Get Application - Central Ohio Group Insurance

This guide provides step-by-step instructions on completing the Application for Medicare Supplement Insurance from Aetna Health and Life Insurance Company. By following these instructions, you can efficiently fill out the form online and ensure that all necessary information is accurately provided.

Follow the steps to complete your application successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the proposed insured information, including their full name as it appears on their Medicare card, address, phone number, and email. If available, include a copy of the Medicare card with the application.
3. Enter the date of birth that matches the birth certificate, include Medicare card number details, and indicate the dates of enrollment in Medicare Parts A and B.
4. Proceed to Section 2, where you must select the plan for which you are applying. Indicate eligibility for the household premium discount by answering the questions truthfully.
5. In Section 3, answer the eligibility questions carefully. Provide accurate information about your Medicare status, other coverage, and health history.
6. Fill out Section 4 if this is not an Open Enrollment or Guaranteed Issue application, ensuring all health questions are answered, as positive responses can affect your eligibility.
7. Complete Sections 5 and 6 regarding health history and physician information, including details about any medications prescribed.
8. Read and understand the Important Statements in Section 7, where you'll acknowledge your awareness of policy terms and coverage implications.
9. Provide any necessary account information in Section 11 for electronic funds transfer (EFT) payment, ensuring to include a voided check as instructed.
10. Review all information for completeness, sign the application where indicated, and include the date of signing.
11. Finally, save your changes, and depending on your needs, download, print, or share the completed application for your records.

Start completing your Application for Medicare Supplement Insurance online today for a seamless process.