RESOURCE CENTER

NJ
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AFA Paperless Process
aka, Automated New Business Submission Process. Attached is the new process - it clearly outlines all the steps needed to submit new small group AFA business as well as who is responsible for each item.
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AFA GRX census template
To be used for groups with 15+ enrolled and they wish to receive a firm AFA quote with underwriting based on Rx lookup. This census MUST be used.
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2017 AFA IMQ Questionnaire (short form)
Required for any groups with less than 20 enrolling or a virgin groups. If UW has more questions, a long form may be requested. Illustrative quote can be obtained, but rates will not be firm until IMQ is received.
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Electronic enrollment, Billing/payment, and Access agreement (form NB411)
required for all groups. This form authorizes the setup of e-enrollment and e-billing, and it must be filled out to authorize use of eLists for electronic eligibility.
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04.30.2014
2014 NJ Installation Checklist (1-50 eligible)
Aetna branded checklist for new business in NJ with 1-50 eligible employees
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02.17.2014
2014 Certification Form for SEH Benefits
This form is to be completed by any group with 2-50 eligible employees as part of their NB submission. It is also required on an annual basis, per DOBi mandate.
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2014 Employee Enrollment/Change Form (51-100 Eligible NJ Employees)
Employee enrollment form for NJ situs groups groups with 51-100 eligible employees. This app must be used for groups 2014 effective and forward, old apps will not be accepted.
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2014 Employee Enrollment/Change Form (1-50 Eligible NJ Employees)
Employee enrollment form for NJ situs groups groups with 1-50 eligible employees. This app must be used for groups 2014 effective and forward, old apps will not be accepted.
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2014 Employer Application (for NJ group coverage 51-100 eligible)
Aetna branded installation form to be completed by employer for new NJ situs 51-100 size business. This form MUST be used for 2014 effective dates and forward. Old applications will no longer be accepted.
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2014 Employer Application (for NJ group coverage 1-50 eligible)
Aetna branded installation form to be completed by employer for new NJ situs 1-50 size business. This form MUST be used for 2014 effective dates and forward. Old applications will no longer be accepted.
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2014 NJ Installation Checklist (51-100 eligible)
Aetna branded checklist for new business in NJ with 51-100 eligible employees
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12.14.2012
2013 new business deadlines (NE region)
Listing of Aetna new business submission deadlines in calendar form
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10.26.2012
Employer Application (for NJ group coverage 2-50 eligible - eff 12/1/12)
Aetna branded installation form to be completed by employer for new NJ situs 2-50 size business. This form MUST be used for 12/1/12 effective dates and forward. Old applications will no longer be accepted.
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10.26.2012
Employee Enrollment/Change Form (2-50 Eligible NJ Employees - eff 12-1-12)
Employee enrollment form for NJ situs groups groups with 2-50 eligible employees. This app must be used for groups 12/1/12 effective and forward, old apps will not be accepted.
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10.26.2012
Employee Enrollment/Change Form (SPANISH 2-50 Eligible NJ Employees - eff 12-1-12)
SPANISH version - Employee enrollment form for NJ situs groups groups with 2-50 eligible employees. This app must be used for groups 12/1/12 effective and forward, old apps will not be accepted.
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