Aetna International - Enrollment Change Request - English Accessible - Aetna International - Enrollm 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin with Section A, Transaction Information. Select whether you are enrolling, changing, or terminating coverage by checking the appropriate box.
  3. Fill in the Effective Date of Transaction at the top right corner of the form. Ensure all fields in Section B (Employer Information) are completed accurately.
  4. In Section C, provide your Employee Information. Make sure to include your full name, Social Security Number, and contact details.
  5. For dependents, navigate to Section D. List each individual for whom you are electing or changing coverage and complete all required fields.
  6. Finally, review Section E for acknowledgments. Sign and date the form electronically to confirm your submission.

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