Aetna Employer Administrative Tools
Check our main AETNA page for current selling information.
|Learn about plan features, member tools, enrollment, and value-add programs.|
|Employer Applications||Use form for employer’s medical coverage selections|
|Employee Enrollment Forms||Order via: 1-877-249-2472 or Order via: Aetna Answer Team 1-800-343-6101 (representatives are available 8 am – 5 pm PST)
Use form to enroll an employee and their family.* This form should be used for all New Hires, changes and terms. It should be the standard enrollment form utilized for all transactions except regular Plan Changes during renewal.
Completed forms can be emailed to: [email protected]
|Evidence of Insurability||Employee must complete this form for approval of Life Insurance Elections over the Guaranteed Issue Amount which is $20,000 for groups 2-9 employees, $75,000 for groups 10-25 employees and $100,000 for groups 26-50; or Late Enrollee for Life and/or Disability – an individual enrolling more than 31 days from the date first eligible is considered a late enrollee.|
|ER Verification Form||Use to update # of eligible employees in an established group|
|eList tool||The eList Tool is a macro-enabled replacement of the eList template. This tool is to be used for New Business/Renewal submissions with 2-100 eligible employees. New versions are available at different times so always download a new tool for each case.|
|Automated Clearing House New Business Request||For groups to complete to have their first month’s premium released via EFT.
For new business only
|Full-time Equivalent Certification||Use this form for the employer to provide the number of full-time equivalent employees|
|Attestation||Open Enrollment – complete this form for new business groups enrolling during open enrollment – 11/15 to 12/15 for a 1/1 effective date.|
||This standalone form can be used for vision only but if you have multiple products with Aetna, use the multiproduct form when available.
Completed form can be emailed to: [email protected]
|Consumer Directed Products|
|Aetna HealthFund® One-to-One Powered by PayFlex®||Aetna Flexible Spending Account (FSA) Premium Only Plans (POP) & Aetna HealthFund Health Reimbursement Arrangement for Small Group (HRA)
Website to be used for all pre-sale, enrollment and ongoing administration materials and forms.
Administrative Handbook Rev 9.2016
2016 California Enrollment Guide for 1-100
2016 California Enrollment Guide for 1-100 – Spanish
2015 California Enrollment Guide for 1-50 eligible employees
2015 California Enrollment Guide for 51-100 eligible employees
California New Business Checklist 1-100
Employer Application 1-100
Employee Enrollment Form 1-100
Employer Application 1-100 2016
Employee Enrollment Form 1-100 2016
Employee Enrollment Form 1-100 2016 (Spanish)
Automated Clearing House New Business Request
FTE Certification Form – use this form for employers with 1-100 employees
Request for Continuation of Coverage for Handicapped Child
Handicapped Child Attending Physician’s Statement