Florida Atlantic University
Domestic Student
Insurance Program for Domestic Students

Helpful resources and forms

Contact us

All customer Service inquiries, including Provider network questions, should be directed to Aetna Student Health by calling 877-409-7360 or emailing Customer Service.

Claim forms

If the Provider does not file the claim directly with Aetna Student Health, then you must file the claim by submitting an Aetna Claim Form and itemized bill immediately after treatment to us. Your name, social security number and school name should be written clearly on all medical bills. Always retain copies for your records.

To receive reimbursement, you will need to submit a claim form and the prescription receipt to Aetna. Fax your completed Aetna Prescription Drug Claim Form and receipts to Fax (888) 472-1128 or mail it to:

Aetna Pharmacy Management
P.O. Box 52444
Phoenix, AZ 85072-2444

Personal health information requests

We need your permission to release your personal health information. Print out the PHI Request 67902-5 form and fax it to (860) 907-3017 or mail it to:

Aetna Legal Support Services
151 Farmington Avenue, RT65
Hartford, CT 06156-9998

We need your permission to release your personal health information with your providers. Print out the PHI Request 67938-5 form and fax it to (859) 455-8650 or mail it to:

Aetna Legal Support Services
PO Box 14079
Lexington, KY 40512-4079


This material is for information only. Health insurance plans contain exclusions, limitations and benefit maximums. The plan will pay benefits in accordance with any applicable state insurance law. If any discrepancy exists between this website and the Master Policy, the Master Policy will govern and control the payment of benefits. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professionals. Preferred providers are independent contractors and are neither agents nor employees of Aetna Life Insurance Company, Chickering Claims Administrators, Inc., or their affiliates. Aetna does not provide healthcare or guarantee access to health services. Information is believed to be accurate as of the production date; however, it is subject to change. Policy forms issued in OK include: GR-96134.