Employee instructions: Complete sections 1-3. Attending physician instructions: Complete sections 4-6 and return the completed form to the employee. 1. Employer information Name (as shown on ID card) Policy/Group number 2. Employee information Name ID number Birth date (MM/DD/YYYY) 3. Dependent child information Name Birth date (MM/DD/YYYY) 4. Physician s statement For medical conditions, please complete section A below. For behavioral health conditions, please complete sections A an.
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How to fill out the Aetna GC-464 online
The Aetna GC-464 is a crucial form that allows users to document a disabled child's attending physician's statement effectively. This guide provides clear and supportive instructions to help users navigate the form with ease.
Follow the steps to complete the Aetna GC-464 efficiently.
- Click the ‘Get Form’ button to obtain the Aetna GC-464 form and open it in the editor.
- Complete sections 1-3 as the employee. Section 1 requires employer information including the employer's name and policy/group number as displayed on the ID card. In section 2, provide your personal details: your name, ID number, and birth date in the format MM/DD/YYYY. Section 3 requires the dependent child's information: their name and birth date in the same format.
- For the physician's statement in sections 4-6, the attending physician must fill out the necessary details. Section 4 begins with details regarding medical and behavioral health conditions. This includes the diagnosis, the date of onset of the disability, objective findings substantiating impairment, and any additional clinical information that supports how the disability affects employment for individuals over age 18.
- If the child has behavioral health conditions, the physician must complete section B, which includes providing the individual's IQ score and a functional assessment detailing communication ability, psychiatric symptoms, stability, treatment response, and prognosis.
- In section C, physicians should refer to the Social Security Disability Guidelines to quantify the disability. Select the affected body system(s) and document the appropriate ‘listing’ number(s) relevant to the individual’s condition.
- Section 5 requires the attending physician's contact information, including their name, telephone number, and address. The physician must also provide their signature and the date.
- For section 6, list any other treating physicians or healthcare providers currently involved in the treatment of the individual’s mental or physical disability, including their contact details.
- After completing the form, review all information for accuracy, then save changes, download, print, or share the completed Aetna GC-464 as needed.
Complete your Aetna GC-464 form online today for efficient processing.
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Get answers to your most pressing questions about US Legal Forms API.
Are group ID and member ID the same?
No, the group ID and member ID are not the same. The group ID refers to your specific plan under Aetna, such as the Aetna GC-464, while your member ID uniquely identifies you as an individual insured under that plan. Understanding this difference can help when accessing healthcare services.
What is the group number on an insurance card?
The group number on an insurance card identifies your specific employer’s health plan. When you hold an Aetna GC-464 plan, you will find this number useful for coordinating benefits and understanding your coverage. Always have this information ready when you visit healthcare providers.
How to get group ID on Aetna insurance card?
To get your group ID on your Aetna insurance card, simply refer to the card itself. The group ID is typically displayed alongside the group number and is essential for understanding your coverage under the Aetna GC-464 plan. If you can’t find it, you may contact Aetna customer service for assistance.
Where is the group ID number?
The group ID number is often located next to your group number on your Aetna insurance card. Check the section that lists your health plan details. This group ID helps healthcare providers know which benefits apply to your Aetna GC-464 plan, ensuring a smoother experience when you receive care.
Where to find group number on Aetna?
You can easily find your group number on your Aetna insurance card. Typically, it is printed prominently in the middle or upper part of the card. Remember, the group number is crucial for identifying your specific plan, like the Aetna GC-464, so keep it handy when seeking medical services.
How do I activate my Aetna card?
Activating your Aetna card is a straightforward process. You can start by visiting the Aetna website and following the prompts for card activation. Make sure you have your Aetna GC-464 information available, as it will help streamline the activation process and ensure your coverage is active.
How to submit prior authorization for Aetna?
To submit a prior authorization request for Aetna, visit the Aetna website or contact their customer service. They will guide you through the necessary steps, including providing the Aetna GC-464 plan details. Utilizing their online services can simplify the process and speed up your request.
How to get group number on Aetna insurance card?
To find your group number on your Aetna insurance card, first, locate the section that displays your member information. The group number typically appears above or near your member ID. Having the Aetna GC-464 card in hand will make this process easier, as the numbers are clearly labeled.
How to get authorization for Aetna?
Getting authorization for Aetna requires a few steps. You need to contact your healthcare provider, who will submit a request on your behalf. If you have Aetna GC-464, make sure your provider is aware of your plan's requirements for obtaining pre-authorization.
How to order OTC items from Aetna?
Ordering OTC items from Aetna involves a straightforward process. First, you should check your Aetna GC-464 plan to confirm your eligibility for OTC benefits. Then, you can place orders through their online platform or by calling customer service for assistance.
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