Get Aetna Gc-12437 2018-2025

This guide provides a straightforward approach to completing the Aetna GC-12437, a dental benefits request form. By following these steps, you will ensure that your submission is complete and accurate, facilitating the timely processing of your claim.

Follow the steps to successfully fill out the Aetna GC-12437 online.

1. Press the ‘Get Form’ button to obtain the Aetna GC-12437 form and open it for editing.
2. Begin by filling in the employer's name in the designated field. Ensure this is the full legal name of your employer.
3. Next, enter the policy or group number associated with your dental benefits.
4. Provide your Aetna ID number in the corresponding field, ensuring that it is accurate.
5. Fill in your name as the employee, providing first and last names as requested.
6. Indicate your birthdate in the specified format (MM/DD/YYYY).
7. Enter your address, making sure to include the ZIP code.
8. Select your employment status by indicating whether you are active or retired, and if applicable, provide your date of retirement.
9. List the name of the patient receiving dental care.
10. If the patient is different from you, fill in their address if necessary.
11. Provide the patient's Aetna ID number.
12. Input the patient's birthdate similarly to yours.
13. Select the patient's gender from the options provided.
14. Indicate whether the patient is a full-time student and include their expected graduation date if applicable.
15. State the patient's marital status and whether they are employed.
16. If the claim is related to an accident, indicate this and provide the relevant details.
17. If there are any other health plans covering the patient's expenses, mention these in the relevant section.
18. After completing all sections, review your entries for accuracy.
19. Sign the authorization to release information, ensuring you date your signature.
20. If you wish for the dental benefits to be paid directly to your dentist, sign the appropriate section.
21. Finalize your submissions by downloading, printing, or sharing the form as needed.

Complete your Aetna GC-12437 form online today to ensure your dental benefits request is submitted without delay.