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Looking for an approved HICE document/template? They can be found in the Approved HICE Documents folder - click here for a list of available documents for each HICE team: APPROVED HICE DOCUMENTS.

Health Plan Specific Letter Templates
Health Plan Specific Letter Templates
01_Template Instructions
Participating health plans that have confirmed the templates have been reviewed to determine regulatory compliance are able to use a self-service web-based tool to upload their health plan-specific templates to this site. Please contact the plans directly for any templates not available on the HICE website. To receive broadcast messages when letter templates are added/updated by participating plans, add the "Health Plan Specific Letter Template Notifications" Team to your HICE account (see Teams" page for instructions on how to do this or contact admin@iceforhealth.org if assistance is needed).
Aetna
		File	Upload	Review
	Title	Size	Date	Date
	Aetna_UM_Comm_LAP_Option 2_CA Commercial Non-Discrimination Notice 0218	16 KB	2/21/2018	2/15/2021
	Aetna_UM_Comm_LAP_Option 2_CA State Taglines 0218	29 KB	2/21/2018	2/15/2021
	Medicare Multi Language Insert	33 KB	1/13/2023
	Implementation Date for Notice/Description: 2022
	03-23 CMS-10003_IDN-NDMCP_ Medical Services	55 KB	5/5/2023
	03-23 CMS-10003_IDN-NDMCP_ Part B drug	55 KB	5/5/2023
	Aetna CA Comm Service Denial Notice (CSDN)_rev 10.2022_CLEAN	70 KB	1/13/2023
	Implementation Date for Notice/Description: 2022
	Aetna_Claims_Commercial_HCR_Denial Ltr_12042018	76 KB	12/14/2018	2/8/2022
	12-20_CA_ONLY AETNA_UM_MA_ME09_Notice of Medicare Non Coverage_Spanish	89 KB	1/7/2021
	12-20_CA_ONLY_AETNA_UM_MA_DENC AETNA ME11_ (Spanish version)	93 KB	1/7/2021
	ME17-Aetna-Enrollment Source ID 42 (2022)	102 KB	1/13/2023
	Implementation Date for Notice/Description: 2022
	ME17-Aetna-Enrollment Source ID 42 (2022)	102 KB	5/5/2023
	Aetna_UM_Comm_LAP_Option 2_Approval FI California_rev 021318	127 KB	2/21/2018	2/15/2021
	Aetna Pend Letter clinical 2021	205 KB	1/11/2023
	Implementation Date for Notice/Description: 2021
	Aetna_UM_Comm_LAP_Option 2_CA State Taglines 0218 GT ID 2017 V 2.1	469 KB	2/21/2018	2/15/2021
Anthem Blue Cross
Cigna
Clever Care Health Plan
Health Net
Sharp Health Plan

HICE documents can be altered for use by organizations/other regions as needed; however, the HICE logo/any HICE references should be removed if the document is not being used in its original format. Documents available within the Library are intended to be used as printed documents. To the extent such documents are used digitally, it shall be the user's responsibility to ensure their use of the documents adheres to the accessibility standards applicable to their organization.

HICE is a voluntary 501(c)3 organization that includes participation by and advice from accrediting and regulatory agencies. The goal of HICE work products is to offer HICE participating organizations standardized tools and best practices toward optimizing efficiencies to implement health industry requirements. HICE heeds feedback from accrediting and regulatory agency partners regarding HICE work products; however, HICE does not obtain official regulatory approval for its work products. As such, HICE work products are not to be considered exempt from any approval process required by regulatory agencies.