Get Ca C12914 2018

The CA C12914 form is essential for small business employee enrollment with Blue Shield of California. This guide provides a clear, step-by-step approach to assist users in efficiently completing the form online.

Follow the steps to accurately complete the CA C12914 form.

1. Click ‘Get Form’ button to access the CA C12914 document and open it in your preferred editor.
2. Provide the subscriber information by filling out the last name, first name, middle initial, and Social Security number. Ensure all required fields are complete to avoid processing delays.
3. Indicate the reason for application by selecting one of the options, such as new group enrollment or open enrollment. Fill in any relevant dates as required.
4. In Section 1a, choose a health plan from the list offered by your employer. Review the options carefully to select the best fit for you.
5. If applicable, complete Section 1b regarding specialty benefits for dental, vision, and life insurance. Make your selections and ensure you've attached any necessary forms.
6. Fill out Section 2 with additional subscriber information, including home address, contact numbers, and language preferences.
7. If selecting an HMO plan, complete Section 3 by designating a primary care physician or requesting one assigned by Blue Shield.
8. Complete Section 4 with dependent information if applicable. Ensure each dependent's details are filled out accurately.
9. Fill out Sections 5 through 7 if relevant, providing information about other health plans, Medicare, or COBRA enrollment where necessary.
10. Review all entries for accuracy and completeness. Once satisfied, you can save your changes, download, print, or share the form as needed.

Complete your CA C12914 form online today to ensure timely processing of your enrollment!