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Authorization For Release Of Protected Health Information I hereby authorize Aetna Life Insurance Company and any of its parents subsidiaries and affiliates including but not limited to Aetna Health Management Inc. Aetna s affiliated HMOs and Aetna Integrated Informatics and their respective agents and subcontractors to disclose confidential information about the member/insured identified below. I UNDERSTAND THAT THIS AUTHORIZATION IS VOLUNTARY. Please Print All Responses If you do not fill...

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How to fill out Aetna GR-67938 S

1. Obtain the Aetna GR-67938 S form from the Aetna website or your employer's HR department.
2. Read the instructions carefully before starting to fill out the form.
3. Fill in your personal details, including your full name, address, and contact information.
4. Provide your Aetna member ID number in the designated section.
5. Indicate the type of claim you are submitting, ensuring to provide any necessary documentation.
6. Review all the information for accuracy and completeness.
7. Sign and date the form at the bottom.
8. Submit the completed form via the specified method, such as mail or online submission.

Who needs Aetna GR-67938 S?

1. Individuals who are covered under an Aetna health plan and need to file a claim.
2. Employees who have received Aetna GR-67938 S form as part of their benefits program.
3. Dependents of Aetna members who require access to health benefits.

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What is Aetna GR-67938 S?

Aetna GR-67938 S is a specific form used for reporting health insurance benefits and claims for covered individuals under Aetna's policy.

Who is required to file Aetna GR-67938 S?

Employers or plan administrators who have Aetna health insurance plans are required to file Aetna GR-67938 S.

How to fill out Aetna GR-67938 S?

To fill out Aetna GR-67938 S, complete each section of the form with accurate information regarding the insured individual's details, claim specifics, and any other required data as indicated on the form.

What is the purpose of Aetna GR-67938 S?

The purpose of Aetna GR-67938 S is to facilitate the reporting of insurance claims and provide necessary information for processing benefits for eligible policyholders.

What information must be reported on Aetna GR-67938 S?

The information that must be reported on Aetna GR-67938 S includes the insured person's personal details, claim number, service dates, nature of service provided, and amounts billed.