Follow the steps to successfully complete your claim form.

1. Click ‘Get Form’ button to obtain the form and open it in your document editor.
2. Begin with the 'Policyholder (Member) Information' section. Fill in all the required fields, including the policy name, policy number, member's name, date of birth, Aetna identification number, and contact details.
3. Next, move to the 'Patient Information' section. Provide the patient's full name, Aetna identification number, gender, relationship to the policyholder, and date of birth.
4. In the 'Other Health Insurance Coverage' section, indicate whether you hold any other insurance. If yes, complete the additional fields including the other insurance policy number and name of the other carrier.
5. Proceed to the 'Claim Information' section. Ensure you include the dates of service, descriptions of services, names of providers, diagnoses, and total charges. Provide detailed information regarding any accidents or prescribed medications.
6. In the 'Summary of Payment Details,' select your reimbursement method and fill in the required payment information. Ensure that the details are correct to avoid delays.
7. Complete the 'Declaration' by signing and dating the form. If the patient is under 18 years of age, a parent or guardian must sign.
8. Finally, review the completed form to ensure all sections are filled out correctly. Save your changes, and then download, print, or share the form as necessary.

Submit your claim form online today to ensure timely processing of your benefits.