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Forms and Resources for Employers

Forms & Resources for Employers

Group Quote Tools:

How to Obtain a More Accurate Quote for Size 2-99 Groups [PDF]
Request for Proposal [PDF]
Census [PDF]
Employee and Family Medical Questionnaire [PDF] Español [PDF]
Sales Compensation Information [PDF]
Satisfaction Survey Results [PDF]
Benefit Summaries and Benefit Comparisons

New Group Enrollment Tools:

New Group Checklist [PDF]
Employer Application (2-99 employees) [PDF]
Group Certification Document [PDF]
Sole Proprietor, Partner, or Corporate Officer Statement [PDF]
Common Ownership Form [PDF]
Employee Application [PDF]
Employee and Family Medical Questionnaire [PDF] Español [PDF]
Welcome Guide for New Members [PDF]
Domestic Partner Affidavit [PDF]
Benefit Summaries and Benefit Comparisons

Existing Group Tools:

Medical Claim Form [PDF]
Employer Application (2-99 employees) [PDF]
MSP Certification Document [PDF]
Employee Application [PDF]
Welcome Guide for New Members [PDF]
2010 Benefit Changes for 2-99 Groups
- BluePreferred No Copay [PDF]
- BluePreferred No Copay 100% [PDF]
- BluePreferred Copay [PDF]
- BluePreferred Copay 100% [PDF]
- BluePreferred Basic [PDF]
- BluePreferred Saver 100% [PDF]
- BluePreferred Saver 80% [PDF]
- BlueEssential [PDF]
- BlueSelect [PDF]
- BlueSolutions [PDF]
HealthyBlue Resources
Learn more about BCBSAZ health and wellness programs.
- HealthyBlue Brochure [PDF]
- HealthyBlue Presentation [PDF]
- Sample Report: groups of 100 contracts or more [PDF]
- Sample Report: groups of 2-99 contracts [PDF]

Privacy:

HIPAA Notice of Privacy Practices [PDF]

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