Forms

Below are forms that you may need as a member of Aetna Better Health Premier Plan. These forms can help you manage claims, access information and more. If you need a form not listed here, contact us.

Notice of Privacy Practices  (English & Español)

Multi-Language Insert (English & Español)

Appointment of Representative Form

Authorization to Release Protected Health Information (PHI)  (Spanish/Polish)

Authorization to Release Psychotherapy Notes

Prior Authorization Form

Behavioral Health Prior Authorization Form (coming soon)

IDT Training Brochure

Prescription Drug Mail Order Form (English & Español)

Coverage Determination Form

Coverage Redetermination Request Form

Prescription Reimbursement Request Form (English & Español)

Hospice Part D Exception Form

Advance Directives