Aetna forms you will need for your small business to help employers and their staff to sign-up or make changes to their existing Aetna health insurance, dental or life policies for small groups.

Aetna Forms for small business health insurance
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Select a SubCategory...    Group Medical   |   Dental   |   Life & Disability
Group Medical - EMPLOYEE
 Description Form # Rev Date Fillable
Employee Enrollment

 Use this form to enroll employee and their family. California Small Group Health Insurance (2-50 eligible employees)
GR-67834
11-08
Yes
Use this Spanish form to enroll employee and their family.
GR-67834-3-SP
4-07
  
For existing enrollments only
GR-68313
11-08
  
HSA Employee Enrollment Form    
10-08
  
Group Medical - EMPLOYER
Description Form # Rev Date Fillable

Employer Application

 California Small Group Business Employer Application for group coverage (2-50 eligible employees)
AGR-96241
11-08
  
Aetna HealthFund® Health Savings Account (HSA) Enrollment (small business)  
10-08
  
Small Business Employer HSA Contribution Form and Instruction Sheet
GR-68112
10-06
 Yes
Medicare Advantage Application for Small Group Employers
GR-68448-2
11-06
  
Group Medical - OTHER
Description Form # Rev Date Fillable
Mental Health Provider's Statement
GC-1422-4
6-02
 Yes
California Small Group Health Insurance Coverage Employer Notice of Occurrence of Qualifying Event for Right to Continuation Coverage under CalCobra Consumer Markets 2-19 size groups
GR-67564
5-04
 Yes
Aetna HealthFund® Health Savings Account (HSA) Beneficiary Designation
GS-1546-1
10-05
  
Commercial Prescription Drug Claim Forms
GC-1360
2-07
 Yes
Attending Physician Behavioral Health Statement
GC-1493-2
6-03
 Yes
Employee Request For Information
GC-1502-2
8-03
 Yes
Reimbursement Request and Aetna claim forms.
GC-1578
12-06
 Yes
Cancellation Opt-Out FSA Form.
GC-1579
1-07
  
HRA Reimbursement Request
GC-1593
11-07
 Yes
Cancellation Opt-Out HRA Form.
GC-1594
11-07
  
Medical Benefits - Claim Instructions and form.
GC-7-39
2-04
  
California Small Business Health Insurance Coverage.
GR-67564
5-04
 Yes
Coverage for a Special Dependent Child.
GR-67814
11-03
 Yes
Authorization For Release Of Protected Health Information.
GR-67938
3-03
  
Spanish Version
GR-67938-SP
3-03
  
Agreement to the establishment of an insurance trust fund for the purposes of implementing a Trust Agreement, and to designation of the Chase Manhattan Bank Delaware, DE, as "Trustee" for the Fund and Agreement Form.
GR-67987
7-03
 Yes
COBRA/CAL.COBRA Questionnaire (For use in CA only). These Aetna forms must be completed when replacing another group plan.
GR-68924
4-04
  
Declaration Of Domestic Partnership
N/A
3-08
  
Declaration Of Termination of Domestic Partnership
N/A
3-08
  
Proof of Eligibility Form For Small Business Employer health insurance (2-50) Sole Proprietors, Partners or Corporate Officers.
N/A
6-04
 Yes
 
GC-1395
3-06
 Yes
Select a SubCategory...    Group Medical   |   Dental   |   Life & Disability
Dental
 Description Form # Rev Date Fillable
Dental Benefits - Claim Instructions and Form
GC-8-13
01-04
 Yes
Spanish Version
GC-8-5-SP
01-04
 Yes
For Employers. This application is to be used by existing Aetna Small Groups within 60 days of the original Aetna Medical effective date.
GR-68107-2
11-06
 Yes
For Employees. Small Business health insurance. This application is to be used by existing Aetna Small Groups within 60 days of the original Aetna Medical effective date.
GR-68108-2
11-06
 Yes
Life Insurance
Description Form # Rev Date Fillable
Proof of Death - Group Life Insurance and Group Accidental Death Benefit Request Aetna forms.
GC-1373
03-04
 Yes
Spanish Version
GC-1373-SP
03-04
  
< Go Back    or view forms for small business health insurance:
Aetna  |  American Fidelity  |  Blue Cross  |  Blue Shield  |  California Choice  |  coPower  |  First Dental Health  |  First Horizon  |  The Hartford  |  Health Net  |  Kaiser
PacifiCare  |  Sharp  |  Sterling HSA  |  The Standard  |  UHC  |  Unum