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Please complete the registration form.

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Employer Information
I am covered under an Aetna Group Insurance Policy or I am a dependent or beneficiary of someone who is covered by Aetna.
Your registration code is your date of birth plus the last four digits of your social security number.

For example, if your Date of Birth is 02/25/1967 and the last 4 digits of you Social Security Number are 9568, your registration code would be 022519679568.
Account Information

User Name Guidelines:

  • User Names must have between 6 and 50 characters and contain at least one number.

Password Guidelines:

  • 8-15 characters, no spaces
  • It must include letters and numbers (or special characters)
  • It cannot match your User Name
  • It is not case sensitive

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