Get Aetna International - Recurring Reimbursement Election Form

This guide provides you with clear, step-by-step instructions on how to fill out the Aetna International - Recurring Reimbursement Election Form online. Completing this form correctly ensures you receive your benefit reimbursements in your preferred currency and method.

Follow the steps to complete your form accurately.

1. Click ‘Get Form’ button to access the Aetna International - Recurring Reimbursement Election Form. This will allow you to open the document in your preferred online editor.
2. In the Contract Information section, enter your Group Control-Suffix-Account number, which can be found on your Aetna ID card. This information ensures your reimbursement is linked to the correct account.
3. In the Employee Name field, provide your full name, including your first name, middle initial, and last name. This identifies who will be receiving the claim reimbursements.
4. Provide your Employee Social Security/I.D. Number, which is required for verification purposes. This can be your Social Security Number or an Aetna-assigned identification number.
5. Enter your Employee Telephone number along with any necessary country or city codes. This allows Aetna to contact you if there are any issues with your form.
6. Fill in your Employee Address, including your street, city, state, country, postal code, and email address, to provide Aetna with accurate contact information.
7. If you are not the Bank Accountholder, enter the bank accountholder’s telephone number to facilitate communication regarding fund transfers.
8. In the Bank Name field, write the name of your bank or financial institution where benefit payments will be deposited.
9. Enter the Bank Identification Code/Routing Number for your bank. Ensure this is accurate by verifying with your bank.
10. Provide your Bank Account Number where benefit payments should be processed.
11. In the Bank Accountholder’s Name field, write the name of the account holder as it appears on banking documents.
12. Fill in the Bank Address with the required details, including bank street address, city, state, postal code, and the bank’s telephone number, including country code.
13. In the Payment Information section, check the box for your preferred method of payment and specify the desired country/currency for your reimbursements.
14. For the Reimbursement Election Request, choose whether this is an initial request, change request, or termination request.
15. Sign and date the form in the Authorization section, ensuring both the covered member and the bank accountholder (if applicable) provide their signatures.
16. Once you have completed all sections of the form, save your changes, download a copy for your records, and then share or submit the form as needed.

Complete your Aetna International - Recurring Reimbursement Election Form online today for efficient benefit reimbursements.