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Get Aetna Disenrollment Form

F California Human Resources See page 2 for plan addresses. If you are not enrolling in another Medicare Advantage plan or you are suspending your medical plan, complete this form to disenroll yourself and/or your enrolled Medicare family members from your current Medicare Advantage plan. Disenrollment for yourself and/or your family members will be effective the last day of the month in which your medical plan carrier receives this completed and signed form, or the date you are requesting be.

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