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Get Employee Enrollment/change Form-2014 - Aetna
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How to fill out the Employee Enrollment/Change Form-2014 - Aetna online
Completing the Employee Enrollment/Change Form-2014 from Aetna online is a straightforward process. This guide provides clear step-by-step instructions to ensure you fill out the form accurately, catering to your enrollment or change requests.
Follow the steps to successfully complete the form.
- Click the ‘Get Form’ button to access the form and open it in your editor.
- Begin with the Employer Group Information section. Enter the group name, group number, and any relevant codes provided by your employer in the designated fields.
- Proceed to Section A, where you will indicate the type of activity. Check the appropriate boxes to add, change, or remove coverage for dependents or other activities, and fill out the dates as prompted.
- In Section B, provide your personal details including your social security number, name, address, and contact information. Ensure all fields are completed clearly.
- In Section C, select the medical plan options available through your employer. Make sure to check only one plan option and specify details where required.
- Section D requires you to list all individuals being covered. Indicate whether you are adding, changing, or removing coverage using the provided options.
- Move to Section E to disclose any previous or other health and prescription drug coverage. Fill out the relevant details for transparency.
- Complete Section F by providing any additional dependent information, including their current living situation and any differences in last names.
- In Section G, if you choose, you may provide information regarding your race or ethnicity as part of statistical tracking.
- Finally, ensure you sign the Employee Signature section to validate your application. The employer must also verify by signing the Employer Verification section.
- After filling out all sections, save your changes, and consider downloading, printing, or sharing the completed form as needed.
Complete your documents online for a smoother enrollment process.
To edit a field, click the Edit icon of the field from the custom field list. In the Add Field/ Edit Field overlay, you can check the Make this field as required checkbox to make the field mandatory. A pop up appears to confirm this.