Ing house transfers (ACH). I acknowledge there will be recurring debits in an amount equal to cover Customer s then-due premiums and I agree to keep sufficient funds in the bank account to cover these debits. I understand that Aetna s rights with each debit are the same as if the debit was a signed check. I agree to abide by the timing and rules regarding billing and payment as contained in the Group Policy or Group Agreement, as applicable, and the Small Business Employers Administrative Ha.
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How to fill out the Aetna Small Group ACA Banking Consent Form online
Filling out the Aetna Small Group ACA Banking Consent Form online can streamline your billing process and ensure timely payments. This guide walks you through each section of the form, offering clear and supportive steps to complete it efficiently.
Follow the steps to fill out the Aetna Small Group ACA Banking Consent Form.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering your name in the 'Customer Name' field. This identifies you as the person authorizing the banking consent.
- In the 'Effective Date' field, indicate the date from which this authorization will be effective. Ensure this date is accurate to avoid any issues.
- Proceed to the 'Bank Name' field and fill in the name of the financial institution where your account is held.
- Enter your 'Bank Account Number' in the designated field. Double-check for accuracy to prevent transaction errors.
- Select your 'Bank Account Type' by checking either 'Savings Account' or 'Checking Account'. This information is crucial for processing your debits.
- Provide your 'ACH Routing (ABA) Number'. This number is necessary for the automated clearing house transfers. Verify its accuracy with your bank.
- Choose your 'Draft Date'. Options include a 'Due Date' or specific days between the 2nd and 28th of the month, or the last banking day of the current month. Make your selection clearly.
- Fill out the 'Accounts Payable' section. In the 'Customer Contacts' area, provide the name, title, phone number, and email of the person responsible for payments.
- In the 'Customer Authorized Signature' section, sign your name, print it again, and complete the title, phone number, email, and date fields. Your signature authorizes Aetna to process debits from your account.
- Once all fields are completed, ensure you save your changes, then download, print, or share the form as needed.
Complete your Aetna Small Group ACA Banking Consent Form online today for efficient billing and payments.
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