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 on the 1st of the month. Billing schedule is subject to change due to holidays and weekends.
2019 Medical Loss Ratio (MLR) Form - To be completed for 2020 group renewals
Submit the MLR Form, as required by the Affordable Care Act (ACA).
Employee 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.
Health 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.