Member Forms
Forms for Members
Authorization for Release of Protected Health Information (PHI) (third party authorization) (PDF)
Autorización para divulgar información protegida de salud (PDF)
Formulario de solicitud de acceso a la informacion medica protegida (PHI) (PDF)
Member Complaint and Appeal (PDF)
Request for Protected Health Information (PHI) (PDF)
Revocation of Authorization previously given to Aetna (Third party authorization) (PDF)
Transition of Coverage Form (PDF)
Vision Claim Form - Benefit as part of your medical plan (PDF)
Vision Claim Form - Benefit through Aetna Vision Preferred (separate plan from medical) (PDF)
Transforming health care, together
Banner|Aetna aims to offer access to more efficient and effective member care at a more affordable cost. We join the right medical professionals with the right technology, so members benefit from quality, personalized health care designed to help them reach their health ambitions.
Language services can be provided by calling the number on your member ID card. For additional language assistance:
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