Get New Jersey Application/change Request Aetna Life Insurance ...

Filling out the New Jersey Application/Change Request for Aetna Life Insurance online is a straightforward process. This guide provides step-by-step instructions to help you navigate each section of the form effectively.

Follow the steps to complete your application or change request smoothly.

1. Click the 'Get Form' button to obtain the application/change request form and open it in your browser.
2. In Section A, select the type of activity you are completing—either Enrollment or Change. Clearly indicate if you are adding or removing coverage for a spouse, partner, or dependent by checking the corresponding boxes.
3. Continue to Section B, where you will provide your personal information. Fill in your last name, first name, middle initial, email address, social security number, and contact numbers for both work and home. Make sure to provide a complete home address, including the apartment number, city, state, and ZIP code.
4. In Section C, check the appropriate Plan Option that you wish to enroll in. You will need to indicate the deductible amounts where applicable.
5. Section D requires you to list the individuals covered under your application. For each individual, specify if you are adding, changing, or removing coverage. Provide their full name, sex, date of birth, social security number, and additional identifying information required.
6. If applicable, complete Section E regarding pre-existing conditions for all persons being covered who are age 19 or older. Answer all questions accurately, and provide additional details on a separate sheet if necessary.
7. If you have had previous insurance coverage, complete Section F with the required details regarding the plan type and carrier name.
8. For Section G, if any dependent lives at a different address, note this in the provided space and explain the circumstances as required.
9. In Section H, indicate whether you or anyone named in the application is eligible for other coverage under various plans, and provide details as necessary.
10. You will then need to fill in Section I regarding race and ethnicity, although this is optional.
11. Complete Section J with payment information, selecting your preferred payment schedule and method.
12. Finally, in Section K, sign and date the application, affirming that all provided information is accurate and complete.
13. Once you have reviewed the entire form, save any changes you made, then download, print, or share the form as needed.

Continue completing your documents online for a smooth and efficient process.