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Get Aetna Gr-68189 2014-2026
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How to fill out the Aetna GR-68189 online
Completing the Aetna GR-68189 form online is a straightforward process designed to facilitate the enrollment of young adult dependents in health coverage. This guide will lead you through each section of the form, ensuring that you provide all necessary information clearly and accurately.
Follow the steps to successfully complete the form.
- Press the ‘Get Form’ button to access the form and open it in the editor.
- In Section A, enter the group name and group number/control number. Next, fill in the employee's name and Aetna ID number.
- Move to Section B and check the applicable type of activity. If you are changing coverage or adding or removing a young adult dependent, ensure you also provide the effective date of coverage next to each option.
- If you are adding a young adult dependent, select the direct billing method if applicable and provide their billing address, ensuring to include street, apartment number, city, state, and ZIP code.
- Proceed to Section C to input information for the young adult dependent. Include their full name, sex, and birthdate. Specify if they have current or previous health coverage, and provide details as required.
- In this section, if the dependent has previous coverage, fill in the effective date, name of the prior carrier, termination date of prior coverage, and prior plan number if applicable.
- Finally, in Section D, both the employee and the young adult dependent must sign and date the form, confirming the accuracy of the information provided.
- After completing the form, save any changes made. You can then download, print, or share the completed document as necessary.
Start filling out the Aetna GR-68189 form online today!
Aetna offers Medicare plans under the Aetna Medicare name, catering to various needs. These plans include options for prescriptions and additional health services. If you are exploring options like Aetna GR-68189, it's crucial to evaluate what each plan offers thoroughly. Our USLegalForms website can assist you in understanding the details of these plans and their benefits.
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