Forms and Resources
- 2025 Employer Health Insurance Product Guide Group Size 2 to 50January 2025 Employer Health Insurance Product Guide Groups Size 51 or MoreJanuary 2025 Employer Health Insurance Product Guide Balanced Funding2024 Employer Health Insurance Product Guide Groups Size 2 to 50April 2024 Employer Health Insurance Product Guide Groups Size 51 or MoreApril 2024 Employer Health Insurance Product Guide Balanced FundingJanuary 2024 Employer Health Insurance Product Guide Groups Size 51 or MoreJanuary 2024 Employer Health Insurance Product Guide Balanced Funding2023 Employer Health Insurance Product Guide Groups Size 2 to 50Census for Groups Size 2 Plus
- 2025 Enrollment CensusACH Payment FormNew Group ChecklistSole Proprietor Partner or Corporate Officer StatementCommon Ownership FormNew Member Benefit Access OverviewDomestic Partner AffidavitEmployer ApplicationEmployee ApplicationEmployee Application SpanishGroup Certification Document
- Medical Claim FormDental Claim FormBlueDental Prevention Plus1 Submission FormCOBRA ApplicationEmployer ApplicationEmployee ApplicationEmployee Application Spanish
- Instructional PDF for Machine Readable Files
- Mental Health Parity Disclosure Request Form
- Your Rights and Protections Against Surprise Medical BillsYour Rights and Protections Against Surprise Medical Bills in Spanish
- Notice of Privacy Practices
- How to Get Care or Prescriptions Without Your ID CardExpanded Customer Service Hours