Member Service

Formulary Drug Listing:

Prior Authorization Drug Listing:

Preferred Drug List:

• Preferred Drug List - 2025 1st Quarter

Specific Drug Listings for California group contracts:

• CA Formulary – 12/2024
• CA Formulary – 1/2025

Specific Drug Listings for Illinois group contracts:

• Drug List/Formulary 2024 IL
• Drug List/Formulary 2025 IL
• Prior Authorization and Specialty RX Guidelines – 2024 IL
• Prior Authorization and Specialty RX Guidelines – 2025 IL
• Notice of Changes – 2024 IL
• Notice of Changes – 2025 IL

Specific Drug Listings for New Jersey group contracts:

• Drug List/Formulary – Q4 2024
• Drug List/Formulary – Q1 2025

Specific Drug Listings for New York group contracts:

• New York (NY) - Weight Loss Medications
  Prescription weight loss medications are eligible for coverage. Please note, specific criteria will apply for Prior Authorization (PA) requirements related to weight loss medications. This change is allowed for all NY clients and membership regardless of the individual client's renewal dates. Updated documents will be posted shortly.
• Drug List/Formulary – Q4 2023 NY – For all renewals prior to 4/1/2024
• Drug List/Formulary – Q2 2024 NY – For groups with renewal dates of 4/1/2024, 5/1/2024 and 6/1/2024
• Drug List/Formulary – Q3 2024 NY – For groups with renewal dates of 7/1/2024, 8/1/2024 and 9/1/2024
• Drug List/Formulary – Q4 2024 NY – For groups with renewal dates of 10/1/2024, 11/1/2024 and 12/1/2024
• Drug List/Formulary – Q1 2025 NY – For groups with renewal dates of 1/1/2025 and later

Specific Drug Listings for Texas group contracts:

2025

• Drug List/Formulary – 2025 TX
• Prior Authorization and Specialty RX Guidelines – 2025 TX
• Notice of Changes – 2025 TX
• Prior Authorization Request Form for Prescription Drug Benefits - TX

2024

• Drug List/Formulary – 2024 TX
• Prior Authorization and Specialty RX Guidelines – 2024 TX
• Notice of Changes – 2024 TX
• Prior Authorization Request Form for Prescription Drug Benefits - TX

2023

• Drug List/Formulary – 2023 TX
• Prior Authorization and Specialty RX Guidelines – 2023 TX
• Notice of Changes – 2023 TX
• Prior Authorization Request Form for Prescription Drug Benefits - TX

• Important Information for Medical Office Staff (ASA only)
• Important Information for Dental Office Staff (ADA only)

• Flu Shot Program 2024-2025

• Flu Shot Program 2024-2025 (Japanese)

• Flu Shot Program 2024-2025 (Spanish)

• California
• Colorado
• Connecticut
• Georgia
• Illinois
• Indiana
• Kentucky
• Michigan
• New Jersey
• New York
• Ohio
• Pennsylvania
• South Carolina
• Tennessee
• Texas
• Wisconsin
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• Important Information for Medical Office Staff (ASA only)
• Important Information for Dental Office Staff (ADA only)

• Claim Payment Overview

• Precertification
• Claim forms: Looking for a claim form? You may print or download one of the following forms to use.
  
  

  Standard Claim Forms

  • CVS Caremark Prescription Reimbursement Claim Form
  • FSA Request for Reimbursement Form
  • Limited Purpose FSA Claim Form
  • HRA Claim Form
  • Member or Members Dependent Authorization for Disclosure of Health Information
  • Aetna International Claim Form
  
  

  Medical

  • Medical Claim Form
  • Medical Claim Form - CA
  • Member or Members Dependent Authorization for Disclosure of Health Information
  
  

  Dental

  • Dental Claim Form
  • Dental Claim Form - CA
  • Dental Claim Form - NJ
  • Member or Members Dependent Authorization for Disclosure of Health Information
  
  

  Vision

  • Vision Claim Form
  • Vision Claim Form - CA
  • EyeMed Vision Care Out of Network Claim Form
  
  

  Life

  • Life Insurance Claim Form
  • Life Insurance Beneficiary Quick Reference Guide
  • Life Insurance Beneficiary Designation/Change Form
  • Life Insurance Community Property Consent Form
  • Life Insurance Affidavit
  
  

  Disability

  • Disability Claim Form
  • Continuance of Disability Form

Precertification Explained

Want to look up the status of a claim? Or review your benefits? Register and log in to our member portal to have immediate access to all of the information you need about your insurance coverages.

• California Wildfires - Notifications

• CA Confidential Communications Website Notice