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  • Excellus B-274 2003

Get Excellus B-274 2003-2025

DO NOT USE - MICROFILM USE ONLY 165 Court Street Rochester, New York 14647 An Independent Licensee of the BlueCross BlueShield Association TEFRA / DEFRA Election Form Group Name Group Number Group.

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How to fill out the Excellus B-274 online

Filling out the Excellus B-274 form online is an essential step for individuals electing to enroll in the Employer Group Plan as primary coverage for those over 65. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the Excellus B-274 form online.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. In the 'Group Name' field, enter the name of the employer group associated with the plan.
  3. Fill out the 'Date' field with the current date when you are completing the form.
  4. In the 'Group Number' field, provide the unique identification number for the employer group.
  5. Enter the 'Group Telephone Number' for any associated inquiries.
  6. Have the 'Group Representative' sign the form and include the date of their signature.
  7. For the section pertaining to the over 65 active employee or spouse, locate the 'Subscriber #' field and input the corresponding subscriber number.
  8. Fill in the 'Employee Name' using the full name of the active employee.
  9. In the 'Medicare Health Insurance Claim ID #' field, input the claim ID in the format provided.
  10. Complete the effective dates for Medicare Part A and Part B as applicable for the employee.
  11. If not eligible for Medicare Part A or B, provide required reasons in the designated fields.
  12. Repeat steps 7 to 11 for the spouse’s information, if applicable.
  13. Once all fields are filled out completely and accurately, review the information you provided.
  14. Save changes, download the completed form, print it, or share it as required.

Complete your documents online today to ensure you have the necessary coverage.

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In New York, BlueCross BlueShield is known as Excellus BlueCross BlueShield. This brand ensures that residents have access to a range of health insurance options. The Excellus B-274 plan is one example of how they cater to diverse healthcare needs, making it important for New Yorkers to know this distinction.

Another common name for Blue Cross Blue Shield is simply 'BCBS.' This acronym encompasses the collective offerings of various regional health insurance companies. Excellus B-274 is specifically linked to the Excellus name, which represents the commitment to providing quality healthcare solutions in New York.

For members of Excellus BCBS, the timely filing limit for an appeal is generally 120 days from the date of service. It is essential to adhere to this timeline to ensure your appeal is considered. By understanding the rules around your Excellus B-274 plan, you can navigate the process effectively and avoid unnecessary delays.

Excellus health Plan is owned by Excellus BlueCross BlueShield, a not-for-profit health insurance company based in New York. As part of the BlueCross BlueShield Association, it serves many members throughout the state. With a focus on delivering quality healthcare services, they ensure members have access to comprehensive health plans, including the popular Excellus B-274.

BCBS HMO insurance is a type of health plan that typically requires members to use a network of doctors and hospitals for care. Under this model, patients usually need a referral from their primary care physician for specialty services. Excellus B-274 falls into this category, allowing for coordinated care and often lower out-of-pocket costs.

To determine if your BCBS plan is PPO or HMO, check your insurance documentation or member card. Most documents clearly state the plan type. Additionally, you can directly contact customer support for clarification. If you've chosen Excellus B-274, it likely falls into a specific category, which means you’ll have clear guidelines on how to access your care.

Excellus HMO Blue Option is a health insurance plan designed for members who prefer an HMO structure. This plan offers a network of doctors and specialists, requiring referrals for specialized care. Choosing Excellus B-274 means accessing a comprehensive range of services under one cohesive plan, ensuring focused and consistent medical attention.

Blue Cross Blue Shield is a federation of independent companies. These companies operate under separate licenses, but they share a common brand. Excellus BlueCross BlueShield is one of those independent companies, serving customers in New York. Hence, when discussing options like Excellus B-274, it's important to know the specific company behind your insurance.

To submit claims to Excellus, you'll need to complete a claim form, which you can find on the Excellus BCBS website. Ensure you gather all necessary documentation, such as medical bills and service descriptions. After filling out the form, submit it along with your documents to the address provided on the form. By following these steps, you can ensure that your claims are processed efficiently.

Yes, Excellus is a regional branch of Blue Cross Blue Shield. While both offer similar health insurance services under the BCBS umbrella, Excellus focuses primarily on the upstate New York market. This regional specificity means that certain coverage options and provider networks may differ. Understanding these distinctions can help you choose the right plan.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232