Enrollment Kit - AFA (medical) 10-50
X
0
Forms Selected
Clear Selection
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.
This checklist is provided as a guide. The carrier may require additional items and documentation. Please refer to the carrier’s underwriting guidelines for a complete list of requirements. Please use the latest version of forms.
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 lists outlines Aetna Funding Advantage's case submission requirements.
10 to 50 Eligible Employees
1. Submit sales notice form to afasalescoordinator@aetna.com and your sales rep
We will begin our review process once we receive all items listed below:
2. Email the following to our sales coordinator team (afasalescoordinator@aetna.com)
- Springboard Marketplace census template - Fully completed Defined Contribution/Census template
- Signed proposal - Employer must circle, sign and date the selected plans
- AHIA Data Software License Agreement - A copy is needed for each agency the group authorizes on the employer application (if applicable).
- Prior Carrier Bill - Bill must be the latest available with employer roster and premium summary page.
- Quarterly Wage & Tax Statement (groups with 2 to 4 eligible employees only*)
- Must provide complete, unaltered Quarterly Wage & Tax Statement and most current ownership tax documents (i.e. Schedule K-1, Schedule C, etc.) if owner/officer/partner not listed on Quarterly Wage & Tax Statement.
- Employer application
- Stop loss application
- NY HCRA form
- Banking form
Licensing: Broker appointment must be completed online via this link. NOTE: The group will not be approved until licensing is received.
| After approval, prior carrier termination letter must be submitted by the employer or broker. |
Important Reminder: To help your client comply with ACA requirements, provide a copy of the appropriate Summary of Benefits and Coverage (SBC) to each employee at the Enrollment Meeting, via email or by posting on an internal company website. For the most recent information regarding Aetna’s SBCs, please go to the SBC Page or contact your Word & Brown Representative.
For other useful or older documents, please refer to the Forms database.