Get Application To Enroll Or Change Enrollment - Nf-2 - Capital Blue Cross

This guide provides clear and detailed instructions on filling out the Application To Enroll Or Change Enrollment - NF-2 - Capital Blue Cross form online. By following the steps outlined below, users can complete the process efficiently and accurately.

Follow the steps to complete your application online.

1. Press the ‘Get Form’ button to access the form and open it in your document management tool.
2. In the Group Administrator box, fill in all required fields including the Employer's Name, Group Name, and Group Number. Ensure to provide the effective date of coverage or change along with information about employment size regarding Medicare Secondary Payer laws.
3. Indicate the type of activity by checking the appropriate box: enrollment, change, or termination of group coverage.
4. Complete the Subscriber Information section with your identification number, birth date, sex, marital status, and current mailing address. Also, provide your home email address and phone numbers.
5. In the Enrollment/Change Information section, list the names of all eligible dependents. Indicate their sex, relationship to you, and whether they are being added or removed from the coverage.
6. Select the coverage type in the Coverage Selection/Change section by marking 'A' to add or 'R' to remove coverage for each dependent.
7. Complete the Physician of Choice section, selecting a primary care provider as required by your coverage type.
8. If applicable, fill in the Medicare Coverage Information section if you or your dependents are eligible for Medicare.
9. Provide details about handicapped dependents if necessary, along with any other insurance coverage you or your dependents may have.
10. Finally, review your information in the Change Information section to ensure accuracy and then sign and date the Statement of Application to confirm that all provided information is correct.

Complete your documents online for efficient processing.