Get Newborn/adopted Child Change Form - Arkansas Blue Cross And ...

Completing the Newborn/Adopted Child Change Form is essential for adding a newborn or adopted child to your Arkansas Blue Cross and Blue Shield policy. This guide provides clear, step-by-step instructions to help you fill out the form accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Click the 'Get Form' button to download the form and open it for editing.
2. Begin by filling in the policyholder information section. Provide your Member ID, Group Number, your Date of Birth, First Name, Middle Initial, and Last Name.
3. Complete the contact information section, including your primary and alternate phone numbers, the best time to call, and your email address.
4. In the newborn or adopted child(ren) information section, list the names of the children you wish to add to the policy. Include their first name, last name, middle initial, sex, date of birth, and specify whether they are a newborn or adopted child.
5. If the children are adopted, provide the date of the adoption petition filing. Indicate whether the children reside with you and, if they do not, provide the contact information of the parent or guardian that they reside with.
6. Review the important notes before signing. Confirm your understanding of the terms, including the possibility of rejection and the requirement for accurate information.
7. Sign and date the form. Ensure you do this in dark blue or black ink, and initial any corrections made to the form.
8. Once completed, make a photocopy for your records. Save the changes, download the form, or print it. Finally, return the form to Arkansas Blue Cross and Blue Shield as per the instructions provided.

Ensure your child's coverage today by completing the Newborn/Adopted Child Change Form online!