Member materials and forms

Here is where you’ll find the information and forms you need to get the most from your Aetna Better Health^® of Illinois plan.

Member materials

Aetna Better Health of Illinois member handbook 2023 — English (PDF)

Aetna Better Health of Illinois member handbook 2023 — Spanish (PDF)

Aetna Better Health of Illinois Certificate of Coverage — English (PDF) | Spanish (PDF)

Aetna Better Health of Illinois MLTSS Certificate of Coverage — English (PDF) | Spanish (PDF)

Aetna Better Health of Illinois MLTSS eligibility document — English (PDF) | Spanish (PDF)

Aetna Better Health of Illinois You and your PCP Preventive Care Flyer — English (PDF) | Spanish (PDF)

Forms

Health risk screening form (Adult) — English (PDF) | Spanish (PDF)

Health risk screening form (Child) — English (PDF) | Spanish (PDF)

Authorization to disclose protected health information form — English (PDF) | Spanish (PDF)

Removal of authorization to disclose information form — English (PDF) | Spanish (PDF)

Authorized representative designation form — English (PDF) | Spanish (PDF)

Medical appeal request form— English (PDF) | Spanish (PDF)

Power of attorney for health care — English (PDF) | Spanish (PDF)

Primary care physician (PCP) change request form — English (PDF) | Spanish (PDF)

Notification of pregnancy form — English (PDF) | Spanish (PDF)

Authorization to release psychotherapy notes form — English (PDF) | Spanish (PDF)

Protected Health Information Access Request form — English (PDF) | Spanish (PDF)

Request for an accounting of Disclosures of PHI form — English (PDF) | Spanish (PDF)

Additional resources