Aetna International Enrollment/Change Form - DoD NAF Health ... 2026

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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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