For use when you have paid for out-of-network expenses.  No Claim Form is needed for in-network expenses.

You will need Adobe Acrobat Reader to download the following files.

Managed Choice Claim Form (page 1) Managed Choice Claim Form (page 2)
	(For California, Washington D.C., Maine, and Oregon)
QPOS Claim Form (For states not mentioned above)
	Complete Claim Form above and send to:
		AETNA U.S. HEALTHCARE MAIL STOP 28B PO Box 1125 Blue Bell, PA 19422-0089
Aetna Dental Claim Form
	For Use with our Traditional and PPO Dental Plans. You do not need a claim form for services under the DMO Plan (For all states)

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