Initiate a Direct Settlement Request

For a true emergency, please have the missionary seek care at the closest facility and contact Aetna afterward to arrange for payment of services.

Reminder: For pre-planned services or care, it is recommended that you submit this form to the Aetna International Service Center so as to allow a reasonable amount of time for arrangements to be made prior to your planned date of service. For urgent care, please make sure the request is clearly marked as urgent.

For an immediate response, you can contact Aetna customer service by phone. Contact details are available on country specific pages.

* Required Fields

Please provide the following information:
Missionary Name *
Missionary Aetna W-ID (numbers only)*
Mission Name *
Missionary/Patient Date of Birth * (mm/dd/yyyy)
Missionary Email Address (if available)
Missionary Mobile Phone Number

Missionary information:
Name of contact submitting this request (Requester)*
Phone number where we can reach you*
Requester's Email Address*
Requested Medical Procedure *
Missionary medical concern *
Brief description of services needed*
Is this an urgent request? (care needed same day or following day)*	Yes No
Date of Service or Appointment* (mm/dd/yyyy)

Provider Information:
Name *
Address *

City *
State / Province
Zip / Postal Code
Country *
Phone Number

Direct Settlement is a service designed to assist Aetna International members with coordinating payment to the provider.

Some providers may require you to pay out-of-pocket. Out-of-pocket payments can be reimbursed. Completed claim form should be submitted to the Aetna International Service Center for reimbursement.