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Claims and reimbursement (ask us to pay you back)

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Get paid back for prescriptions

 

Did a pharmacy bill you for a covered prescription drug? If so, complete and mail a prescription form to ask for reimbursement.

Get paid back for fitness items or services

 

Did you pay for a covered fitness item or service? Mail us your completed fitness form to ask for reimbursement.

Get reimbursed for paying provider or service-related bills

 

You can use the paper form or the online form if you were billed by a medical, dental, vision, hearing or vaccine provider.

Complete online form

 

To get paid back for wigs, use the paper form. 

 

First, download the form in English or Spanish. Then, mail or fax the completed form to us.

 

Want to know more about how it works?
 

The video mentions dental, vision and hearing benefits. Yet, you can follow the same steps for many covered expenses.

Claims and reimbursement (ask us to pay you back)

Get paid back for prescriptions

 

Did a pharmacy bill you for a covered prescription drug? If so, complete and mail a prescription form to ask for reimbursement.

Choose PDF language

Claims and reimbursement (ask us to pay you back)

Get paid back for fitness items or services

 

Did you pay for a covered fitness item or service? Mail us your completed fitness form to ask for reimbursement.

Choose PDF language

Claims and reimbursement (ask us to pay you back)

Get reimbursed for paying provider or service-related bills

 

You can use the paper form or the online form if you were billed by a medical, dental, vision, hearing or vaccine provider.

Complete online form

 

To get paid back for wigs, use the paper form. 

 

First, download the form in English or Spanish. Then, mail or fax the completed form to us.

 

Want to know more about how it works?
 

The video mentions dental, vision and hearing benefits. Yet, you can follow the same steps for many covered expenses.

Choose PDF language

Give someone permission to help with your care

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Let someone talk to us about your health or coverage

 

Call us with a caregiver or someone else on the line to give them permission to speak with us (just one time, on that call). Or, mail us a completed PHI (protected health information) form to give them permission more often.

Let someone make requests for you

 

Give a caregiver or someone else permission to act on your behalf. They will be able to:

 

  • File a complaint (grievance)
  • Ask for coverage
  • Make an appeal for you

Just have this person sign your completed Appointment of Representative form and send it to us. This person is then your appointed representative for one year from the date that you both sign the form.

Give someone permission to help with your care

Let someone talk to us about your health or coverage

 

Call us with a caregiver or someone else on the line to give them permission to speak with us (just one time, on that call). Or, mail us a completed PHI (protected health information) form to give them permission more often.

Choose PDF language

Give someone permission to help with your care

Let someone make requests for you

 

Give a caregiver or someone else permission to act on your behalf. They will be able to:

 

  • File a complaint (grievance)
  • Ask for coverage
  • Make an appeal for you

Just have this person sign your completed Appointment of Representative form and send it to us. This person is then your appointed representative for one year from the date that you both sign the form.

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Order prescriptions by mail

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Medication order form for CVS Caremark® Mail Service Pharmacy

Order prescriptions by mail

Medication order form for CVS Caremark® Mail Service Pharmacy

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Exceptions, appeals and grievances

Complaints and coverage requests

 

Have a concern about your coverage or care? Our Member Services team is here to help. Just give us a call at the number on your member ID card.

Exceptions, appeals and grievances

Complaints and coverage requests

 

Have a concern about your coverage or care? Our Member Services team is here to help. Just give us a call at the number on your member ID card.

Disenrollment (leaving or canceling a plan)

Leave or cancel your Medicare Advantage (MA) or Medicare Advantage Prescription Drug (MAPD) plan

 

Call us at the number on your ID card if you want to leave or cancel your current plan and not join another one. Or select your current plan and find its phone number on our Contact Member Services page.
 

We’ll let you know your options. Like joining a plan, there are only certain times when you can disenroll*. You may also download, complete and submit a disenrollment form — use the PDF link for your plan below to print its form:
 

Medicare Advantage Plan Disenrollment Form

Medicare Advantage Plan Disenrollment Form - Español

 

Please complete the relevant form and mail it to:

Aetna
PO Box 7405
London, KY 40742


Timing Considerations: 
If there are 10 days or fewer left until the end of the month, please fax the form to 1-866-756-5514. If you leave us during the annual election period, your last day of coverage is usually Dec. 31.


Important Note:
 If you change from a Medicare Advantage plan that includes prescription drug coverage to a Medicare prescription drug plan, this will disenroll you from your Medicare Advantage plan. You’ll return to Original Medicare if you switch from a Medicare Advantage plan (with drug coverage) to a Medicare prescription drug plan.

Leave or cancel your prescription drug plan (PDP)

 

If you want to cancel or switch your Medicare Part D plan (PDP), find out what your options are. Learn all about how and when to disenroll.

Disenrollment (leaving or canceling a plan)

Leave or cancel your Medicare Advantage (MA) or Medicare Advantage Prescription Drug (MAPD) plan

 

Call us at the number on your ID card if you want to leave or cancel your current plan and not join another one. Or select your current plan and find its phone number on our Contact Member Services page.
 

We’ll let you know your options. Like joining a plan, there are only certain times when you can disenroll*. You may also download, complete and submit a disenrollment form — use the PDF link for your plan below to print its form:
 

Medicare Advantage Plan Disenrollment Form

Medicare Advantage Plan Disenrollment Form - Español

 

Please complete the relevant form and mail it to:

Aetna
PO Box 7405
London, KY 40742


Timing Considerations: 
If there are 10 days or fewer left until the end of the month, please fax the form to 1-866-756-5514. If you leave us during the annual election period, your last day of coverage is usually Dec. 31.


Important Note:
 If you change from a Medicare Advantage plan that includes prescription drug coverage to a Medicare prescription drug plan, this will disenroll you from your Medicare Advantage plan. You’ll return to Original Medicare if you switch from a Medicare Advantage plan (with drug coverage) to a Medicare prescription drug plan.

Disenrollment (leaving or canceling a plan)

Leave or cancel your prescription drug plan (PDP)

 

If you want to cancel or switch your Medicare Part D plan (PDP), find out what your options are. Learn all about how and when to disenroll.

 

* FOR TIMES YOU CAN DISENROLL: If you don't have creditable coverage for 63 days or more, you may have to pay a late penalty when you sign up. For example, creditable coverage from an employer or union should pay, on average, at least as much as Medicare's standard prescription plan. You can generally keep your coverage without paying a penalty if you enroll in Medicare prescription drug coverage later.