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Utah Small Group Employee Enrollment change form

Utah Small Group Employee Enrollment change form 2025

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The document is an Employee Enrollment Form for Aetna Life Insurance Company, intended for employees of Utah Group Businesses with 2 to 50 eligible employees. It outlines the process for enrolling in various insurance coverages including medical, dental, life, and disability. Employees must complete the form accurately to avoid processing delays and are advised to protect their health information confidentiality. The form includes sections for personal information, coverage selection, dependent information, health history questionnaires, and options for waiving coverage.

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Click ‘Get Form’ to open the Utah Small Group Employee Enrollment change form in the editor.
Begin by filling out your personal information in Section B. Ensure you provide your Social Security Number, name, job title, and contact details clearly.
In Section A, select your desired coverage options for medical, dental, and life insurance. Make sure to check only one option per category.
If applicable, complete Section C by listing all individuals you are enrolling or changing coverage for. Include their names and relevant details.
For any dependents living at a different address, fill out Section D with their information.
Complete the Health Questionnaire in Section G honestly and thoroughly to avoid delays in processing your enrollment.
Finally, review all sections for accuracy before signing and submitting the form. Remember to protect your health information as advised.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What paperwork does a new employee need to fill out?

New employees need to fill out a Form I-9 to verify employment eligibility as well as a W-4 for income tax. In states with an income tax, its necessary to fill out a second W-4.

What forms must an employee complete when beginning a new job?

I-9 form. The I-9 form verifies your identity and employment eligibility; it was revised in August 2023. You might receive a paper copy to fill out and will need to produce your documents in person.

What forms do new employees need to fill out in Utah?

New Hire Paperwork and Compliance for Utah Employment Eligibility Verification (Form I-9) Employees Withholding Certificate (Form W-4) DWS New Hire Reporting in Utah. Enroll Employee for IRS Form W-2. Enroll Employee for IRS Form 941. Utah Withholding Return Form TC-941. Enroll Employee for IRS Form 940.

What is an employee enrollment form?

Enrollment forms record whether employees have enrolled in or waived group benefits. For instance, if you have more than 50 full-time employees, you will need this data to complete IRS forms 1094 and 1095, which record health care coverage.

What paperwork must be completed when you start a new job?

Both a W-2 and a W-4 tax form. These forms will come in handy for both you and your new hire when its time to file income taxes with the IRS. A DE 4 California Payroll tax form. Issued by the Employment Development Department, this form helps employees calculate the correct state tax withholding from their paycheck.

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