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Please select your client's company size:
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Middle Market (51 - 3000 Eligible Employees)
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Small Group
2 - 50 eligible employees
Your state: Pennsylvania
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Administrative Tools
Administration Manuals
Enrollment form tool
Enrollment Forms
Employer - Dental Verification Form
(1 page)
Employee Enrollment/Change Form
(4 pages)
Employee Enrollment/Change Form (Spanish)
(4 pages)
2009 Medicare Employer Application
(2 pages)
Employer - Application and Joinder Agreement
(4 pages)
2009 Medicare Employer Application
(2 pages)
2009 Medicare Group Enrollment -Medicare Golden Advantage and Golden Choice Plans
(2 pages)
2009 Medicare Group Enrollment Form - PFFS "Open" Plans
(2 pages)
Group Medical Questionnaire
(1 page)
DE Supplemental Enrollment Form (DE HB 446)
(1 page)
Aetna HealthFund HSA with HealthEquity
For new HSA-Compatible business only starting with 7/1/08 effective dates.
Visit
http://aetna.healthequity.com
for enrollment forms.
Aetna HealthFund HSA Forms - For business prior to 7/1/08
HSA Small Group Member Enrollment Form
HSA Beneficiary Form
HSA AutoDebit Information
(4 pages)
HSA EFT form
Employer HSA Contribution Form - PDF version
Employer HSA Contribution Form - Excel version
HSA Rollover Form
HSA Deposit Slips
Member Letter
(2 pages)
Aetna HealthFund HRA Materials
HRA Plan Sponsor Brochure
(8 pages)
HRA Employee Brochure
(4 pages)
HRA Employee Brochure (Spanish)
(4 pages)
Pricing Guide
(1 page)
Cafeteria Plans Enrollment Forms
Employer Request for Participation
(1 page)
Claims/Reimbursement Forms
Medical Claim Form
(2 pages)
Dental Claim Form
(2 pages)
Pharmacy Claim Form
(2 pages)
Vision Claim Form
(2 pages)
Term Life Claim Form
(2 pages)
Disability Claim Form
(1 pages)
Disability Attending Physician Statement
(2 pages)
Mail Order Delivery Registration/Order Form
(2 pages)
Handicapped Child Continuation of Medical Coverage
(2 pages)
Handicapped Child Attending Physical Statement
(2 pages)