Small Business Library

Small Business Library

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Documents Library

Current forms and applications, January 1 to June 30, 2022:
Employee Application  English  |  Spanish
Enrollment Spreadsheet with Master Group Agreement  Download
Group Change Request  English  |  Spanish
Master Group Application  English  |  Spanish
Subscriber Change Request  English  |  Spanish
Forms and applications from previous quarters. 
Other useful documents from across the small business Broker Connection pages, organized from A to Z.
Accelerated Death Benefit Claim
Additional Contact Designation: Notice of Lapse or Term of Policy for Non-Payment
American Specialty Health (ASH) – Subscriber Claim Form
Authorization to Disclose Health Information
Away From Home Care (HMO Only)
Beneficiary Affidavit
Beneficiary Change Request
BlueCard Brochure
BlueCard Worldwide International Claim
Book of Business Transfer Request
Broker Bonus Calculator
Broker Renewal Guide
Bundled Savings
Cal-COBRA Continuation of Coverage
Cal-COBRA Dental Election
Cal-COBRA Election
Cal-COBRA Notice of Qualifying Event
Caries Risk Management Assessment
Changes To (2022)  HMO Mirror  |  HMO Off-Exchange  |  PPO Mirror  |  PPO Off-Exchange  |  PPO Savings Off-Exchange  |  Specialty
Changes To (2021)  HMO Mirror  |  HMO Off-Exchange  |  PPO Mirror  |  PPO Off-Exchange  |  PPO Savings Off-Exchange  |  Specialty
Changes To medical plan names  2022  |  2021
CMS Reporting
Continuing Group Coverage after Federal COBRA Cal-COBRA Election
Conversion to Individual Coverage of Group Life
CVS Mail Order Form
Declaration of Disability of Over Age-Dependent Children  |  Fillable Form
Dental Claim
Dental Implant Benefits
Dental Network Map
Dental plans - competitive highlights
Direct Elite Rewards
Dismemberment Claim
EFT Banking Changes
Employee Cancellation Notification 
Employee Change/ Cancellation Transmittal
EPIC Hearing Aid
Find A Doctor  English  |  Spanish
Find dental and vision providers of your choice
HMO Network Comparison
Identity Theft Protection Services 2021  English  |  Spanish
Key contacts and estimated processing times
LifeReferrals 24/7
Mail service prescriptions     PDF Version
Managing your dental plan online
Managing your vision plan online
Member Guide to Orthodontic Coverage  English  |  Spanish
Notice Informing Individual about Nondiscrimination and Accessibility Requirements
Notification of CMS Reporting Requirements
NurseHelp 24/7  English  |  Spanish
Online and Mobile Tools  English  |  Spanish
Open Enrollment PowerPoint Presentation
Owner Eligibility Statement
Pediatric dental and vision coverage
Pediatric dental and vision FAQs
Pharmacy Reimbursement Form  English  |  Spanish
Plan Cheat Sheet  2022  |  2021
Plans at a Glance  2022  |  2021
Premium Only Plan (POP) by HealthEquity
Preventive Health Guidelines  English  |  Spanish 
Print or Order ID Card  English  | Spanish
Privacy Policy  English  | Spanish
Proof of Death
Quick Match ProgramSM 
Recertification Guidelines
Refusal of Coverage
Relaxed Participation
Sales Guide - Medical  Q3 2022  |  Q2 2022 |  Q1 2022  |  Q4 2021
Sales Guide - Specialty  Q3 2022  |  Q2 2022  |  Q1 2022  |  Q3 2021
Shield Concierge
Small Business Administrator's Guide  2022  |  2021
Small Business service support
Small Group Incentive Program
Small Group Bonus Programs
Small Group Initial Payment Form
Small Group Producer of Record Change Request
Sole Proprietor, Partner of Corporate Office Statement
Specialty Drug List for Standard Drug Formulary
Standard Drug Formulary
Start-up / Spin-off Eligibility Attestation
Subscriber Statement of Claim
Subscriber Statement of Claim - Life
Summary of Benefit FAQ
Tandem PPO Flyer
Tandem PPO vs. Full PPO
Teladoc 2022  English  |  Spanish
Tiered Pharmacy Network 
Tivity Health Fitness Your Way  English  |  Spanish
Trio HMO Flyer
Trio Network Brochure
Trio Qualification Tool
Total Health and Wellness  English  |  Spanish
Underwriting Guidelines  2022  |  2021
Vaccine List  English  |  Spanish
VBB Plan Benefits at a Glance
Vision Claim
Vision Network at a Glance
Vision Plan Info Card for CA Members  English  |  Spanish
Vision Plan Info Card for Out-Of-State Members
Waiver of Premium Claim
Wellness Discounts
Wellvolution
What's New  Q3 2022  |  Q2 2022  |  Q1 2022  |  Q4 2021
Why Blue Shield  English  |  Spanish
Why Blue Shield Small Business
Why choose Tandem PPO
Why choose Trio HMO
Women's Preventive Health
 

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