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Member materials and forms

Here, you’ll find the info and forms you need to get the most from your plan.

Member materials

Member handbook ― English (PDF) | Spanish (PDF)

 

Managed long-term services and supports (MLTSS) handbook — English (PDF) | Spanish (PDF)

 

Hello to Health magazine — English (PDF) | Spanish (PDF)

Forms

Appointment Assistance Request Form —  Online | English (PDF) | Spanish (PDF)

The Appointment Assistance Request Form can be mailed to the address below:

Aetna Better Health of New Jersey - Appointment Assistance Request

3 Independence Way, Suite 104

Princeton, New Jersey 08540-6626

 

Transition of care form — English (PDF) | Spanish (PDF)

 

Online grievance and appeal form

 

Online fraud, waste and abuse form

 

Authorization to Release Protect Health Information (PHI) — English (PDF) | Spanish (PDF)

 

Authorization to Release Psychotherapy Notes —  English (PDF) | Spanish (PDF)

 

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

 

Request for Accounting of Disclosures of Protected Health Information (PHI) —  English (PDF)  | Spanish (PDF)

 

Removal of Authorization Previously Given to Aetna —  English (PDF)  | Spanish (PDF)

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