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Get Blue Shield Of California Small Group Subscriber Change Request Form

Small Business Subscriber Change Request Blue Shield of California and All change requests must be received within 31 days of the effective date of the change. This form is used to request changes in personal information add/cancel dependent coverage or change plans during open enrollment. To request a new Personal Physician HMO plans visit blueshieldca.com or call Blue Shield at the number on the back of your Blue Shield member ID card.

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