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RBG, MIAMI - FORMS
AETNA RELEASED DOWNLOAD
Employer Enrollment
CDHP_Employer Attestation Form_6-1-10 effective

Description:
Beginning with June 1, 2010 effective dates this form is required for all New and Renewal Business electing an HSA Compatible health plan. (pdf , 35k)
Version: GR68528_0609

5/10/2010   Download
Employer Verification Form (RENEWALS ONLY)

Description:
This form is used to prepare the Aetna renewal for a group. Form typically goes out to a group 4-6 months prior to renewal. (pdf , 103k)

11/30/2004   Download
Employee Enrollment
Employee Enrollment~Change Request_10-10

Description:
Member Enrollment or Change Request form, use limited to only FL SmGrp Business 2-50 eligible employees. (pdf , 491k)
Version: GR67834-1010

2/8/2011   Download
Administration
Administrative Guide
 7/16/2009   Download
Aetna Rx Home Delivery

Description:
the attachment includes the Home Delivery brochure, Order Form and Sample 90 day Prescription (pdf , 498k)
Version: Form 7/07

4/28/2009   Download
Claims
Authorization for Release of PHI

Description:
authorization for individual/company to have access to a member's confidential health information (pdf , 30k)

2/6/2007   Download
Dental Claim form
 11/20/2009   Download
Medical Claim Form
 10/30/2006   Download
Prescription Claim Form
 10/30/2006   Download
Prescription_Precert~Medical Exception Request
 3/26/2010   Download
Preventive Health Services--Child/Adult Schedule
 5/12/2009   Download
Transition of Care

Description:
TOC form and Question and Answer page. This is for new group only (pdf , 384k)
Version: 0607

6/9/2009   Download
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