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  • Special Offer Application For Individual Coverage Bcbs Form

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Ication promptly, please remember to: Print all answers in black ink. Pencil will not be accepted. Make sure you personally sign the application as the Primary Applicant. If your spouse or any dependent child(ren) age 18 or over is also applying for coverage, have him/her personally sign the appropriate signature line. Parent/guardian must sign if primary applicant is a minor. If it is necessary to correct any errors, simply cross off what is incorrect and write your initials next to.

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Claims should be submitted to Blue Shield of California via the Real-Time Claims web tool or electronically using Electronic Data Interchange, though they can also be submitted by mail.

When submitting a claim for a patient with coverage through more than one BCBS plan: Submit a claim for the primary insurance, then submit the secondary claim.

A change in your situation — like getting married, having a baby, or losing health coverage — that can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment Period.

You qualify for a Special Enrollment Period if you've had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount.

Fill out an application to see if you are eligible to enroll in health coverage through MNsure. Any Minnesota resident who is a U.S. citizen, U.S. resident, or lawfully present can enroll. There are no age restrictions for applicants. Adults who are not applying for themselves may still apply on behalf of their child.

Common life events that may qualify for special enrollment include job loss, early retirement, loss of dependent status, marriage, divorce, birth or adoption of a child or a move. For special enrollment, you'll need to enroll within the required time frame — usually within 60 days of the life event.

Below is a list of the qualifying life events: Gaining a dependent or becoming a dependent through birth or adoption. Getting married. Applicant or dependent lost minimum essential coverage due to termination or change in employment status.

If the employee chooses to file a claim online, they can do so by going to ancillary.bcbsil.com. They will follow the guided steps and be provided additional forms that will need to be completed by their employer and their attending physician.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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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