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This document is used to enroll, change, or terminate life and disability insurance coverage for employees and their dependents through Aetna Life Insurance Company.
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How to fill out life and disability enrollmentchange
How to fill out Life and Disability Enrollment/Change Request
01
Obtain the Life and Disability Enrollment/Change Request form.
02
Read the instructions carefully before filling out the form.
03
Provide your personal information, including your name, address, and employee ID.
04
Indicate whether you are enrolling for the first time or making a change to your existing coverage.
05
Select the type of coverage you wish to enroll in or change, including Life Insurance and Disability Coverage.
06
Fill in the relevant beneficiary information if applicable.
07
Sign and date the form to certify that the information provided is accurate.
08
Submit the completed form to your HR department or designated representative.
Who needs Life and Disability Enrollment/Change Request?
01
Employees who wish to enroll in Life and Disability Insurance for the first time.
02
Employees who are making changes to their existing Life and Disability Insurance coverage.
03
Employees seeking to update beneficiary information.
04
New hires needing to establish their benefits during the onboarding process.
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What is Life and Disability Enrollment/Change Request?
The Life and Disability Enrollment/Change Request is a form used to enroll or make changes to life insurance and disability insurance coverage for employees.
Who is required to file Life and Disability Enrollment/Change Request?
Employees who wish to enroll in or make changes to their life and disability insurance coverage are required to file this request.
How to fill out Life and Disability Enrollment/Change Request?
To fill out the form, individuals need to provide personal information, select the coverage options they wish to enroll in or change, and sign the document to confirm their choices.
What is the purpose of Life and Disability Enrollment/Change Request?
The purpose of the form is to formally document an individual's request for enrollment or changes in life and disability insurance benefits.
What information must be reported on Life and Disability Enrollment/Change Request?
The information that must be reported includes personal identification details, selection of coverage options, dependent information (if applicable), and any changes to existing coverage.
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