Forms and Documents

Small Business Enrollment Forms

Your state: California

Administrative Tools

New Business Paperwork

American Recovery and Reinvestment Act of 2009 (ARRA)

Health Care Reform:

Addendum to New Business Input Documents (PDF, 241 KB) Mandatory Requirement for Health Care Reform - Rebate - The employer must complete the attached to determine any potential rebates entitled under the new medical loss ratio requirements set forth in the Affordable Care Act (ACA).
Enrollment Forms
Employer - Dental Verification Form (1 page)
Employee Enrollment/Change Form - Spanish (PDF, 779 KB) Effective prior to 4/1/2012
Employee Enrollment/Change Form - Spanish (PDF, 779 KB) Effective 4/1/2012 and later
Employee Change of Coverage Application - for existing enrollments only (PDF, 202 KB) Effective 4/1/2012 and later
Employee Change of Coverage Application - for existing enrollments only (PDF, 202 KB) Effective prior to 4/1/2012
Employee Change of Coverage Application - Spanish - for existing enrollments only (PDF, 202 KB) Effective prior to 4/1/2012
Employee Change of Coverage Application - Spanish - for existing enrollments only (PDF, 202 KB) Effective 4/1/2012 and later
Supplemental Dependent Enrollment/Change Form (PDF, 591 KB)
Employee - Dental Life Group Election Form (3 pages)
Employee - Dental Life Group Election Form - Spanish (3 pages)
Employer - Dental Life Group Election Form (1 page)
Employer - Application (PDF, 171 KB)
Employer - COBRA/Cal-COBRA Questionnaire (PDF, 46 KB) Must be used when completing Employer Application
Employee - 2011 Medicare Group Enrollment for (HMO/PPO) (PDF, 307 KB)

Aetna HealthFund HSA with HealthEquity
For new HSA-compatible business that started with 10/1/08 effective dates.

Aetna HealthFund HSA Forms - For business prior to 10/1/08

Vitalidad México con AetnaTM

Claims/Reimbursement Forms