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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)

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

HBIA HBIS member handbook — English (PDF)

HBIA HBIS member handbook — Spanish (PDF)

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

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

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

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

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

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

Member Quick Reference Guide ― English (PDF)

Forms

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

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

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

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

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

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

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

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

Authorized representative designation form — English (PDF)

Authorized representative designation form — Spanish (PDF)

Medical appeal request form — English (PDF)

Medical appeal request form — Spanish (PDF)

Power of attorney for health care — English (PDF)

Power of attorney for health care — Spanish (PDF)

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

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

Notification of pregnancy form — English (PDF)

Notification of pregnancy form — Spanish (PDF)

Authorization to release psychotherapy notes form — English (PDF)

Authorization to release psychotherapy notes form — Spanish (PDF)

Protected Health Information Access Request form — English (PDF)

Protected Health Information Access Request form — Spanish (PDF)

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

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

Outpatient treatment request form — English (PDF)

Additional resources

Office visit checklist — English (PDF)

Office visit checklist — Spanish (PDF)

Childhood wellness visit checklist — English (PDF)

Childhood wellness visit checklist — Spanish (PDF)

Child immunization — English (PDF)

Child immunization — Spanish (PDF)

You and your PCP - Preventive Care Flyer — English (PDF)

You and your PCP - Preventive Care Flyer — Spanish (PDF)

Flu Shot Flyer — English (PDF)

Flu Shot Flyer — Spanish (PDF)

Discover the benefits of Aetna Medicaid 360 — English and Spanish (PDF)

Sync up with SNAP in Aetna Medicaid 360 — English (PDF)