AETNA
Program Announcements:
Aetna has gone mobile! 
The Aetna Mobile app works with iPhone® mobile digital devices, BlackBerry® smartphone and Android™. Use a different smartphone or mobile device? Please visit www.aetna.com and use the mobile web version of the site. There are two ways to download your FREE Aetna Mobile App:
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*Standard text messaging rates may apply. To learn more, please visit Aetna's website at www.aetna.com/mobile |
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- Plan Administrator
- Program Description
- Summary Plan Descriptions
- Urgent Care Facilities for HMO and CDH Gold Plans
Customer Service: 1-877-542-3862
Flu Shot Information:
- Poster
- Delaware Flu Shot Provider List (Retail Pharmacies)
- Flu Shot administered in Physician's Office
- HMO Plan provides flu shot as a preventive service with member responsible for the applicable co-pay
- CDH-Gold Plan provides flu shot as a preventive service with member using a participating provider with no co-pay OR if using a non-participating provider with 30% coinsurance after deductible is met
- Flu Shot administered at a Delaware Flu Shot Provider
- Delaware Flu Shot Provider List
- HMO Plan member is required to show his/her Aetna Identification Card and will be billed the applicable co-pay. A referral from member's Primary Care Physician (PCP) is not required. A Delaware Flu Shot Provider must be used or claim will be denied.
- CDH Gold member is required to show his/her Aetna Identification Card and flu shot is covered at 100% with no deductible. A Delaware Flu Shot Provider must be used OR pay at the time of service and submit a claim form to be reimbursed with 30% coinsurance after deductible is met.
- Questions or concerns on administration of Flu Shots or health plan's coverage
- Contact Customer Service at 1-877-542-3862
- Participating Lab
- Quest Diagnostics is a Participating Provider
- Information on Herpes Zoster (Shingles) Vaccine
- Documentation
Forms, Documentation, and Special Applications
- Statement of Support Form
This form must be completed, signed, and provided to your HR/Benefits Office.
- Full-Time Student Certification Form
This form must be completed, signed and provided to your HR/Benefits Office.
- 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.
- Dependent Child Coordination of Benefits Form
Please print the form, complete, and send by U.S. Mail to:
Aetna, Inc.
1425 Union Meeting Road, U21S
Blue Bell, PA 19422
- Dependent Child Coordination of Benefits Form
- Claim Form
Please print the Claim Form, complete, and fax to (859) 455-8650 or send by U.S. Mail to:
Aetna, Inc.
Attn: Claims
P.O. Box 981106
El Paso, TX 79998-1106
- Incapacitated Child - Member Form
- Incapacitated Child - Physician Form
- Appeal Process
- Appeal Process for HMO Plan
- Appeal Process for CDH Gold Plan
To request a review or appeal the processing of claims for health care services, member must complete the following two forms and submit to the Statewide Benefits Office.
- Appeal Process for HMO Plan
