Get Enrollment/change Request - Aetna

Filling out the Enrollment/Change Request - Aetna form is a straightforward process that allows you to enroll in or make changes to your health insurance coverage. This guide provides step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to complete your Enrollment/Change Request form.

1. Click ‘Get Form’ button to obtain the Enrollment/Change Request - Aetna and open it.
2. Review the instructions provided on the back of the form to ensure you understand the requirements before proceeding.
3. Complete the Employer Group Information section, including the full name and address of your employer.
4. In Section A, indicate the type of activity by checking the relevant boxes for Enrollment or Change, and provide effective dates and other requested information.
5. Fill out Section B with your Employee Information, including your Social Security number, last name, first name, home address, and telephone number.
6. If applicable, complete the Beneficiary Information section, including the name and Social Security number of your beneficiary.
7. Select your Plan Options in Section C by checking one of the offerings provided by your employer.
8. In Section D, list the Individuals Covered by your plan. Use ‘A’, ‘C’, or ‘R’ to indicate whether you are adding, changing, or removing coverage for each individual.
9. Ensure that all required fields are completed with accurate details for each individual, including birthdates and relationship codes.
10. If required, provide details for any prior insurance coverage and ensure you check the box if any dependent has a different address.
11. After completing all sections, carefully review your form for accuracy, then sign and date the form at the bottom.
12. Save changes, download, print, or share the completed form as needed.

Complete your Enrollment/Change Request - Aetna online today for seamless processing.