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    • Aetna Better Health® of Illinois

    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 — English (PDF) | 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) 

     

    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 

     

    Childhood wellness visit checklist

     

    Child immunization schedule

     

    Aetna Better Care Rewards Brochure — English (PDF) | Spanish (PDF)