Small Business Library

Broker Resources

Documents Library

Forms and applications for the current quarter (January 1 - March 31, 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 Flier
BlueCard Worldwide International Claim
Book of Business Transfer Request
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
COBRA Employee Application
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
Preventive Health Guidelines English \| Spanish
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
Sales Guide Q1 2022 \| Q4 2021 \| Q3 2021 \| Q2 2021
Shield Concierge
Small Business Administrator's Guide 2022 \| 2021
Small Business service support
Small Group Incentive Program
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
Specialty Sales Guide Q1 2022 \| Q3 2021 \| Q2 2021
Standard Drug Formulary
Start-up / Spin-off Eligibility Attestation
Subscriber Statement of Claim
Subscriber Statement of Claim - Life
Summary of Benefit FAQ
Tandem PPO vs. Full PPO
Teladoc 2021 English \| Spanish
Teladoc 2020 English
Tiered Pharmacy Network
Tivity Health Fitness Your Way English \| Spanish
Trio HMO Flier
Trio Network Brochure
Trio Qualification Tool
Total Health and Wellness English \| Spanish (coming soon)
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 Q1 2022 \| Q4 2021 \| Q3 2021 \| Q2 2021
Why Blue Shield English \| Spanish
Why Blue Shield Small Business
Why choose Tandem PPO
Why choose Trio HMO
Women's Preventive Health