Aetna International Enrollment/Change Form - DoD NAF Health ... 2025

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The document is an Enrollment/Change Request form for Aetna International, detailing the procedures for new enrollees, changes to existing coverage, and terminations. It provides instructions for both employers and employees on how to accurately complete the form, including necessary sections and required signatures. The document emphasizes the importance of providing accurate information and includes sections for personal details, coverage selections, and acknowledgments regarding healthcare information disclosure.

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Click ‘Get Form’ to open it in the editor.
Begin by completing Section A1 for new enrollees, providing the Effective Date of Transaction and checking the appropriate box.
For changes, navigate to Section A2, ensuring you complete all relevant fields and indicate any changes in Sections B, C, and D.
If terminating coverage, fill out Section A3 with the Effective Date of Transaction and specify the reason for termination.
In Section D, list all individuals for whom you are electing or changing coverage. Ensure all required fields are filled out completely.
Finally, sign and date the form in Section E to acknowledge your understanding of the terms.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I change my name on Aetna?

If you have an Aetna plan through your employer: Let your employer know your name or address has changed. Your employer will send this update to us. If you bought a plan directly from us (not through your employer): Log in to send us your name and address change through the Contact Us feature.

How do I change my name on my Medi Cal card?

If your name has changed, you have moved to a different address, changed your telephone number, or need to correct any of your personal information, please call the Los Angeles County Department of Public Social Services at 1-866-613-3777 (TTY) 1-800-660-4026 Monday Friday from 7:30 a.m. 6:30 p.m. (excluding

How do I change my name on my United Healthcare account?

How do I change my name or address? Contact your organizations Benefit Administrator to change your name or address. They will forward the information to us. Contact the toll-free number on the back of your medical ID card.

How do I change my federal employee health insurance?

You may change the plan in which you are enrolled or from high to low option coverage during the annual Open Season for electing coverage. If you need assistance with your health benefits enrollment, call 1 (888) 767-6738 , to change your enrollment or if you need to speak with a Customer Service Specialist.

How do I change my last name on my Blue Cross insurance?

Direct policyholders should request your name change through the agent that issued your policy. Find contact info for your local BCBS company online at .