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Form Name
Effective Date
Current As Of
"Current As Of" signifies the latest date on which a Word & Brown
Team Member confirmed that the Forms/Document available for download represents the most up-to-date and recently
revised version accessible.
Our goal is to process your new group enrollment easily and efficiently in order to provide you and your client with a quick approval. The following list outlines the health plan’s case submission requests:
Aetna International Plans are effective on the 1st of the month. All paperwork is required for submission 30 days prior to the
effective date:
- AI Group Application
- Employer address should reflect United States location, unless company is headquartered in Canada. If headquartered in Canada, please list Canadian address.
- Include total number of employees worldwide in Section A for Eligibility/Participation. A minimum of 51+ employees worldwide is required for eligibility.
- AI Joinder Agreement
- The Signed at (City/State) should match the location listed on the group application.
- Witness signature is also required.
- Electronic Publishing & Enrollment Agreement (ePub Agreement)
- Electronic Enrollment Spreadsheet
- All enrolling members, including dependents, must be listed individually on their own separate line. Dependents should be listed directly under the employee.
- Salary, Beneficiary, and EOI information are only required for groups purchasing a life policy
- Implementation Details Sheet