Get Aca Change Application - Florida Blue

The ACA Change Application is an essential form for individuals seeking to update their health insurance information with Florida Blue. This guide will provide you with clear, step-by-step instructions on how to complete the application online, ensuring a smooth and efficient process.

Follow the steps to complete your application online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out Part 1 with the current policy holder’s name, plan number, and policy number. Ensure that you include your complete street address, county, city, state, and ZIP code. Provide a contact telephone number with the area code, your date of birth, age, and select your sex.
3. List all eligible dependents to be added to your policy as a result of the change. Include their first name and middle initial. Attach any necessary documentation, such as a marriage certificate, if applicable.
4. Continue in Part 2 by confirming the status of the policy holder and entering the date of birth and age for the policy holder as well as for each dependent. Indicate the relationship of each dependent to the policy holder by selecting the appropriate option, such as spouse, domestic partner, or child.
5. In Part 3, if your plan does not cover pediatric dental services, check the appropriate box and acknowledge that you must have separate coverage for children under 19. Also, answer whether any applicant or dependent has used tobacco regularly in the past six months and provide the last date of use if applicable.
6. For Part 4, confirm that the changes made are for a marriage or newly eligible domestic partner. Provide the event date for your change and indicate any name changes requested, along with the reason.
7. Review all information for accuracy. Sign and date the application to certify that all statements are true and complete. Remember that the changes will not take effect until the application is accepted.

Complete your ACA Change Application online today to ensure your health coverage is updated promptly.