Forms
- 2023 Employer Health Insurance Product Guide Groups Size 2 to 50April 2023 Employer Health Insurance Product Guide Groups Size 51 or MoreApril 2023 Employer Health Insurance Product Guide Balanced FundingJanuary 2023 Employer Health Insurance Product Guide Groups Size 51 or MoreJanuary 2023 Employer Health Insurance Product Guide Balanced Funding2022 Employer Health Insurance Product Guide Groups Size 1 to 50April 2022 Employer Health Insurance Product Guide Groups Size 51 or moreApril 2022 Employer Health Insurance Product Guide Balanced FundingJanuary 2022 Employer Health Insurance Product Guide Groups Size 51 or moreJanuary 2022 Employer Health Insurance Product Guide Balanced FundingCensus for Groups Size 2 PlusCensus Template for Online QuotingCensus Template Full for Online Quoting
- 2023 Enrollment Census for 1 to 502023 Enrollment Census for 51 to 992023 Enrollment Census for Balanced Funding2022 Enrollment Census for 1 to 502022 Enrollment Census for 51 to 992022 Enrollment Census for Balanced FundingACH Payment FormNew Group ChecklistSole Proprietor Partner Corporate Officer StatementCommon Ownership FormNew Member Benefit Access OverviewDomestic Partner AffidavitEmployer ApplicationEmployee ApplicationEmployee Application SpanishGroup Certification Document
- Medical Claim FormDental Claim FormWhy is BCBSAZ Asking Group Size QuestionsCOBRA ApplicationEmployer ApplicationEmployee ApplicationEmployee Application Spanish
- Instructional PDF for Machine Readable FilesBCBSAZ Machine Readable FilesAmerican Specialty Health Machine Readable FilesDavis Vision Machine Readable Files
- BCBSAZ Confidential Information Release for HIV-Related InformationBCBSAZ Confidential Information Release for HIV-Related Information in SpanishPharmacy Confidential Information Release FormBCBSAZ Confidential Information ReleaseBCBSAZ Confidential Information Release in SpanishNotice of Privacy Practices