Get Aetna Student Health Prescription Reimbursement Form

This guide provides comprehensive instructions for completing the Aetna Student Health Prescription Reimbursement Form online. By following these steps, users can ensure that they fill out the form accurately and completely for successful reimbursement.

Follow the steps to fill out the Aetna Student Health Prescription Reimbursement Form online.

1. Press the ‘Get Form’ button to obtain the form and open it in the editable interface.
2. In the first section, enter your Aetna member number, as the claim cannot be processed without this number. Ensure accuracy, as any mistakes can delay your reimbursement.
3. Fill in your group number if applicable, and indicate if you are enrolled in Medicare by checking the corresponding box.
4. Provide the student's full name including first, middle, and last names, followed by their birthdate in MM/DD/YYYY format.
5. Input the student's address, including street, city, state, and ZIP code. This information is vital for correspondence regarding the claim.
6. Include the name and address of the school the student is attending. This section helps verify eligibility.
7. Sign where indicated with the student’s signature. This confirms the accuracy of the provided information and authorizes the claim.
8. Enter the student's telephone number in the designated field. This will be used for any necessary follow-up communication.
9. For the prescription information, indicate whether the claim is for the student, spouse, or dependent by providing the last name, first name, and middle initial.
10. Specify the gender of the patient by selecting either 'Male' or 'Female' accordingly.
11. Enter the patient’s birthdate in MM/DD/YYYY format to confirm their identity.
12. Indicate if any family member's expenses are covered by another plan. If 'Yes', provide details including the policy or contract holder's information and the name and address of the insurance company.
13. If applicable, check all Medicare options that apply to the patient, including Medicare Part A, Part B, and Part D.
14. Indicate why you are filing the claim manually, such as 'Coordination of Benefits' or 'Emergency'. Attach necessary documentation like an explanation of benefits or detailed receipts.
15. Complete the pharmacy information section by attaching detailed prescription receipts. This documentation is required to process your claim.
16. Review the entire form for completeness. Incomplete forms will be returned. Ensure every required field is filled out correctly.
17. Once all information is entered and reviewed, save changes to the form. You may then choose to download, print, or share the filled-out form to submit it.

Complete your Aetna Student Health Prescription Reimbursement Form online today for a smooth reimbursement experience.