BTexasb Employee EnrollmentChange bFormb - 2-100 Employees - Aetna 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Section A, Employee Information. Enter your last name, first name, middle initial, and Social Security Number. Provide your home address and contact numbers.
3. In Section B, Coverage Selection, clearly indicate your chosen medical, dental, and vision plans by checking the appropriate boxes and entering any required plan numbers.
4. Proceed to Section C to list individuals you are enrolling or changing coverage for. Ensure all names and details are accurate.
5. Complete Section F if you are waiving coverage. Check the relevant boxes and provide a reason for declining coverage.
6. Review all sections for accuracy before signing at the end of the form. Use our platform’s tools to ensure everything is filled correctly.

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