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]
• 2008 Benefit Changes for Groups of 2-99 Contracts
  • BluePreferred [PDF]
  • BluePreferred Copay [PDF]
  • BluePreferred Saver [PDF]
  • BlueSelect [PDF]
• 2009 Benefit Changes for Groups of 2-99 Contracts
  • BluePreferred [PDF]
  • BluePreferred 100% [PDF]
  • BluePreferred Copay [PDF]
  • BluePreferred Copay $5000/100% [PDF]
  • BluePreferred Basic [PDF]
  • BluePreferred Saver [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]