Ohio Employee Enrollment Change Form (For groups with - Aetna 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Employee Information' section. Provide your Social Security number, name, job title, and contact details. Ensure accuracy as this information is crucial for processing.
3. In the 'Coverage Selection' section, indicate your choices for medical, dental, and vision coverage by checking 'Yes' or 'No'. Specify the plan options you wish to enroll in.
4. Complete Section C by listing all individuals you are enrolling or changing coverage for. Include their names, birthdates, and relationship to you.
5. If applicable, fill out the health questionnaire in Section H. This is essential for determining eligibility and coverage options.
6. Review all sections for completeness before submitting. Remember to tape or staple the form if health information is visible to maintain privacy.

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