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Life Enrollment/Change Request Aetna Life Insurance Company 151 Farmington Avenue Hartford, CT 06156 () FAX: () Aetna Life Insurance Company A. Transaction Information Requested Dependent Coverage

How to fill out life enrollmentchange request

How to fill out life enrollmentchange request

1. Step 1: Obtain the life enrollment change request form from the HR department or your insurance provider.
2. Step 2: Read the instructions on the form carefully to understand the required information and supporting documents.
3. Step 3: Fill out your personal details such as name, address, contact information, and employee ID.
4. Step 4: Indicate the reason for the enrollment change request, such as a marriage, divorce, birth/adoption of a child, or a change in dependent status.
5. Step 5: Provide the effective date for the requested change and specify the coverage options you desire (e.g., adding or removing dependents, changing beneficiaries).
6. Step 6: If necessary, attach any supporting documents required to validate the change (e.g., marriage certificate, divorce decree, birth certificate).
7. Step 7: Review the completed form for accuracy and ensure that all required fields are filled.
8. Step 8: Sign and date the form at the designated space.
9. Step 9: Submit the filled-out form to the HR department or insurance provider according to their specified submission process.
10. Step 10: Keep a copy of the completed form for your records.

Who needs life enrollmentchange request?

1. Employees who wish to make changes to their life insurance coverage or add/remove dependents from their policy.
2. Employees who experience qualifying life events such as marriage, divorce, birth/adoption of a child, or a change in dependent status.

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What is life enrollmentchange request?

Life enrollment change request is a form used to make changes to your life insurance policy such as adding or removing beneficiaries, changing coverage amount, or updating personal information.

Who is required to file life enrollmentchange request?

Any policyholder who wants to make changes to their life insurance policy is required to file a life enrollment change request.

How to fill out life enrollmentchange request?

To fill out a life enrollment change request, you need to provide your policy information, details of the changes you want to make, and any supporting documentation required.

What is the purpose of life enrollmentchange request?

The purpose of life enrollment change request is to update and make changes to your life insurance policy to ensure it meets your current needs.

What information must be reported on life enrollmentchange request?

You must report your policy number, current information, requested changes, and any supporting documentation on the life enrollment change request form.