Get Appeal Of Waiver Denial Form - Aetna Student Health

Filing an appeal for a waiver denial can feel overwhelming, but understanding the process will make it manageable. This guide provides clear steps to help you complete the Appeal Of Waiver Denial Form for Aetna Student Health online.

Follow the steps to complete the Appeal Of Waiver Denial Form accurately.

1. Press the ‘Get Form’ button to access the Appeal Of Waiver Denial Form and open it in your preferred document editor.
2. Begin by providing your student information in Section A. Print your name clearly in the designated fields, including your last name, first name, middle initial, current address, student ID, date of birth, confirmation number, telephone number, and email address.
3. Indicate your academic standing by checking the appropriate box for new or continuing undergraduate or graduate status, as well as the term of the appeal.
4. In the provided space, clearly articulate the nature of your appeal and the specific circumstances related to your situation. Be as detailed and specific as possible to support your request.
5. Gather required documents. Attach a copy of your insurance card (front and back) along with the statement or summary of benefits from your health insurance plan. If you are using an international plan, include the entire policy written in English and in U.S. dollars. Ensure all attachments are complete, as appeals without this documentation will be denied.
6. Review all the information filled in the appeal form. Confirm its accuracy and legibility, then sign the form in the designated area to attest that the information provided is true.
7. Submit your completed form and required documentation by mailing it to the Student Health Insurance Office at the provided address, or send it via fax or email as specified.
8. Once your appeal is submitted, allow time for processing. You will receive a notification regarding the approval or denial of your appeal.

Start filling out your Appeal Of Waiver Denial Form online today!