Forms and Resources

2024 Employer Health Insurance Product Guide Groups Size 2 to 50

April 2024 Employer Health Insurance Product Guide Groups Size 51 or More

April 2024 Employer Health Insurance Product Guide Balanced Funding

January 2024 Employer Health Insurance Product Guide Groups Size 51 or More

January 2024 Employer Health Insurance Product Guide Balanced Funding

2023 Employer Health Insurance Product Guide Groups Size 2 to 50

April 2023 Employer Health Insurance Product Guide Groups Size 51 or More

April 2023 Employer Health Insurance Product Guide Balanced Funding

January 2023 Employer Health Insurance Product Guide Groups Size 51 or More

January 2023 Employer Health Insurance Product Guide Balanced Funding

Census for Groups Size 2 Plus

2024 Enrollment Census

ACH Payment Form

New Group Checklist

Sole Proprietor Partner or Corporate Officer Statement

Common Ownership Form

New Member Benefit Access Overview

Domestic Partner Affidavit

Employer Application

Employee Application

Employee Application Spanish

Group Certification Document

Medical Claim Form

Dental Claim Form

BlueDental Prevention Plus1 Submission Form

COBRA Application

Employer Application

Employee Application

Employee Application Spanish

Instructional PDF for Machine Readable Files

Mental Health Parity Disclosure Request Form

Your Rights and Protections Against Surprise Medical Bills

Your Rights and Protections Against Surprise Medical Bills in Spanish

Notice of Privacy Practices

How to Get Care or Prescriptions Without Your ID Card

Expanded Customer Service Hours