AETNA
- Plan Administrator
- Summary Plan Description
- State of Delaware Consumer-Directed(CDH) Gold Plan
- Urgent Care Facilities for HMO and CDH Gold Plans
Customer Service: 1-877-542-3862
- Participating Lab
- Quest Diagnostics is a Participating Provider
- 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
