CBIA/Aetna Forms

• CBIA/Aetna Enrollment Application/Change Form
• Medical Loss Ratio
• Family Health Statement
• Aetna Medical Claim Form
• Employer Request for Partial Month Termination Credit
• Aetna STD Request
• CBIA/Aetna Supply Request Form
• Aetna Dental Benefits Request
• Sole Survivor Affidavit
• Proof of Death
• Aetna Life Conversion
• Life Insurance Premium Waiver
• Aetna Physicians Statement
• CMS Data Form

• Aetna Rx Home Delivery (Mail Order Pharmacy)
  • Mail the completed form to:
    Aetna Rx Home Delivery
    PO Box 417019
    Kansas City, MO 64179-9892

For refills or supply questions, call Aetna Rx Home Delivery toll-free at 1-866-612-3862.