Small Business Clients, Update Your Contact Info (Mid Atlantic)

Thank you for your interest in Aetna Small Group. Please complete the following information so we can best help you.

All fields marked with a RED asterisk (*) are required in order to proceed.

* Business name

* First and last name

* Business address

* City

*State

*5 digit ZIP code

Business phone number (10 digits)

* Email address (formatted as example@sample.com)

* Group number

This field refers to the identification number assigned to your policy and consists of a series of six numbers.
It may be listed as: Group#, Control#, Policyholder#, Contractholder#

Number of employees in your business

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Do you have Aetna insurance through an employer or are you a Medicare member? Yes No

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Small Business Clients, Update Your Contact Info (Mid Atlantic)

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