Below are some forms you may need:
(Download Free Adobe Reader if you’re having trouble viewing the documents)
Young Adult Children Coverage
In-Network claims (services rendered by Participating BCBS provider) should be filed directly with the provider’s local BCBS (by your provider).
Out-of-Network Claims for Active and Retiree < 65 should be filed using the Alicare claim form below.
Medicare Primary Claim Form
- For more information please go to http://swschp.aetnamedicare.com (effective 5/21/14) or call 1-855-395-9722.