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1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name and Aetna ID number in the Employee Information section. Ensure that all details are accurate for smooth processing.
3. Fill out the Patient Information section, including the Policy/Group Number and the patient's birthdate. If applicable, indicate if the address is new.
4. In the Coverage Information section, answer whether any family members have expenses covered by another health plan. If yes, provide necessary details.
5. Complete the Claim Information section by indicating if the claim is related to an accident or employment, and provide a description if applicable.
6. Finally, sign and date the form in both the Release and Employee Certification sections to authorize information sharing and confirm accuracy.

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