Enrollment Kit - Aetna (dental)
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Effective Date
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"Current As Of" signifies the latest date on which a Word & Brown
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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 list outlines Aetna’s case submission requirements.
- Employer Application
- Employee Applications - Application or eList Tool
- Application for eligible employees enrolling or waiving health coverage.
- Waivers may be submitted in a separate excel waiver listing with the reason for waiving included.
- eList Tool
- Must have macros enabled prior to entering data and completed in full.
- Do not amend the eList Tool forman in any manner.
- When you use the tool, do not send the employee enrollment forms. All the required information must be entered into the eList Tool.
- ACA Banking Consent Form.
- ACA Banking Consent Form - the form must be fully completed, payment will be deducted when case is approved.
- Payment by check is no longer accepted.
- Wage and Tax Statement
- A Quarterly Wage and Tax Statement (QWTS) must be provided for the following groups
- -- 1 to 19 enrolled employees
- -- 20 to 100 employees with:
- no current health coverage
- more than 10% of the employees are located outside of California
- more than 20% are COBRA/CalCOBRA enrollees
- associated, affiliated, multiple companies
- Sole proprietors, partners, and officers not listed on the QWTS are not required to submit tax documents; underwriter may request if needed.
- There must be at least one enrolled W-2 employee who is not an owner and not the owner’s spouse.
- Dental Benefit Summary to receive credit for major and orthodontic coverage
- Illustrative quote with sold plan(s) marked
- Please Note: Any missing information may result in the effective date being moved forward to the next available date.
- Licensing: Broker appointment must be completed online via this link. NOTE: The group will not be approved until licensing is received.
- Small Employer Certification
TE: Group will not be approved until licensing is received.
| After approval, prior carrier termination letter must be submitted by the employer or broker. |
For other useful or older documents, please refer to the Forms database.