Get Aetna Gc 1373 Form

This guide provides clear and concise instructions on how to fill out the Aetna Gc 1373 Form online. By following these steps, users can efficiently complete the form, ensuring all necessary information is provided correctly.

Follow the steps to fill out the Aetna Gc 1373 Form online.

1. Click ‘Get Form’ button to access the Aetna Gc 1373 Form and open it for editing.
2. Begin by providing information about the deceased in section A. Fill in the deceased's full name, relationship to the employee, Social Security number, birthdate, date of death, age, gender, last residence address, city, state, and zip code.
3. In section B, enter details about the employee. Include their name, Social Security number, last residence address, city, state, birthdate, employment start date, work location, hourly or salary status, date last worked, and the reason they did not return to work.
4. Next, move to section C, which focuses on the employee's coverage. Fill in the employer's name, contact representative's name and email address, street address, city, state, zip, and telephone number. Answer questions regarding any claims submitted prior to the deceased's death and provide details about the coverage being claimed.
5. Proceed to section D to list the beneficiaries. Offer names, addresses, Social Security numbers, relationships to the employee, birthdates, and telephone numbers for each beneficiary. Indicate if the benefit ownership has been assigned.
6. In section E, select how you wish the benefit payment to be distributed by checking the relevant option: directly to the beneficiary, the employer, or another party.
7. Finally, complete any required employer instructions in section F and ensure that all needed attachments are provided. This includes the death certificate and any documentation relating to minor beneficiaries or trusts if applicable.
8. Review the entire form for accuracy, then you can save your changes, download, print, or share the form as needed.

Complete your Aetna Gc 1373 Form online today and ensure all information is accurately submitted.