Get Aetna Gc-1373-4 2009-2025

Filling out the Aetna GC-1373-4 form is an important step in managing claims related to life insurance and accidental death benefits. This guide will walk you through each section of the form, ensuring you provide the necessary information clearly and accurately.

Follow the steps to complete the Aetna GC-1373-4 effectively.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. In section A, you will need to provide details about the deceased. Enter the deceased’s name, relationship to the employee, social security number, birthdate, date of death, age, gender, state, zip code, and last residence. Ensure that all information is accurate and legible.
3. In section B, complete the employee information section. Here, enter the employee's name, social security number, last residence, birthdate, city, state, date employed, work location, hourly or salary status, zip code, date last worked, and the reason they did not return to work.
4. In section C, detail the employee's coverage. Fill out the employer's name, contact person's name and email address, and address. Indicate if any prior claims were submitted before the death and fill in coverage details including term life, dependent coverage, and supplemental insurance if applicable. Confirm the status of insurance premiums and any necessary dates.
5. Proceed to section D to provide information about the beneficiary or beneficiaries, including their names, addresses, social security numbers, relationships to the employee, and any assigned benefits. Note whether the benefit ownership has changed.
6. In section E, specify where the benefit payment should be sent, whether to the beneficiary, employer, or another entity.
7. Review the employer’s instructions in section F carefully. Attach all required documents as listed, including death certificates and original beneficiary designations, and ensure the deceased’s name is noted on any additional pages if necessary.
8. Finally, complete the employer's authorized representative section. Provide necessary signatures, dates, and personal information before submitting the form.
9. Once all sections are filled out and reviewed, save your changes, download a copy of the completed form, and either print or share it as required. You may fax it to the provided number or mail it to the address listed.

Complete your documents online today to ensure timely processing of your claims.