Forms

• 2020 Employer health Insurance Product Guide Groups Size 1 to 50

• April 2020 Employer Health Insurance Product Guide Groups Size 51 or more

• January 2020 Employer Health Insurance Product Guide Groups Size 51 or more

• April 2020 Employer Health Insurance Product Guide Balanced Funding

• January 2020 Employer Health Insurance Product Guide Balanced Funding

• 2019 Employer Health Insurance Product Guide Groups Size 1 to 50

• 2019 Employer Health Insurance Product Guide Groups Size 51+

• Census for Groups Size 2 Plus

• Census Template for Online Quoting

• Census Template Full for Online Quoting

• BCBSAZ Commission Schedule

• 2020 Enrollment Census for 1 to 50

• 2020 Enrollment Census for 51 to 99

• 2020 Enrollment Census for Balanced Funding

• New Group Checklist

• Sole Proprietor Partner Corporate Officer Statement

• Common Ownership Form

• Welcome Guide for New Members

• Domestic Partner Affidavit

• Employer Application

• Employee Application

• Employee Application Spanish

• Group Certification Document

• Medical Claim Form

• Dental Claim Form

• BlueDental Prevention Plus1 Submission Form

• Welcome Guide for New Members

• Why is BCBSAZ Asking Group Size Questions

• COBRA Application

• Employer Application

• Employee Application

• Employee Application Spanish

• BCBSAZ Confidential Information Release for HIV-Related Information

• BCBSAZ Confidential Information Release for HIV-Related Information in Spanish

• Pharmacy Confidential Information Release Form

• BCBSAZ Confidential Information Release

• BCBSAZ Confidential Information Release in Spanish

• Notice of Privacy Practices