Most-Used Employer Forms

If you can't find the form you need, contact a member of your Blue Team.

Complete bank information and attach a copy of a cancelled or voided check to verify account and routing/transit numbers. Payment withdrawals from your bank account will be completed the fourth business day after billing date.
 
Submit the information to receive monthly Group Communications Materials for your company. All fields are required in order to be able to process your request.
 
PDF Icon2014 Medical Loss Ratio (MLR) Form - To be completed for 2015 group renewals
Submit the MLR Form, as required by the Affordable Care Act (ACA).
 
PDF IconEmployee Change Form - Submit this form whenever you have an employee to cancel from coverage, change in an employee's address or an update to an employee's name.
 
PDF IconHealth Affiliation and OOA Waiver - If you offer a health plan that requires the selection of a specific network, this form can be used to indicate that specific network. This form can be used after initial enrollment to change the network choice at renewal, or one other time throughout the year. This form can also be used to put a waiver on a covered family member who may reside outside the network service area.
 
PDF IconWaiver of Health Coverage - Use this form to confirm that you offered your employee health coverage and that the employee waived coverage for a specific reason. This is a good form to keep in your files so you have proof coverage was offered when the employee was first eligible for benefits.
 

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