New Jersey Application for a Small Group Health Benefit Policy - Aetna New Jersey Application for a 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section I: POLICYHOLDER INFORMATION. Fill in the full legal name of your company, tax identification number, and main address including city, state, and ZIP code.
3. Provide contact details such as telephone number, facsimile number, and email address. Specify the name of the correspondent and their telephone number.
4. Indicate the type of organization (Corporation, Partnership, etc.) and describe the nature of your business along with the SIC code.
5. Complete employee-related fields by entering the number of eligible employees in your company and those to be insured. Specify any classes to be excluded from coverage.
6. In Section II: SPECIFICATIONS FOR COVERAGE, select your desired health benefits plan options and provide necessary details for each option chosen.
7. Answer all questions in Section III thoroughly. This includes confirming if there are any current group health plans or if you have been uninsured for three months prior to application.
8. Finally, review Section IV: AGENT/PRODUCER INFORMATION and fill out agent details before signing in Section V. Ensure all modifications are attested by signatures as required.

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