Get Aetna Afa Medical And Stop Loss Employee Enrollment Change Form

Filling out the Aetna Afa Medical And Stop Loss Employee Enrollment Change Form online can streamline your enrollment process. This guide provides step-by-step instructions to ensure accurate and complete submission, allowing for prompt processing of your request.

Follow the steps to successfully complete your enrollment change form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editing tool.
2. Fill out the effective date, date of hire, and member ID number (if available) in the designated fields.
3. Indicate your employer name and select the appropriate status option from the available choices, including new hire, rehire, or other relevant categories.
4. In section A, provide your personal information, including your social security number, full name, phone numbers, and addresses. This ensures accurate identification.
5. Select your employment type under section A, identifying whether you are full-time, part-time, or in another category.
6. In section B, choose your medical coverage option from the options provided.
7. Detail any dependents in section C who require coverage, including their names and addresses if they live separately.
8. Complete section D regarding other medical coverage for individuals who may have additional insurance concurrently.
9. Fill out section E for any individuals who are covered by Medicare, indicating whether they have Parts A, B, or D.
10. If you are declining or waiving coverage, complete section F and provide a detailed reason for your decision.
11. In section G, list any individuals enrolling or changing coverage, ensuring to indicate whether they are being added or removed.
12. Complete the health questionnaire in section H, providing information if anyone enrolling has consulted a healthcare professional about health conditions in the last five years.
13. Review all information entered for accuracy and completeness, as any mistakes could delay processing.
14. Finally, save your changes, and download, print, or share the completed form as necessary.

Complete your Aetna Afa Medical And Stop Loss Employee Enrollment Change Form online to ensure a smooth enrollment process.