Aetna GC-12 2010-2025 free printable template

Aetna Inc. PO Box 4000 Richmond KY 40476-4000 Fax to 1-888-238-3539 1-888-AET-FLEX Flexible Spending Account FSA Dependent Care Reimbursement 1B 0B For the hearing impaired call 1-877-703-5572 TDD/TTY To avoid claim payment delay you must complete all sections including if applicable Section 4 and sign and date this form. If attaching a receipt from a dependent care provider the receipt must include the following information 1 name and address of caregiver 2 name of qualifying person 3 dates...

How to fill out dependent care reimbursement form

How to fill out Aetna GC-12

1. Gather all necessary personal information such as your name, address, and contact details.
2. Provide your Aetna policy number in the specified section.
3. Fill out the date of the incident or claim.
4. Clearly describe the reason for the claim or the type of service rendered.
5. Attach any required documentation, such as receipts or medical records, as specified in the instructions.
6. Review your completed form for accuracy and completeness.
7. Sign and date the application at the bottom of the form.
8. Submit the completed GC-12 form to the appropriate Aetna claims address.

Who needs Aetna GC-12?

1. Individuals who are Aetna insurance policyholders seeking to file a claim.
2. Providers or healthcare professionals submitting claims for reimbursement on behalf of their patients.
3. Members who have undergone medical treatments or services that are covered under their Aetna plan.

Video instructions and help with filling out and completing dependent care reimbursement form

Instructions and Help about dependent care reimbursement form

A dependent care flexible spending account FSA is pre-tax money you set aside out of your paycheck to cover day care costs with a dependent care FSA you can pay for fees for licensed daycare or adult care facilities and even before and after school care programs and summer day camps for dependents under 13 the money you put in your FSA is taken from your pay before federal state or social security taxes this decreases your taxable income and increases your take-home pay so how does an FSA work when choosing your benefits you must decide how much money you want to put in your dependent care FSA for the entire year, although there are limits the amount you choose for the year is taken out of your paycheck in equal amounts and placed in your flexible spending account unlike a Health FSA where you have access to your total contribution for the year on the first day your benefits become active with your dependent care FSA you must have enough money available in your account to cover any expenses unlike a health FSA where you can carry over up to $500 to the next year with your dependent care FSA you are not able to carry over any unused dollars so use it or lose it how do I get my money out of the FSA to pay for these expenses most FSA plans offer an FSA debit card which allows you to pay for approved expenses directly at the place you get care or buy medicine the card will only work for FSA eligible expenses and is the most convenient way to use your FSA if your FSA doesn't offer a debit card you will pay out of pocket and then send a copy of the receipt to your FSA provider who will issue a check to pay you back when can I use a dependent care FSA dependent care FSA's can be used to pay for the cost of daycare for kids up to thirteen years old elder care if you were taking care of a parent or spouse and care for physically or mentally challenged dependents heads up you can only use this type of FSA if you and your spouse are working and/or in school if you are separated from your spouse only the parent with physical custody of the child can use the dependent FSA and remember dependent care FSA's are not prefunded, so you can only withdraw from the account as much as you have put into it to sum it up a dependent care FSA is a pre-tax savings account to be used for daycare costs you decide at the beginning of the plan year how much to contribute for the next twelve months and your account will be funded as you go most FSA's offer a debit card, so you can conveniently use the funds in your account you

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What is Aetna GC-12?

Aetna GC-12 is a form used by Aetna to collect data related to general contracts and financial information from providers who participate in their network.

Who is required to file Aetna GC-12?

Providers that are part of the Aetna network and need to report financial information related to general contracts are required to file the Aetna GC-12.

How to fill out Aetna GC-12?

To fill out Aetna GC-12, providers must provide accurate financial information, including but not limited to revenue data, contract details, and other related metrics as specified by Aetna guidelines.

What is the purpose of Aetna GC-12?

The purpose of Aetna GC-12 is to ensure that Aetna has accurate and comprehensive financial reporting from its providers, which aids in contract management and compliance.

What information must be reported on Aetna GC-12?

The Aetna GC-12 must report information such as total revenue, expenditures, and other financial metrics relevant to the provider's contracts with Aetna.