Get Hsa Small Group Member Enrollment Form - Aetna 2006-2025

Filling out the HSA Small Group Member Enrollment Form - Aetna online is an essential step for users looking to manage their Health Savings Account effectively. This guide provides clear instructions to help you navigate each section of the form with ease.

Follow the steps to complete your enrollment form accurately.

1. Press the ‘Get Form’ button to acquire the form and open it in your preferred document editor.
2. Begin by providing your account holder information. Input your last name, first name, middle initial, birthdate in MM/DD/YYYY format, and Social Security number. Ensure that all details are accurate and clearly printed.
3. Next, enter your daytime and evening telephone numbers, ensuring to format them correctly, followed by your street address, city, state, zip code, and country.
4. Indicate your email address, which is optional, and then provide the effective date of your high deductible health plan in MM/DD/YYYY format.
5. Specify your type of coverage preference: either individual or family. You may also provide the Control-Suffix-Account number as required.
6. If you wish to request an additional Aetna HSA Visa debit card for a spouse or dependent, include their name along with their last name, first name, and middle initial.
7. If you're interested in obtaining HSA checks, select that option and request the Check Signature Card Form.
8. Review the statement option and understand whether you prefer electronic access to account balance and transaction history or wish to receive a paper statement by contacting Member Services.
9. In the certification section, confirm that you meet the eligibility criteria for establishing an HSA and that all information provided is correct. Ensure to include your signature, printed name, and the date signed in the designated areas.
10. Once you have filled in all necessary information and verified its accuracy, save the changes, and prepare to print or share the form as needed.

Complete your HSA Small Group Member Enrollment Form - Aetna online today and take control of your health savings.