USC Student Health Insurance

Office Location and Hours

Plan Description

Aetna Benefit Charts

Optional Dental Plan

Enrollment / Waiver

Costs / Coverage Dates

Enrollment Information

Claim Form

Aetna Student Health Insurance Plan

Usually, your health care provider will bill the insurance company directly for services provided to you or your covered dependents. If a provider bills you directly or requires payment at the time of service, you may submit a claim form for payment or reimbursement.

The Claim Packet you submit to Aetna Student Health Insurance Plan must include the following:

Completed Aetna Medical Claim Form

Completed Referral Form from the Student Health Center (students only).
Routine medical care outside the student health center requires a referral form from your student health center provider. If you receive treatment for a medical emergency, a referral is not necessary.

Itemized Bills
Itemized statements must be on the provider’s official letterhead and must include the following:

Patient’s name

Service date

Service rendered

Amount charged

Diagnosis for each service

Paid Receipts
If you have already paid for the service, include your receipt with a written request for Aetna to reimburse you directly rather than pay the provider.

Please submit a claim packet each time you make a claim for payment or reimbursement. Refer to the back of your insurance ID card for the claim mailing address.

You should keep a photocopy of each document in the Claim Packet for your records.

Other Claim Forms

Aetna Rx Claim Form

Delta Dental Claim Form

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