Aetna Employer Administrative Tools

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  Health Care Tools & Apps

California

 
Enrollment
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]   Sales Contact Tools https://www.aetna.com/insurance-producer/sales-contact-tool.html
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.
  • Aetna Vision Preferred Enrollment/Change Form
  • Aetna Vision Preferred Enrollment/Change Form Spanish
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.
Claims/Reimbursement Forms
Claims/Reimbursement Forms  

  SBC Summary of Benefits Search Renewal ProceduresRenewal Procedures   

 

 

Enrollment Forms 

Quotit Paper - PDF

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ONLINE Enrollment Tools - Instructions 

Email us for link to get your applications going

PRO-Apply-Flyer
Employee Guide_Pro Apply
Pro Apply_Intake Form
PRO-Apply_-BROKER_Information
User Guide_Pro Enroll_Broker

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