• Aetna Handicap Child Doctor
  Aetna HMO enrollees who have a handicapped dependent child over age 23 must have the attending physician complete this form. You should send it to Aetna along with the member form (below) per instructions on the form.

• Aetna Handicap Child Member
  Aetna HMO enrollees who have a handicapped dependent child over age 23 must complete this form annually and send it to Aetna per instructions on the form. The doctor form (above) must also be sent to Aetna.

• Medical Benefit Enrollment and Change (ADM 4717)
  Needed to initially enroll yourself and your dependents in a health care plan such as an HMO or the Ohio Med PPO. Also used to make changes throughout the year such as the addition of a newborn or adopted child, the removal of a dependent due to them reaching age 19, changing from family to single coverage, etc. For more information, see the Benefits Decision Comparison Guide.

• Request to Extend Limiting Age for Mentally Retarded, Severely Mentally Ill or Physically Handicapped Dependent Child (ADM 4730)
  
  
  

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If you are unsure of which category your form falls into, click here for an alphabetized list of all available forms.