Small Business Library

Broker Resources

Documents Library

Forms and applications for the current quarter (July 1, 2020 - September 30, 2020):
Employee Application English \| Spanish
Enrollment Spreadsheet with Master Group Agreement coming soon
Master Group Agreement English \| Spanish
Request for Contract Change English \| Spanish
Subscriber Change Request English \| Spanish
Forms and applications from previous quarters can be found here.

Other useful documents from across the small business Broker Connection pages, organized from A to Z.
Accelerated Death Benefit Claim
Access to Care English \| Spanish
Additional Contact Designation: Notice of Lapse or Term of Policy for Non-Payment
Authorization to Disclose Health Information
Beneficiary Affidavit
Beneficiary Change Request
BlueCard Flier
BlueCard Worldwide International Claim
Book of Business Transfer Request
Broker Direct Deposit Authorization Form
Broker Open Enrollment Presentation
Bundled Savings
Cal-COBRA Continuation of Coverage
Cal-COBRA Dental Election
Cal-COBRA Election
Cal-COBRA Notice of Qualifying Event
Call the Car (Trio HMO members only)
Caries Risk Management Assessment
Changes To (2020) HMO Mirror \| HMO Off-Exchange \| PPO Mirror \| PPO Off-Exchange \| PPO Savings Off-Exchange
Changes To (2019) HMO Mirror \| HMO Off-Exchange \| PPO Mirror \| PPO Off-Exchange \| PPO Savings Off-Exchange
Changes To medical plan names 2020 \| 2019
CMS Reporting
COBRA Employee Application
Continuing Group Coverage after Federal COBRA Cal-COBRA Election
Conversion to Individual Coverage of Group Life
CVS Caremark RX Mail Order
Declaration of Disability of Over Age Dependent Children \| Fillable Form
Dental brochure for brokers 2020 \| 2019
Dental Claim
Dental Network Map
Dental Nomination Form
Dental plans - competitive highlights
Dental Smile Rollover Rewards
Direct Elite Rewards
Dismemberment Claim
Eligibility/Participation Attestation
Employee Change/ Cancellation Transmittal
EPIC Hearing Aid
Express Enrollment
Find A Doctor
Group information update
Group name change protocol
Heal
HMO Network Comparison Guide (Updated March 2020)
Identity Theft Protection Services English \| Spanish (coming soon)
Life Insurance Brochure for Brokers 2020 \| 2019
Mail Service Prescriptions English \| Spanish
Managing your dental plan online
Managing your vision plan online
Medical Incentive Bonus Program
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
Owner Eligibility Attestation
Online and Mobile Tools English \| Spanish
Pediatric Dental and Vision Coverage
Pharmacy Reimbursement
Plan Cheat Sheet 2020 \| 2019
Plans at a Glance 2020 \| 2019
Premium Only Plan (POP)
Preventive Health Guidelines English \| Spanish (coming soon)
Print or Order ID Card English \| Spanish
Privacy Policy English \| Spanish
Proof of Death
Quick Match Program^SM
Recertification Guidelines
Refusal of Coverage
Relaxed Participation
Request for COC Notice - HMO Enrollees
Request for COC Service - Members or New Enrollees
Sales Guide Q2 2020 \| Q1 2020 \| Q4 2019 \| Q3 2019
Shield Concierge
Small Business Administrator's Guide 2020 \| 2019
Small Business Tiered Pharmacy Network CA Level A Pharmacy Directory
Small Group Initial Payment Form
Small Business Online Roadshow Presentation \| Recording \| Questions Answered
Small Group Producer of Record Change Request
Sole Proprietor, Partner of Corporate Office Statement
Specialty Drug List for Standard Drug Formulary
Specialty Quick Facts
Standard Drug Formulary
Start-up / Spin-off Eligibility Attestation
Subscriber Statement of Claim
Subscriber Statement of Claim - Life
Summary of Benefit FAQ
Teladoc 2020 English \| Spanish
Teladoc 2019 English
Tiered Pharmacy Network
Tivity Health Fitness Your Way English \| Spanish
Trio Flier
Trio Qualification Tool
Total Health and Wellness English \| Spanish
Underwriting Guidelines 2020 \| 2019
Vaccine List
Vision Brochure 2020 \| 2019
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 2020 \| Q2 2020 \| Q1 2020 \| Q4 2019
Why Blue Shield English \| Spanish
Why Blue Shield Small Business
Why choose Tandem PPO
Why choose Trio HMO
Women's Preventive Health