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Get Ca C12914 2019
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How to fill out the CA C12914 online
The CA C12914 form is essential for enrolling employees in health, dental, vision, and life insurance plans offered by Blue Shield of California. This guide provides a clear, step-by-step approach to assist users in completing the form accurately and efficiently online.
Follow the steps to complete the CA C12914 form online.
- Press the ‘Get Form’ button to access the CA C12914 form and open it in the editing tool.
- Begin by entering the subscriber information including the last name, first name, middle initial, and Social Security number. Ensure all required fields are completed as missing information may delay processing.
- Indicate the reason for the application by selecting one of the options provided, such as new group enrollment, new hire, or COBRA enrollment. Enter relevant dates where prompted.
- In Section 1a, select your preferred health plan from the provided options. You must choose one plan from the package offered by your employer.
- Section 1b involves selecting specialty benefits. Choose any dental, vision, or life insurance plans that your employer offers.
- Complete Sections 2a and 2b, which require additional subscriber and employment information. This includes your mailing address, employer details, and employment status.
- Fill out Section 3 only if you selected an HMO plan, by providing your primary care physician information.
- Provide information regarding any dependents in Section 4. Ensure to list their names, relationships, and other requested details.
- Complete any necessary sections regarding other health plans, Medicare information (if applicable), and COBRA/Cal-COBRA enrollment.
- In the final sections, review the acknowledgment and signature requirement. Sign to confirm that all provided information is correct and true to the best of your knowledge.
- Once completed, save your changes. You can download, print, or share the form as necessary.
Encourage others to complete their documents online for a smooth enrollment process.
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