Forms

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.

https://ajbid.org/wp/wp-content/uploads/2018/07/medical-claim-form-1.pdf

Dental https://ajbid.org/wp/wp-content/uploads/2018/07/dental-claim-form.pdf

Pharmacy https://ajbid.org/wp/wp-content/uploads/2017/06/CIGNA_IGO_Claim_Form_ENGLISH.pdf

Vision link=”https://ajbid.org/wp/wp-content/uploads/2018/07/vision_claim_form.pdf”

Scroll to Top Skip to content