Forms

[vc_row][vc_column][vc_column_text]For services outside the USA:

  • Please use the Aetna medical services reimbursement form for medical, dental and vision services. The same form is used for drug prescription reimbursement requests.

For services in the USA:

  • For medical services in the USA, please use the drug prescription card from Aetna. To request reimbursement, please use the Aetna medical services reimbursement form.
  • For vision services in the USA please use the Vision network card from Aetna. To request reimbursement, please use the Aetna medical services reimbursement form.

[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column width=”1/4″ el_class=”col-5″][vc_single_image image=”9264″ img_size=”full” alignment=”center” onclick=”custom_link” img_link_target=”_blank” title=”Medical” link=”https://ajbid.org/wp/wp-content/uploads/2018/07/medical-claim-form-1.pdf”][/vc_column][vc_column width=”1/6″ el_class=”col-5″][vc_single_image image=”9260″ img_size=”full” alignment=”center” onclick=”custom_link” img_link_target=”_blank” title=”Dental” link=”https://ajbid.org/wp/wp-content/uploads/2018/07/dental-claim-form.pdf”][/vc_column][vc_column width=”1/6″ el_class=”col-5″][vc_single_image image=”9262″ img_size=”full” alignment=”center” onclick=”custom_link” img_link_target=”_blank” title=”Pharmacy” link=”https://ajbid.org/wp/wp-content/uploads/2017/06/CIGNA_IGO_Claim_Form_ENGLISH.pdf”][/vc_column][vc_column width=”1/4″ el_class=”col-5″][vc_single_image image=”9258″ img_size=”full” alignment=”center” onclick=”custom_link” img_link_target=”_blank” title=”Vision” link=”https://ajbid.org/wp/wp-content/uploads/2018/07/vision_claim_form.pdf”][/vc_column][/vc_row]

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