Get Securon Evidence Of Insurability Form

Filling out the Securon Evidence Of Insurability Form online is a crucial step in obtaining long-term disability coverage. This guide provides clear and supportive instructions to help users complete the form accurately and efficiently.

Follow the steps to fill out the Securon Evidence Of Insurability Form online.

1. Press the ‘Get Form’ button to access the Securon Evidence Of Insurability Form and open it in your online editor.
2. Carefully complete Section A, ensuring all fields are filled. Include the Control Number, Suffix, Account numbers, Employee/Member’s Social Security Number, and both names and addresses as specified.
3. Provide the telephone number of the authorized representative, the Employee/Member’s date of hire, and their home and work telephone numbers. Ensure that the e-mail addresses for both the Employee/Member and the Plan Sponsor are included.
4. Fill in the Employee/Member’s Annual Earnings and the current and requested amounts for coverage. Sign Section A at the bottom.
5. Submit the form to the Employee/Member for confidential completion and submission to Aetna.
6. Instruct the Employee/Member to double-check Section B by verifying that their name, address, and Social Security Number are correct. They must then fill in their birthdate, gender, height, and weight.
7. In Section B, the Employee/Member must answer all health-related questions to the best of their knowledge, providing details where necessary. Ensure that they describe any conditions checked in Questions B2g.
8. Sign the form in the designated area, acknowledging the accuracy of the information provided and understanding the implications of any false statements.
9. Make a copy of the completed form for personal records. Choose to mail the original to Aetna or fax it as specified for either US or international applications.

Complete your Securon Evidence Of Insurability Form online today to ensure a smooth application process.