Get North Carolina Employee Enrollment/change Form (51-100 ... - Aetna

Completing the North Carolina Employee Enrollment/Change Form accurately is essential for ensuring your health coverage with Aetna. This guide will walk you through each section and provide helpful tips for successful completion.

Follow the steps to complete your enrollment or change request.

1. Press the ‘Get Form’ button to access the North Carolina Employee Enrollment/Change Form and open it in your preferred editing tool.
2. Fill in general information at the top of the form including the company name and effective date of coverage.
3. Indicate your status by selecting the applicable option, such as 'New Hire' or 'Change of Coverage'. Provide your date of hire if applicable.
4. Complete Section A on coverage selection. Clearly check 'Yes' or 'No' for medical, dental, and life/disability plans. Enter the specific plan options you are electing.
5. In Section B, provide personal information including your social security number, name, job title, and addresses. Make sure to note your primary language if desired.
6. Complete Section C by listing all individuals for whom you are enrolling or changing coverage. It is crucial to include their birthdates and sex.
7. If applicable, fill out Section D for dependents living at a different address and provide any additional information required.
8. In Section E, indicate if you have other health insurance and provide the carrier name.
9. Fill out Section F if you have any Medicare information related to yourself or dependents.
10. In Section G, indicate any waivers of coverage. Make sure to check all relevant reasons for waiving coverage.
11. Complete the Health Questionnaire in Section H if applicable. Be thorough while answering all health-related questions.
12. If there are any 'Yes' responses in Section H, provide detailed information in Sections I and J regarding those conditions.
13. Finally, review all provided information for accuracy. Sign and date the form, and ensure your health information is secure before submission.

Complete your documents online to ensure timely processing and secure your health coverage.