Aetna Forms - Connecticut small group (2-50)
 

To respect the privacy of our members, if you download and print enrollment forms that include a medical questionnaire, you should suggest a mechanism for transmitting the completed form.  That mechanism should be one that will protect the confidentiality of the person's health information, such as taping or stapling the forms closed, sealing them in an envelope, and mailing or faxing them to an Aetna address or fax number that you provide.

 

Underwriting Checklist

Underwriting Guidelines

Download

Download

 Information on medical guidelines, case submission and case installation. Use in Connecticut
EE Enrollment Form Download Use form to enroll an employee and their family Use in Connecticut

Employer Application 		Download Use form for employer's Small Group products coverage selections Use in Connecticut
Employer Verification Form Download Use for HMO or PPO enrollment Use in Connecticut
2007 Medicare Group Enrollment Form Download Use form to enroll Medicare eligible employee or retiree Use in Connecticut
Family Health Statement Download Required with new business enrollment paperwork Use in Connecticut
Family Health Statement - Spanish Download Required with new business enrollment paperwork Use in Connecticut
Joinder Agreement Download Use with Employer application Use in Connecticut
Common Ownership Download Submit for Small Employers with affiliated companies, subsidiaries or common ownership Use in Connecticut
Aetna HealthFund® (HSA) Enrollment Materials Download All of these HSA materials should be distributed together as a “kit.” The HSA kits should be presented in conjunction with documents that present HDHP plan information such as the SBS brochure or member product brochures. Use in Connecticut