Get Ar Bcbs Group Employee Application 2019-2025

This guide provides a step-by-step approach to completing the AR BCBS Group Employee Application online. Whether you are a new employee or an existing staff member, this instruction set is designed to help you navigate each section of the application with clarity and ease.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by providing your employer's name and tax ID at the top of the application. Ensure you check the appropriate boxes for the type of coverage desired: Arkansas Blue Cross and Blue Shield, Health Advantage, Dental, or any relevant group numbers.
3. Indicate whether you are a current, active employee. If yes, enter the date of full-time employment. If no, provide your retirement date or COBRA effective date, along with any reasons for COBRA. If you are waiving all coverage, complete Sections 2, 6, and 9 only.
4. In Section 1, check all applicable boxes that reflect your policy eligibility, providing dates for qualifying life events as necessary. Attach any related documentation to confirm qualifying life events if the application is submitted outside of the open enrollment period.
5. Complete Section 2 with information on all members to be covered or waived. Indicate if each dependent is a natural, step, or adopted child. Provide their first name, last name, social security number, and dates of birth.
6. Specify coverage desired for medical, dental, and vision by indicating options such as employee, employee plus spouse, or family.
7. In Section 3, state your marital status by selecting from the options provided: single, married, or divorced/widowed.
8. Fill out Section 4 with your contact information, including address, primary and work phone numbers, and email.
9. Section 5 requires information about your employment status. Include your job title, weekly hours worked, and hourly vs. salary designation.
10. Complete Section 6 if you are declining coverage. Indicate which family members are declining and provide reasons for coverage decline.
11. In Section 7, fill out details regarding any current or previous insurance coverage. Provide the necessary information for all covered family members.
12. Section 8 is for life insurance if applicable. Designate beneficiaries and provide their details.
13. Finally, review Section 9. Ensure all information is accurate and sign the document. Include your name, signature, and date, alongside the employer or group representative if required.
14. After completing the form, you can save changes, download a copy, print it out, or share it as needed.

Complete your application online today for a smooth enrollment process!