Office of Management and Budget : Statewide Benefits Office >> Benefit Programs


Program Announcements:

Aetna has gone mobile! PDF Document
The Aetna Mobile app works with iPhone® mobile digital devices, BlackBerry® smartphone and Android™. Use a different smartphone or mobile device? Please visit and use the mobile web version of the site. There are two ways to download your FREE Aetna Mobile App:

  • Text Apps to 44040 to download now*
  • Scan the code with your mobile device.
Aetna Mobile
*Standard text messaging rates may apply.

To learn more, please visit Aetna's website at

Plan Administrator

Program Description

Summary Plan Descriptions

Urgent Care Facilities for HMO and CDH Gold Plans

Customer Service: 1-877-542-3862

Network Update

Effective September 5, 2013, Orthopedic Associates of Southern Delaware will no longer be an “in-network” provider with Aetna. Claims incurred on and after this date for members enrolled in Aetna's HMO Plan will be denied for payment. Claims incurred on and after this date for members enrolled in Aetna's CDH Gold Plan will be processed for an out-of-network provider with the member being responsible for a greater portion of the claim than if the services were received by an in-network provider. Contact Aetna's Customer Services staff at 1-877-542-3862 for additional information.

Flu Vaccine Information:

Forms, Documentation, and Special Applications

  • Dependent Child Coordination of Benefits
    In accordance with the Group Health Eligibility and Enrollment Rules, a Dependent Coordination of Benefits form must be completed for each dependent child upon enrollment, any time coverage changes, or upon request by the Statewide Benefits Office. Please complete the applicable form below and return it to your health care carrier at the address provided on the bottom of the form.
  • Claim Form PDF Enabled Form
    Please print the Claim Form, complete, and send by U.S. Mail or fax to:
    Attn: Claims
    P.O. Box 981106
    El Paso, TX 79998-1106
    Fax: (859) 455-8650
  • Incapacitated Child - Member Form PDF Enabled Form
  • Incapacitated Child - Physician Form PDF Enabled Form

Appeal Process

Section Manager: Brenda Lakeman

Benefits Documentation

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Last Updated: Wednesday November 19 2014
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