Get Aetna Disenrollment Form

Completing the Aetna disenrollment form online can seem daunting, but with the right guidance, it becomes a straightforward process. This guide provides clear instructions to assist users in effectively filling out each section of the form.

Follow the steps to complete the Aetna disenrollment form online

1. Click ‘Get Form’ button to obtain the disenrollment form and open it for online completion.
2. Begin by filling out the retiree information section. Enter your name in the format of last name, first name, and middle initial. Provide your Social Security number, address (street, city, state, ZIP), and telephone number. Ensure all details are accurate.
3. Indicate your date of birth and, if you are a Kaiser member, include your medical record number.
4. Select the reason for disenrollment from the provided options. If applicable, specify your effective date for disenrollment based on your selected reason.
5. In the section asking for disenrollment requests, clearly write your first name and last name, followed by the name of your current Medicare Advantage plan.
6. List any family members you wish to disenroll from the current plan. For each individual, provide their name, relationship to you, sex, date of birth, and Social Security/ID number.
7. All required signatures must be completed. Ensure that you sign the form, and if applicable, have your enrolled spouse or family member who is eligible for Medicare sign as well.
8. Once you have filled out all sections and secured the necessary signatures, review the form for accuracy. Save your changes, and then download or print the completed form.
9. Return the completed form to the Medicare Advantage medical plan you are leaving, and keep a duplicate copy for your records.

Complete your disenrollment form online today for a smooth transition.