Get the free Connecticut Small Group Business Employee Enrollment/Change Form

This document is used for enrollment or changes to health insurance coverage for employees of small businesses in Connecticut with 1 to 50 eligible employees, managed by Aetna.

How to fill out connecticut small group business

How to fill out Connecticut Small Group Business Employee Enrollment/Change Form

1. Obtain the Connecticut Small Group Business Employee Enrollment/Change Form from your HR department or company website.
2. Begin by filling out the employee's personal information, including name, address, and contact information.
3. Provide the employee's Social Security number and date of birth.
4. Indicate the employee's position and the date of hire.
5. Fill in the details pertaining to the type of enrollment or change (e.g., new employee, change in status, etc.).
6. If applicable, include the employee's dependents' information.
7. Review the form for accuracy and completeness.
8. Sign and date the form where required.
9. Submit the completed form to the HR department or designated administrator.

Who needs Connecticut Small Group Business Employee Enrollment/Change Form?

1. All employers in Connecticut with a small group health insurance plan.
2. Employees who are newly hired or experiencing a qualifying life event that requires enrollment or changes in their health coverage.

For pdfFiller’s FAQs

What is Connecticut Small Group Business Employee Enrollment/Change Form?

The Connecticut Small Group Business Employee Enrollment/Change Form is a document used by small businesses in Connecticut to enroll new employees in health insurance plans or to make changes to existing employee coverage.

Who is required to file Connecticut Small Group Business Employee Enrollment/Change Form?

Small businesses in Connecticut that provide health insurance benefits to their employees are required to file the Connecticut Small Group Business Employee Enrollment/Change Form whenever there are new enrollments or changes to existing coverage.

How to fill out Connecticut Small Group Business Employee Enrollment/Change Form?

To fill out the Connecticut Small Group Business Employee Enrollment/Change Form, the employer must complete the required sections detailing employee information, select the appropriate health plan, and provide any necessary documentation or signatures as indicated on the form.

What is the purpose of Connecticut Small Group Business Employee Enrollment/Change Form?

The purpose of the Connecticut Small Group Business Employee Enrollment/Change Form is to facilitate the accurate and timely enrollment of employees into health insurance plans or to update their existing coverage details.

What information must be reported on Connecticut Small Group Business Employee Enrollment/Change Form?

The information that must be reported on the Connecticut Small Group Business Employee Enrollment/Change Form includes employee personal details (such as name, address, and date of birth), employment information, selection of health plan, and any changes to coverage.