Get Enrollment Application/change Form - Bcbstx

This guide provides you with step-by-step instructions to complete the Enrollment Application/Change Form for Blue Cross Blue Shield of Texas (BCBSTX) online. Whether you are enrolling for the first time, adding a dependent, or making changes to your existing coverage, this guide aims to simplify the process.

Follow the steps to successfully complete your form online.

1. Press the ‘Get Form’ button to download the Enrollment Application/Change Form and open it in your preferred editing software.
2. Read the instructions carefully that accompany the form. This will help you understand the requirements for the specific sections.
3. In Section 1, select all applicable checkboxes to indicate whether you are a new enrollee or requesting a change in coverage. If adding a dependent, provide the required additional information.
4. Complete Sections 2 and 3 with your personal details. Include your full name, social security number, contact information, and employment status.
5. In Section 4, for HMO or POS coverage applicants, select a Primary Care Physician (PCP) for each individual being covered. Ensure the physician is in network.
6. Fill out Sections 5, 6, 7, and 8 as applicable. If you are applying for life insurance or have other health coverage, make sure to provide accurate details.
7. Complete Section 9 if you or any dependent has Medicare coverage. Provide all necessary dates and information.
8. Save your changes to the form. You can download, print, or share the completed form as needed before submission.

Complete your Enrollment Application/Change Form online today to ensure your health coverage is updated efficiently.