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Title Form # Effective Date
New Group Submission Checklist 12-01-2018
Title Form # Effective Date
Aetna 2-100 eList Tool 01-01-2019
Associated Companies GR-69230 04-01-2016
Employer Application GR-69243 10-01-2018
Employer Application (Espanol) GR-69243 SP 10-01-2018
Title Form # Effective Date
AFA Choice POS II 100 50 500D CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 1000 100 70 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 1000 80 60 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 1500 100 70 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 1500 100 80 Int RX CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 1500 80 60 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 2000 100 70 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 2500 100 70 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 2500 100 80 Int RX CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 2500 80 60 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 2750 70 50 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 3000 100 70 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 3500 100 80 Int RX CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 3500 80 60 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 4000 100 70 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 4000 70 50 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 4500 50 50 CY ISL50 - Effective - Effective 1/1/2019 01-01-2019
AFA Choice POS II 4500 50 50 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 500 100 70 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 500 80 60 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 5000 100 70 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 5000 100 80 Int RX CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 6250 100 80 Int RX CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 6750 100 80 Int RX CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS II 6750 80 60 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS ll 100 50 $25 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS ll 100 50 $40 CY ISL50 - Effective 1/1/2019 01-01-2019
AFA Choice POS ll 100 50 25 CY ISL50 - Effective 12/1/2018 12-01-2018
AFA Choice POS ll 100 50 40 CY ISL50 - Effective 12/1/2018 12-01-2018
Title Form # Effective Date
2019 AFA Pharmacy Drug Guide 09-01-2019
AFA Value Drug List 01-01-2019
Title Form # Effective Date
Aetna Provider Search Instructions WNV21397 12-01-2018

Title Form # Effective Date
Submission Checklist (AFA) 10-01-2017
Title Form # Effective Date
Aetna 2-100 eList Tool 01-01-2017
Employer Application GR-69243 07-01-2016
Employer Application GR-69243 05-01-2017
Employer Application GR-69243 05-01-2018
Employer Application (Espanol) GR-69243 SP 05-01-2018
Title Form # Effective Date
2017 National Plans 14.03.412.1 A 01-01-2017
Benefit Grid 14.03.412.1 B 03-01-2017
Benefit Grid - Effective 4/1/2018 60.02.008.1 04-01-2018
Benefit Grid - Effective 4/1/2018 (edit 8/1/18) 60.02.008.1 04-01-2018
Title Form # Effective Date
AFA Choice POS II 100 50 500D CY - Effective 7/1/2017 07-01-2017
AFA Choice POS II 100 50 500D CY ISL50 30001634 06-29-2017
AFA Choice POS II 100 50 500D CY ISL50 01-01-2018
AFA Choice POS II 100 50 500D CY ISL50 04-01-2018
AFA Choice POS II 1000 100 70 CY ISL50 30001639 06-29-2017
AFA Choice POS II 1000 100 70 CY ISL50 01-01-2018
AFA Choice POS II 1000 100 70 CY ISL50 04-01-2018
AFA Choice POS II 1000 100/70 CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 1000 80 60 CY ISL50 30001644 06-29-2017
AFA Choice POS II 1000 80 60 CY ISL50 01-01-2018
AFA Choice POS II 1000 80 60 CY ISL50 04-01-2018
AFA Choice POS II 1000 80/60 CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 1500 100 70 CY ISL50 30001637 06-29-2017
AFA Choice POS II 1500 100 70 CY ISL50 01-01-2018
AFA Choice POS II 1500 100 70 CY ISL50 04-01-2018
AFA Choice POS II 1500 100 80 Int RX CY ISL50 30001653 06-29-2017
AFA Choice POS II 1500 100 80 Int RX CY ISL50 01-01-2018
AFA Choice POS II 1500 100 80 Int RX CY ISL50 04-01-2018
AFA Choice POS II 1500 100/70 CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 1500 100/80 Int RX CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 1500 80 60 CY ISL50 01-01-2018
AFA Choice POS II 1500 80 60 CY ISL50 04-01-2018
AFA Choice POS II 1500 80/60 CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 2000 100 70 CY ISL50 30001638 06-29-2017
AFA Choice POS II 2000 100 70 CY ISL50 01-01-2018
AFA Choice POS II 2000 100 70 CY ISL50 04-01-2018
AFA Choice POS II 2000 100/70 CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 2000 HSA 100 80 CY ISL50 30001659 06-29-2017
AFA Choice POS II 2000 HSA 100 80 CY ISL50 01-01-2018
AFA Choice POS II 2000 HSA 100 80 CY ISL50 04-01-2018
AFA Choice POS II 2500 100 70 CY ISL50 30001636 06-29-2017
AFA Choice POS II 2500 100 70 CY ISL50 01-01-2018
AFA Choice POS II 2500 100 70 CY ISL50 04-01-2018
AFA Choice POS II 2500 100 80 Int RX CY ISL50 30001654 06-29-2017
AFA Choice POS II 2500 100 80 Int RX CY ISL50 01-01-2018
AFA Choice POS II 2500 100 80 Int RX CY ISL50 04-01-2018
AFA Choice POS II 2500 100/70 CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 2500 100/80 Int RX CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 2500 80 60 CY ISL50 30001646 06-29-2017
AFA Choice POS II 2500 80 60 CY ISL50 01-01-2018
AFA Choice POS II 2500 80 60 CY ISL50 04-01-2018
AFA Choice POS II 2500 80/60 CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 2500 HSA 100 80 CY ISL50 30001660 06-29-2017
AFA Choice POS II 2500 HSA 100 80 CY ISL50 01-01-2018
AFA Choice POS II 2500 HSA 100 80 CY ISL50 04-01-2018
AFA Choice POS II 2500 HSA 100/80 CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 2500 HSA 100/80 CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 2750 70 50 CY ISL50 30001650 06-29-2017
AFA Choice POS II 2750 70 50 CY ISL50 01-01-2018
AFA Choice POS II 2750 70 50 CY ISL50 04-01-2018
AFA Choice POS II 2750 70/50 CY- Effective 4/1/2017 04-01-2017
AFA Choice POS II 2750 HSA 80 60 Emb CY ISL50 01-01-2018
AFA Choice POS II 2750 HSA 80 60 Emb CY ISL50 04-01-2018
AFA Choice POS II 2750 HSA 80/60 Emb CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 3000 100 70 CY ISL50 01-01-2018
AFA Choice POS II 3000 100 70 CY ISL50 04-01-2018
AFA Choice POS II 3000 100/70 CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 3500 100 80 Int RX CY ISL50 01-01-2018
AFA Choice POS II 3500 100 80 Int RX CY ISL50 04-01-2018
AFA Choice POS II 3500 100/80 Int RX CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 3500 80 60 CY ISL50 01-01-2018
AFA Choice POS II 3500 80 60 CY ISL50 04-01-2018
AFA Choice POS II 3500 80/60 CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 3750 HSA 80 60 Emb CY ISL50 01-01-2018
AFA Choice POS II 3750 HSA 80 60 Emb CY ISL50 04-01-2018
AFA Choice POS II 3750 HSA 80/60 Emb CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 4000 100 70 CY ISL50 01-01-2018
AFA Choice POS II 4000 100 70 CY ISL50 04-01-2018
AFA Choice POS II 4000 100/70 CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 4000 70 50 CY ISL50 01-01-2018
AFA Choice POS II 4000 70 50 CY ISL50 04-01-2018
AFA Choice POS II 4000 70/50 CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 4000 HSA 100 50 Emb CY - Effective 7/1/2017 07-01-2017
AFA Choice POS II 4000 HSA 100 50 Emb CY ISL50 01-01-2018
AFA Choice POS II 4000 HSA 100 50 Emb CY ISL50 04-01-2018
AFA Choice POS II 4500 50 50 CY ISL50 01-01-2018
AFA Choice POS II 4500 50 50 CY ISL50 04-01-2018
AFA Choice POS II 4500 50/50 CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 500 100 70 CY ISL50 01-01-2018
AFA Choice POS II 500 100 70 CY ISL50 04-01-2018
AFA Choice POS II 500 100/70 CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 500 80 60 CY ISL50 01-01-2018
AFA Choice POS II 500 80 60 CY ISL50 04-01-2018
AFA Choice POS II 500 80/60 CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 5000 100 70 CY ISL50 01-01-2018
AFA Choice POS II 5000 100 70 CY ISL50 04-01-2018
AFA Choice POS II 5000 100 80 Int RX CY ISL50 01-01-2018
AFA Choice POS II 5000 100 80 Int RX CY ISL50 04-01-2018
AFA Choice POS II 5000 100/70 CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 5000 100/80 Int RX CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 5000 80 60 CY ISL50 01-01-2018
AFA Choice POS II 5000 80 60 CY ISL50 04-01-2018
AFA Choice POS II 5000 80/60 CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 5500 HSA 80 60 Emb CY ISL50 01-01-2018
AFA Choice POS II 5500 HSA 80 60 Emb CY ISL50 04-01-2018
AFA Choice POS II 5500 HSA 80/60 Emb CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 5750 HSA 70 50 Emb CY - Effective 7/1/2017 07-01-2017
AFA Choice POS II 5750 HSA 70 50 Emb CY ISL50 01-01-2018
AFA Choice POS II 5750 HSA 70 50 Emb CY ISL50 04-01-2018
AFA Choice POS II 6250 100 80 Int RX CY ISL50 01-01-2018
AFA Choice POS II 6250 100 80 Int RX CY ISL50 04-01-2018
AFA Choice POS II 6250 100/80 Int RX CY - Effective 4/1/2017 04-01-2017
AFA Choice POS II 6250 HSA 100 50 Emb CY - Effective 7/1/2017 07-01-2017
AFA Choice POS II 6250 HSA 100 50 Emb CY ISL50 01-01-2018
AFA Choice POS II 6250 HSA 100 50 Emb CY ISL50 04-01-2018
AFA Choice POS II 6750 100 80 Int RX CY - Effective 7/1/2017 07-01-2017
AFA Choice POS II 6750 100 80 Int RX CY ISL50 01-01-2018
AFA Choice POS II 6750 100 80 Int RX CY ISL50 04-01-2018
AFA Choice POS II 6750 80 60 CY - Effective 7/1/2017 07-01-2017
AFA Choice POS II 6750 80 60 CY ISL50 01-01-2018
AFA Choice POS II 6750 80 60 CY ISL50 04-01-2018
Title Form # Effective Date
2018 AFA Pharmacy Drug Guide 08-01-2018
2019 AFA Pharmacy Drug Guide 01-01-2019
Title Form # Effective Date
AFA Quote cover Sheet 08-01-2018
Title Form # Effective Date
Administrative Handbook 00.02.214.1 D 08-01-2016
Aetna Funding Advantage Attain Flyer Small Group 03-01-2019
Aetna Funding Advantage Fact Sheet 02-01-2019
AFA Networks Flyer 04-01-2018
AFA Networks Flyer 08-01-2018
AFA Nevada Fact Sheet 00.03.783.1 01-01-2016
AFA Nevada Fact Sheet 07-01-2017
AFA Nevada Fact Sheet 07-01-2017
AFA Value Added Flyer 05-01-2018
Customer Flyer 14.03.263.1 C 06-01-2016