Get Aetna Gr-67853-34 2013

This guide provides clear and comprehensive instructions for filling out the Aetna GR-67853-34 form for life and disability insurance coverage. By following these steps, you can ensure accurate completion and submission of your application online.

Follow the steps to successfully complete the Aetna GR-67853-34 form online.

1. Press the ‘Get Form’ button to access the document. This action will open the form for editing and completion.
2. Begin by completing Section A thoroughly. Ensure all items are filled out, including the control number, suffix, and account numbers.
3. Enter the employee/member’s Social Security Number in the designated field.
4. Provide both the plan sponsor's and employee/member's names and addresses accurately.
5. Include the telephone number of the authorized representative, along with the employee/member's date of hire.
6. Fill in the employee/member's home and work telephone numbers, ensuring they include area codes.
7. Enter the email addresses for both the plan sponsor and employee/member.
8. Complete the employee/member’s annual earnings field.
9. Indicate the requested life coverage amount by checking the appropriate box(es) and providing the current and requested amounts.
10. Check the reason(s) for the requested life coverage in the available options.
11. Fill out any requested disability coverage details and ensure current and proposed amounts are documented.
12. Ensure Section A is signed by the authorized representative.
13. Next, the employee/member should verify their details in Section B and complete all required information.
14. Provide height and weight, and ensure the appropriate boxes regarding dependent coverage are checked, if applicable.
15. Complete the health statements and all relevant questions to the best of your knowledge.
16. Describe any medical conditions checked in previous sections and provide additional supporting details.
17. Sign the form, ensuring all necessary signatures are included.
18. Make a copy of the completed form for personal records.
19. Once completed, follow the guidelines to submit the form to Aetna for processing.

Begin filling out your Aetna GR-67853-34 form online today to secure your coverage.