Get Ca C12914 2020-2025

The CA C12914 form is an essential document for employees enrolling in health and related benefits provided by Blue Shield of California. This guide will walk you through each section of the form to help ensure you complete it accurately and efficiently.

Follow the steps to complete your CA C12914 form online.

1. Press the ‘Get Form’ button to retrieve the CA C12914 form and open it in your editor.
2. Begin by entering subscriber information, including the last name, first name, middle initial, and Social Security number. Ensure all information is accurate to prevent any processing delays.
3. In the reason for application section, select the appropriate checkbox for your enrollment reason, such as new group enrollment, new hire, rehire, open enrollment, or other qualifying events. Provide the required dates where prompted.
4. Proceed to Section 1a, where you will select your desired health plan. Review the available packages and mark your choice clearly with a checkmark.
5. Move on to Section 1b, where you can select specialty benefits such as dental and vision insurance. You will need to choose from the plans offered by your employer in this section.
6. Section SB3 requires you to provide details for group term life insurance if applicable. Fill in the necessary employment details, including the job class and average hours worked.
7. Continue filling out Section 2 with additional personal details, including the employer name, Blue Shield Group ID, and contact information. Make sure to fill in language preferences and email addresses.
8. In Section 4, if applicable, provide information about any dependents you wish to enroll. This includes their names, birthdates, and Social Security numbers.
9. Once all sections are completed, review the entire form to confirm accuracy. After validation, you can save changes to your form, print it, or download a copy for your records.

Complete your CA C12914 enrollment form online today to ensure your benefits are processed without delay.