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Plan benefits & forms

Medicare plans have many different details and forms, so we’ve organized everything together into one convenient place.

Your Aetna plan benefits & Star Ratings

Knowing more about your plan can help you get the most from your benefits and covered services. Find your plan’s Summary of Benefits, Formulary (list of covered drugs) and other coverage details below. Your member ID card shows your plan’s name. See a word or term you don't know? Check our glossary.

 

 

Aetna Medicare (HMO) for College Insurance Program (CIP)

Summary of Benefits – (MAPD CIP Plan) - English (PDF) 

Annual Notice of Change (ANOC) – (MAPD CIP Plan) - English (PDF)

Schedule of Cost Sharing (SOC) – (MAPD CIP Plan) - English (PDF)

 

Aetna Medicare (HMO) for State Employees Group Insurance Plan (SEGIP)

Summary of Benefits – (MAPD SEGIP Plan) - English (PDF)

Annual Notice of Change (ANOC) – (MAPD SEGIP Plan) - English (PDF)

Schedule of Cost Sharing (SOC) – (MAPD SEGIP Plan) - English (PDF)

 

Aetna Medicare (HMO) for Teachers’ Retiree Insurance Program (TRIP)

Summary of Benefits – (MAPD TRIP Plan)- English (PDF)

Annual Notice of Change (ANOC) – (MAPD TRIP Plan) - English (PDF)

Schedule of Cost Sharing (SOC) – (MAPD TRIP Plan) - English (PDF)

 

Evidence of Coverage (EOC) - English  (PDF) 

Formulary (list of covered drugs) - English  (PDF)

Star Rating - English (PDF)

 

Review your Evidence of Coverage (EOC) to learn about comprehensive plan details, and your rights and responsibilities. You can request a copy of your Evidence of Coverage if you need one.

Find Medicare forms

 

See below for helpful resources for managing your plan and how to get started with common requests.

 

 

File claims & reimbursement requests

Give someone permission to manage your care

Manage your medications

Exceptions, appeals & grievances

Additional information

We're here to help

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