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Aetna continuity of care form

Aetna transition 2026

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The document is a Transition Coverage Request form for Aetna members seeking coverage for ongoing care from out-of-network healthcare providers. It outlines the process for requesting coverage, including necessary sections to complete, the definition of an active course of treatment, and the conditions under which coverage may be granted. The document also includes FAQs about Transition of Care (TOC) coverage, detailing eligibility criteria, duration of coverage, and instructions for submission.

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Click ‘Get Form’ to open the Aetna Transition Coverage Request in the editor.
Begin with Section 1, where you will enter your Employer Information. Fill in the Employer’s Name, Group Number, and Plan Effective Date.
Proceed to Section 2 for Employee and Member Information. Here, input the Employee Name, Social Security Number (or Aetna ID), Address, Birthdate, Member’s Name, and Telephone Number.
In Section 3, read the Authorization carefully. If you are 17 or older, sign and date the form. If under 17, a parent must sign.
Hand over the form to your doctor for completion of Section 4. Ensure they provide their information accurately to avoid delays.
Once completed by your doctor, fax the entire form to SRC at 1-859-455-8650 for review.

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aetna transition of care form

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