Get Enrollment Application/change Form - Blue Cross And Blue Shield ...

Filling out the Enrollment Application/Change Form for Blue Cross and Blue Shield can seem daunting, but with a clear understanding of each section, you can complete it confidently. This guide provides step-by-step instructions to assist you in navigating the process online.

Follow the steps to successfully complete your enrollment application or change form.

1. Click ‘Get Form’ button to access the Enrollment Application/Change Form and open it for completion.
2. Begin by reviewing Section 1, where you will check all applicable boxes to indicate whether you are a new enrollee or requesting a change to your coverage. Remember to include the event and date if relevant.
3. In Sections 2 and 3, provide your personal information and select the coverage you are applying for. If your employer has 2-50 employees, make sure to enter your specific plan ID.
4. Complete Section 4 by selecting a Primary Care Physician (PCP) if you are applying for HMO coverage. Ensure that you include the necessary details for yourself and any dependents.
5. If you are applying for coverage for a disabled dependent, fill out Section 5, providing documentation for their disability status as needed.
6. In Section 6, report any other health care coverage you or a dependent may have. This section is essential if existing coverage will remain active while applying.
7. Section 7 asks for details about any Medicare coverage you or your dependents have. Provide effective dates and eligibility reasons.
8. For those declining coverage, complete Section 8, indicating your reasons and whether you or your dependents are enrolled in any other plans.
9. Conclude your application with Section 9 by signing and dating the form, affirming your eligibility and agreement to the coverage conditions.
10. Once completed, save your changes, and then download, print, or share the Enrollment Application/Change Form as needed.

Start filling out your Enrollment Application/Change Form online today to ensure your health coverage needs are met.