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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

 Click to close category Health Plan Specific Letter Templates  
     Click to open category 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 if assistance is needed).
     Click to close category Click to Download All Documents in Subfolder Aetna
       File   Upload   Review
  Title     Size   Date   Date
  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   
  12-20_CA_ONLY AETNA_UM_MA_ME09_Notice of Medicare Non Coverage_Spanish   89 KB   1/7/2021   1/2/2024
  12-20_CA_ONLY_AETNA_UM_MA_DENC AETNA ME11_ (Spanish version)   93 KB   1/7/2021   1/2/2024
  Aetna CA Comm Service Denial Notice (CSDN)_rev 10.2022_CLEAN   70 KB   1/13/2023   
Implementation Date for Notice/Description: 2022
  Aetna Pend Letter clinical 2021   205 KB   1/11/2023   
Implementation Date for Notice/Description: 2021
  Aetna_Claims_Commercial_HCR_Denial Ltr_12042018   76 KB   12/14/2018   2/8/2022
  Aetna_UM_Comm_LAP_Option 2_Approval FI California_rev 021318   127 KB   2/21/2018   2/20/2024
  Aetna_UM_Comm_LAP_Option 2_CA Commercial Non-Discrimination Notice 0218   16 KB   2/21/2018   2/20/2024
  Aetna_UM_Comm_LAP_Option 2_CA State Taglines 0218   29 KB   2/21/2018   2/20/2024
  Aetna_UM_Comm_LAP_Option 2_CA State Taglines 0218 GT ID 2017 V 2.1   469 KB   2/21/2018   2/20/2024
  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   
  Medicare Multi Language Insert   33 KB   1/13/2023   
Implementation Date for Notice/Description: 2022
     Click to open category Anthem Blue Cross
     Click to open category Cigna
     Click to open category Clever Care Health Plan
     Click to open category Health Net
     Click to open category 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.


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