Get Application For Blue Shield Individual And Family Health Plans

Completing the Application For Blue Shield Individual And Family Health Plans online can be straightforward when you follow the right steps. This guide provides detailed instructions to help you fill out the form accurately and efficiently.

Follow the steps to fill out the application correctly and efficiently.

1. Click ‘Get Form’ button to obtain the form and access it for completion.
2. Begin by providing your personal information in Part 1. Fill in your Social Security number, first and last name, and indicate the purpose of the application by checking the appropriate box.
3. Next, select your health plan by checking one box only under the health plan options provided. Make sure to read the descriptions to choose the one that best fits your needs.
4. Complete your contact information, including your business and home phone numbers, email address, and mailing address. If you have a different billing address, be sure to provide that as well.
5. In Part 2, list all family members you wish to cover. For each individual, provide their first name, last name, date of birth, height, and weight. Select the appropriate health plan for each member.
6. Part 3 requires you to answer medical history questions for yourself and any applying family members. Ensure you respond 'Yes' or 'No' to each question, circling applicable conditions as specified.
7. In Part 4, provide details of any prior medical coverage that you or your applying family members had in the last 6 months, checking 'Yes' or 'No' as required.
8. If applicable, provide further details about any medical conditions in Part 5 based on your responses in Part 3. Be thorough in outlining the necessary information.
9. Complete Parts 6 and 7 by detailing any recent physician visits and current medications, including the names and conditions for which medication was prescribed.
10. In Part 8, read the disclosure statements carefully, and sign in the indicated areas with the required date. Make sure all required signatures are collected before submission.
11. Finally, review the completed application for accuracy, and save any changes. You can download, print, or share the completed application as necessary.

Start filling out your application online today to secure your Blue Shield health coverage.