Get Maine Employee Enrollment/change Form (1-50 Eligible ... - Aetna

Filling out the Maine Employee Enrollment/Change Form is a crucial process for employees to ensure they obtain the appropriate health coverage. This guide offers clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to properly complete the form.

1. Press the ‘Get Form’ button to access the Maine Employee Enrollment/Change Form and open it in your preferred editing tool.
2. Begin filling out Section A, 'Employee Information.' Ensure you provide your Social Security Number, last name, first name, middle initial, home physical address, job title, and contact details. It's important to be precise to avoid delays in processing.
3. In Section B, 'Coverage Selection,' select your desired medical, dental, life, and disability coverage options by checking the appropriate boxes. Please ensure that you print clearly using black ink.
4. For Section C, 'Individuals Covered,' list any dependents you are enrolling or making changes to. Include their full names, birth dates, and specify their coverage elections. Check the tobacco use box if applicable.
5. If you are waiving coverage, complete Section D, 'Declination/Waiver of Coverage.' Indicate the reason for declining coverage and sign where required.
6. In Section E, provide details about any dependents living at a different address if necessary.
7. Complete Section F regarding other health insurance if applicable, specifying any other carriers.
8. If you choose to complete the optional Section G, provide information related to case management if relevant.
9. Review all information for accuracy and completeness before signing the form in the designated area. Remember, unsigned forms may lead to processing delays.

Ensure your health coverage is in order by completing the Maine Employee Enrollment/Change Form online today.