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  • Blue Shield Of California Small Group Subscriber Change Request Form

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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Contact support

If you have questions related to Blue Shield Promise member's eligibility or benefits, contact Provider Services at (800) 468-9935.

Blue Shield of California members who need immediate assistance can contact customer service at 800-393-6130. Members who may have lost or misplaced their identification card can print a new card on our website at blueshieldca.com.

You must call Customer Service, (855) 836-9705, to have them cancel your current medical plan because, legally, Blue Shield cannot cancel your plan without your authorization. Failure to cancel your plan will result in you having two active plans and two sets of bills.

For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357. Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.

Blue Shield of California is a Registered® mark of the BlueCross BlueShield Association, an association of independent Blue Cross and Blue Shield plans.

Small Group Employer Services (1 – 100): (800) 325-5166. Small Group Broker Services (1 – 100): (800) 559-5905. Core Group Employer Services (101 – 2999): (855) 747-5809.

Need help? Contact your agent for personalized help. You may also call Blue Shield at (855) 836-9705 (PPO), (844) 250-2878 (HMO) or Covered California at (800) 300-1506.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232