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  • Health Plan Employee Enrollment Application Blue Shield Of ...

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Health Plan Employee Enrollment Application Blue Shield plans for 51+ employees Blue Shield of California and Blue Shield of California Life & Health Insurance Company (Blue Shield Life) Please.

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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.

* If you are a Personal Choice plan member or a Blue Choice plan member and wish to add a dependant who is more than 30 days old, please call Alberta Blue Cross at 780-498-8899 or toll free at 1-800-232-1914, extension 8899, to obtain the appropriate form.

Benefits are provided for the first 31 days regardless of whether the newborn has been added to the subscriber's health plan. This immediate accident and sickness coverage includes newborn of enrolled member who is a surrogate mother until the adoptive parents have the right to control the newborn's health care.

Blue Shield must receive a completed Employee Application no later than 31 days after a new employee completes your group's waiting period. To add a dependent, an employee must complete and submit the Subscriber Change Request form. Important: HMO and POS members must select a Personal Physician for each dependent.

Adding dependents Dependents can be added during Open Enrollment, or during a special enrollment period due to a qualifying event. In most circumstances, you cannot use the Quote and Apply tool to properly enroll new dependents on an existing plan/policy.

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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