Below is a listing of plan forms, brochures and documents to help you manage and understand your benefits.
Member Forms & Documents
| Title | Download |
|---|---|
| 2024 – Summary of Benefits | |
| 2024 – Official Plan Brochure | |
| 2024 – Aetna Medicare Advantage Plan Brochure | |
| 2024 Aetna Medicare Advantage Plan for RCBP Summary of Benefits | |
| 2024 Annual Notice of Change | |
| 2024 Evidence of Coverage | |
| 2024 Plan Document Notice | |
| 2024 Schedule of Cost Sharing | |
| 2024 5 Tier Comprehensive Plus Formulary | |
| 2024 Prior Authorization Details | |
| 2024 Step Therapy Detail | |
| 2024 Formulary Changes | |
| 2024 Non-Part D Rider | |
| 2024 Essential Health Supplemental Benefit | |
| PDP Disenrollment Form | |
| 2024 Prescription Drug Guide/Formulary | |
| 2024 Prescription Drug Guide – Specialty Drugs | |
| 2023 – Summary of Benefits | |
| 2023 – Official Plan Brochure | |
| 2023 – Medicare Plan Brochure | |
| 2023 Medicare – 2023 Evidence of Coverage – Medicare Advantage | |
| 2023 Medicare – 2023 Schedule of Cost Sharing – Medicare Advantage | |
| 2023 Medicare Summary of Benefits Guide | |
| 2023 New Member Guide | |
| 2023 Making the Most Out of Your Plan | |
| Medicare Rewards Program – Medicare Advantage | |
| Know Where to Go Guide | |
| Contraceptive Management Exception Form | |
| Claim Form – Medical | |
| Claim Form – Mail Order Prescription | |
| Claim Form – Prescription, Retail Pharmacy | |
| Authorization for Release of Protected Health Information (PHI) | |
|
Aetna Clinical Policy Bulletins (CPBs) These documents explain how we make coverage decisions for services covered under our official Plan brochure. The medical, pharmacy and behavioral health CPBs are based on objective, credible sources, such as the scientific literature, guidelines, consensus statements and expert opinions. |
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