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Aetna FML Cert-COFM 2012-2025 free printable template

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Family Medical Leave Act (FMLA) Certification for Family Members Serious Health Condition1 Return completed form to: Aetna Life Insurance Company PO Box 14560 Lexington, KY 405124560 Fax: 8666671987
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How to fill out Aetna FML Cert-COFM

01
Obtain the Aetna FML Cert-COFM form from the Aetna website or your HR department.
02
Read the instructions carefully to understand the requirements for filling out the form.
03
Provide your personal information, including your name, contact details, and employee ID.
04
Indicate the type of leave you are requesting, such as medical or family leave.
05
Have your healthcare provider complete the relevant sections, including their evaluation and recommendations.
06
Review the completed form for accuracy and ensure all required sections are filled out.
07
Submit the form to your HR department or Aetna according to the provided instructions.
08
Keep a copy of the submitted form for your records.

Who needs Aetna FML Cert-COFM?

01
Employees who are seeking Family and Medical Leave under the Family and Medical Leave Act (FMLA).
02
Individuals who require leave for personal or family health issues covered by Aetna's policies.
03
Employees needing to document their eligibility for FMLA benefits.
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Aetna FML Cert-COFM is a certification form used to document an employee's eligibility for Family and Medical Leave under the Family and Medical Leave Act (FMLA) provided by Aetna.
Employees seeking to take Family and Medical Leave must file the Aetna FML Cert-COFM to validate their request based on qualifying conditions.
To fill out the Aetna FML Cert-COFM, employees need to provide personal information, medical details related to their leave, and supporting documentation from their healthcare provider.
The purpose of Aetna FML Cert-COFM is to ensure that requests for family and medical leave are properly documented and verified according to FMLA regulations.
The Aetna FML Cert-COFM must report information such as the employee’s identification details, the medical condition necessitating leave, duration of the leave, and specifics regarding the healthcare provider's recommendations.
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