administer health benefits. A separate form must be completed for each member who wants to receive this report.

Revocation of Authorization previously given to Aetna (Third party authorization)

Use this form to remove permission previously given to share information about you (or a dependent) with another person or company.

Accessibility Services: If you are a person with a disability who needs assistance using our websites, our Customer Service Representatives can assist you. Please call them at the number on your member ID Card or at 877-480-4161 from 8:30 a.m.-5:30 p.m, Mon-Fri. Persons with a hearing or speech disability can use 711 for Telecommunications Relay Service (TRS).

If you need a PDF document in an accessible format, you can request it directly through"Contact Us" here or at the top of the page.

151 Farmington Avenue, Hartford, CT 06156. 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.

Student health insurance plans are underwritten by Aetna Life Insurance Company (Aetna). In MD and NJ, student medical insurance is underwritten by Aetna Health and Life Insurance Company (AHLIC).Self-insured plans are funded by the applicable school, with claims administration services provided by Aetna Life Insurance Company. Aetna Student HealthSM is the brand name for products and services provided by Aetna Life Insurance Company, Aetna Health and Life Insurance Company and their affiliated companies.