Intro Text 1: We would like to walk you through some common areas of confusion when filling out the Enrollment/Change form.
Intro Text 2: During this presentation, we are using the form shown on the left. The forms you use may look different. The information shown here will generally be the same from one form to another.
Intro Text 3: You can use the buttons below to skip to specific portions of this presentation. The section currently playing will have an arrow next to it.
Employer Text 1: Let's look at the Employer Name first.
Employer Text 2: The Employer Name is used to indicate the name of the company that the employee works for.
Employer Text 3: The employee's name does not belong in this field. On most forms, the employee's name is not placed in the first section.
Hiredate Text 1: Next let's look at the Date of Hire.
Hiredate Text 2: The Date of Hire is important because it is used to determine the effective date of the employee. A missing or incorrect date can have a negative impact on the employee's coverage or the premiums.
Hiredate Text 3: If the Date of Hire is missing, the form may be returned, thereby causing a delay in the enrollment process.
Plan Text 1: Another important part of the enrollment form is the Plan/Coverage Selection.
Plan Text 2: There are three common categories within this section of the form: Medical, Dental, and Life & Disability.
Plan Text 3: It is important for the proper plan choices to be made. If the correct information is not provided here, it may result in incorrect premiums or benefits, or it may result in a delay of services, such as a Doctor visit.
Birthdate Text 1: Another important part of the form is the Birthdate.
Birthdate Text 2: The Birthdate is a very important field that must be completed on the enrollment form. This includes the dates of birth for the employee and for any dependents.
Birthdate Text 3: If the date of birth is missing, the employee and/or dependents cannot be entered into the system. If an incorrect date of birth is provided, it can affect premiums, eligibility, and/or claims payments.
SSN Text 1: The employee's Social Security Number goes here.
SSN Text 2: A member must have a Social Security Number to be enrolled in the system.
SSN Text 3: If it is missing, a phone call will be made or the enrollment form will be returned. Both will cause a delay in the enrollment process.
Signature Text 1: There are two places on the form where the Employee Signature can go. The first signature box (usually located on the first page) should only be signed if the employee is declining coverage.
Signature Text 2: If this box is signed, the employee will not receive benefits.
Signature Text 3: The other signature box is usually located on the last page of the form. A signature is required on this page.
Signature Text 4: If the signature is missing, the enrollment form may be returned, causing a delay in the enrollment process. Certain states require a completed health statement. Please refer to your state form.
Conclusion Text 1: This concludes our review of some of the commonly misunderstood parts of the Enrollment/Change form. We hope that this will help you in assisting your employees in filling this form out correctly.
Conclusion Text 2: Thank you for taking the time to view this presentation.
Conclusion Text 3: Presented by: Aetna Consumer Markets