Group Health Benefits Right of Continuation Notice - Aetna 2026

1. Click ‘Get Form’ to open the Group Health Benefits Right of Continuation Notice in the editor.
2. Begin by filling in your name and address at the top of the form. Ensure accuracy as this information is crucial for correspondence.
3. Indicate the reason for continuation of coverage by checking one of the provided options, such as termination of employment or divorce.
4. Complete the payment section by entering the current monthly cost for yourself and any dependents, ensuring you calculate total premiums accurately.
5. Sign and date the Request/Refusal Statement at the bottom, indicating whether you wish to continue coverage or not.
6. Review all entered information for completeness and accuracy before submitting it back to your group health plan sponsor.

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