Get Aetna Afa Medical And Stop Loss Employee Enrollment Change Form

Completing the Aetna Afa Medical And Stop Loss Employee Enrollment Change Form is crucial for ensuring your healthcare coverage details are accurate and up to date. This guide provides detailed step-by-step instructions to assist you in filling out the form online, ensuring a smooth enrollment process.

Follow the steps to accurately fill out the form online.

1. Click the ‘Get Form’ button to access the enrollment form and open it in the editing interface.
2. Begin by entering the employer name and effective date at the top of the form. Select the appropriate reason for enrollment, such as new hire, rehire, or waiver. Make sure to provide any required details related to your hiring date or termination.
3. In section A, fill out your employee information, including your Social Security number, full name, contact telephone, work email address, and home address. If your mailing address differs from your home address, provide that as well.
4. Indicate your work status by checking the applicable box (e.g., full-time, part-time, retired). Read and acknowledge the employee acknowledgment section regarding the accuracy of the information provided.
5. If waiving coverage, complete sections A and B regarding the decision not to enroll, including your signature and date.
6. In section C, select the appropriate medical coverage plan option that meets your needs.
7. Complete section D by listing any individuals who have other health insurance, providing their names and carrier details.
8. If applicable, fill out section E regarding Medicare coverage, indicating whether any individuals are enrolled in Medicare and the relevant parts.
9. In section F, list all individuals you are enrolling, changing, or removing from coverage, including details such as their last name, first name, birthdate, and relationship. Include their tobacco use status and other relevant health information.
10. Complete section G, the Health Questionnaire, by answering all questions thoroughly regarding past health conditions, treatments, and hospitalizations.
11. Once all sections are completed and checked for accuracy, you can save your changes, download, print, or share the form as required.

Ensure your healthcare enrollment is up to date by completing the Aetna Afa Medical And Stop Loss Employee Enrollment Change Form online today.