Get Important Note: Please Ensure Your Claim Form Is Completed In Full And Returned Within 180 Days Of

Completing the Aetna International Claim Form accurately is essential for timely processing of your claim. This guide will walk you through each section of the form to ensure a smooth submission process.

Follow the steps to successfully complete your claim form.

1. Click ‘Get Form’ button to access the claim form and open it in your preferred document management tool.
2. Complete the 'Policyholder (Member) Information' section. Enter your policy name, policy number, member name, member Aetna identification number, address, telephone numbers, and email address. It is crucial to fill in all the fields to avoid delays.
3. Fill in the 'Patient Information' section. Provide the patient's full name, Aetna identification number, gender, and the relationship to the policyholder. Ensure accurate data entry.
4. In the 'Other Health Insurance Coverage' section, indicate if you hold any other insurance by selecting 'Yes' or 'No.' If applicable, provide other insurance policy details and dates of birth for both the member and patient.
5. Detail the claim in the 'Claim Information' section. Include diagnosis or reason for each service received. If there are multiple services, document the provider's name and address, dates of service, and the total charges. Include any specific information related to accidental injuries or long-term treatments if necessary.
6. Complete the 'Summary of Payment Details' section. Choose your reimbursement method, whether bank transfer or cheque, and provide the necessary payment information. Ensure that if bank transfer is selected, all required banking details are filled out accurately.
7. Review the 'Declaration' section and affirm that all the provided information is correct. If the patient is under 18 years, a parent or guardian must sign. Include the signature and date.
8. After filling in all sections, ensure that you have retained copies of all related documents. Save your changes, and submit the form along with itemized bills and receipts by the preferred method outlined in the claim submission section.

Complete your claim form online today to ensure timely processing and reimbursement.