Get Va 2011-2012 Benefits Request Form 1 - International Calpoly

Filling out the VA 2011-2012 Benefits Request Form 1 - International Calpoly is a vital step in accessing your benefits. This guide provides a clear, step-by-step approach to ensure that you complete the form accurately and efficiently.

Follow the steps to successfully complete the benefits request form.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by entering your school name in the designated field, ensuring that all details are correct.
3. Provide your policy or group number as prompted on the form.
4. Input your Aetna ID number in the specified section.
5. Fill in your full name as it appears on your insurance policy.
6. Enter your current address, including the ZIP code to ensure correspondence reaches you.
7. Input your birthdate in the required format (MM/DD/YYYY).
8. Provide the patient’s name and indicate if their address differs from yours.
9. Complete the daytime telephone number field for prompt communication.
10. Detail the patient’s Aetna ID number and their birthdate.
11. Indicate the patient's relationship to the member.
12. Specify the patient's gender and marital status.
13. Check if the claim is related to an accident and if applicable, provide the necessary details.
14. If the patient is employed, list the employer's name and address.
15. Complete additional questions regarding any other medical coverage.
16. Ensure that the authorization to release information is signed and dated.
17. If preferred, authorize payment of benefits directly to the physician or supplier with your signature.
18. Attach all required documents including itemized bills and prescription information, ensuring completeness.
19. Review all entries for accuracy and completeness before finalizing.
20. You can now save changes, download, print, or share the completed form as needed.

Complete your benefits request form online today to expediate the processing of your claim.