Allina Health | Aetna is an affiliate of Allina Health and Aetna Life Insurance Company and its affiliates (Aetna). Aetna provides certain management services to Allina Health | Aetna.
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Managing my costs
To submit a claim for reimbursement, please download, complete and submit the forms below. Each form includes submission instructions and when you can expect to receive reimbursement.
Medical, Dental, Hearing, Vision and Vaccine Reimbursement Form
No printer? No problem. Here’s what to send us for reimbursement.
Instructions if you can’t print the medical reimbursement form
There are certain steps you need to follow to request coverage for a medical service or prescription drug. The process for each is different. We’ve put together a framework to help you find the right process for your request.
An appeal is a formal way of asking us to review and change a coverage decision we made. The appeals process can differ depending on what type of medical service you’re appealing. You can learn more about how to appeal a coverage decision for medical coverage or prescription drugs at our Appeals and Grievances Center.
The Medicare Extra Help program is for those with limited income and resources. Extra Help from Medicare can help you pay for your prescriptions if you qualify.
Managing my plan
If you’re moving to a new address or getting a new phone number, please let us know right away. Just call Member Services at the number on your ID card. Based on where you move, you may need to enroll in a new plan.
Do you get Medicare coverage through an employer, union or retiree plan? If so, you may need to contact your benefits administrator to update your address or phone number.
Need a new, duplicate or additional ID card? You can view and print one within your secure member website. A digital or printed card is identical to a plastic ID card. If you’re unable to log in or do not have an account, just call Member Services. They can help you log in or replace a lost card.
There are two main time periods when you can change or leave your Medicare Advantage (Part C) or prescription drug (Part D) plan.1
During Medicare's annual election period: 10/15 – 12/7
Medicare annual enrollment goes from October 15 through December 7 each year. During this time you can decide to keep your current plan or select a new plan. If you choose to make a change during the Annual Enrollment Period, your new coverage won’t begin until January 1.
Medicare beneficiaries may also enroll in an Allina Health | Aetna Medicare plan through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.
During a special enrollment period granted to you for certain situations
In certain situations, you can change your Medicare plan outside of Medicare’s annual election period. Some examples include if you:
- Move out of your plan’s service area
- Lose other creditable prescription drug coverage
- Live in a long-term care facility (like a nursing home)
- Have Medicaid
If you get coverage from an employer or group health plan, review the information they provide. It can show you what options are available to you.
Generally, your membership in your current plan will end on the last day of the month after we get your request to switch to Original Medicare or another plan.
Managing care
Some Allina Health | Aetna Medicare plans have a home delivery option through the CVS Caremark® Mail Service Pharmacy. To get started with home delivery, please visit the CVS Caremark® Mail Service Pharmacy page.
If you qualify, you may complete the forms below to enroll.
Mail Service Order Form (Spanish)
Please mail the forms to:
CVS Caremark Mail Service Pharmacy
PO BOX 94467
PALATINE, IL 60094-4467
If you need help with a one-time issue, you can give us your permission by phone. We can speak with that person during the call.
If you want to appoint someone to act as a long-term care manager or authorized representative, you can. You’ll need to mail us an Authorization for Release of Protected Health Information (PHI) form. It lets this person access your personal health information. They can also speak with us on your behalf about benefits, coverage, claims, bills and more.
Return the completed form to us at the address or fax number shown on the form.
It’s important to know:
The PHI form doesn’t override Medicare Power of Attorney documents. You don’t need to complete the PHI form if you have a Power of Attorney (POA).
The PHI form is only good for one year. You need to complete a new form each year for a representative to continue to assist you.
You need to complete a separate form (see below) if you need help filing:
- An initial request for coverage
- A grievance or an appeal
Appointment of Representative CMS Form
You have a few options when filing a complaint. You can:
- Call us at the number on your ID card.
- Submit a complaint online.
- Print a complaint form and fax or mail it to the address shown on the form.
We’ll get back to you within 30 days (24 hours if you request a faster response). To send a complaint to Medicare, complete the Medicare Electronic Complaint form
You can select or change your PCP online through the secure member site. Or you can call us at the number on your ID card. You may need to choose your PCP from your plan’s network.
Allina Health | Aetna Medicare Medication Therapy Management (MTM) programs help you and your doctor manage your medications safely. Visit our MTM information page to learn more about Allina Health | Aetna Medicare MTMs and see if you qualify.
1There may be other times when you can join or leave a plan. See Medicare’s full list of special situations.
Still have questions?
Talk to an Allina Health | Aetna Medicare representative at ${membersPhone} ${tty}, ${membersHours}.