Evidence of Insurability Statement Life and Disability Coverage Aetna Life Insurance Company Read This Instruction Page Carefully. Aetna may contact you directly to request additional information.
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How to fill out the Complete Section A in its entirety online
Completing Section A of the Evidence of Insurability Statement is a crucial step in applying for life and disability coverage with Aetna Life Insurance Company. This guide provides clear and supportive instructions to ensure that each field is accurately filled out online.
Follow the steps to successfully complete Section A.
- Click the ‘Get Form’ button to access the form for your online completion.
- In the Control Number, Suffix, and Account fields (A1), enter the appropriate identifiers as provided by your Plan Sponsor.
- Input the Employee/Member's Social Security Number in section A2.
- In fields A3 and A4, enter the names and addresses of both the Plan Sponsor and the Employee/Member. Ensure this information is accurate and clearly printed.
- Fill in the telephone number of your authorized representative in A5, followed by the Employee/Member's date of hire in A6.
- Provide the Employee/Member’s home and work telephone numbers in A7.
- In field A8, enter the email address of the Plan Sponsor and in A9, enter the email of the Employee/Member.
- Complete the Employee/Member’s Annual Earnings in field A10, ensuring the figure is accurate.
- For coverage requested in A11, check the applicable life coverage boxes, and fill in the current and additional amounts of coverage.
- Indicate the reason for the requested life coverage in A11, choosing all that apply.
- Check the Disability box(es) if applicable, and provide the current and requested amounts of coverage in A11.
- Finally, ensure Section A is signed by the authorized representative in A12.
- Once completed, give the form to the Employee/Member for confidential submission to Aetna. They may choose to save changes, download, print, or share the form.
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