Forms and Resources
- 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 Plus
- 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 Balanced FundingACH Payment FormNew Group ChecklistSole Proprietor Partner or Corporate Officer StatementCommon Ownership FormNew Member Benefit Access OverviewDomestic Partner AffidavitEmployer ApplicationEmployee ApplicationEmployee Application SpanishGroup Certification Document
- Medical Claim FormDental Claim FormBlueDental Prevention Plus1 Submission FormCOBRA ApplicationEmployer ApplicationEmployee ApplicationEmployee Application Spanish
- Instructional PDF for Machine Readable Files
- Mental Health Parity Disclosure Request Form
- Your Rights and Protections Against Surprise Medical BillsYour Rights and Protections Against Surprise Medical Bills in Spanish
- Notice of Privacy Practices