Request for Continuation of Coverage for Handicapped Child - Aetna - webapp montcopa 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section 1, Employee Information. Fill in your name and Aetna ID Number clearly.
3. Proceed to Section 2, Employer Information. Enter your employer's name as required.
4. In Section 3, indicate whether the dependent was previously covered under your plan by selecting 'Yes' or 'No'.
5. Complete Section 4, Employee Statement. Ensure you sign and date this section to confirm the accuracy of your information.
6. Fill out Section 5 with the Attending Physician's details, including their name, address, and contact information.
7. In Section 6, provide your signature and date to authorize the release of medical information.
8. Continue with Sections 7 and 8 by entering dependent information and details about the handicap child’s condition.
9. Review all sections for completeness before submitting. Ensure that any required documents are attached.

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