Fillable PDFs can be saved to your desktop. However, applicants using Acrobat Reader, rather than Acrobat Standard or Pro, will only be able to print the information after it's filled out, not save. If using Standard or Pro, If using Standard or Pro, the filled out information can be saved. If you do not have Adobe Reader or are not able to access these fillable features, download the latest version.
| Form | Download |
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Note: Microsoft Edge is not recommended for viewing or downloading these forms. |
Effective 1/1/2023
Effective 1/1/2022 |
| Welcome letter and checklist Use this customizable employer welcome letter and checklist to help simplify the enrollment process. |
Download (Fillable) |
| Subscriber Change Request Employees can change personal information, change plans during open enrollment, enroll new dependents or cancel dependents (include Refusal or Cancellation of Personal Coverage form). |
Effective 1/1/2023 Effective 1/1/2022 |
| Employee Change/Cancellation Transmittal Submit a monthly summary of employee cancellations and/or changes. |
Download |
| Employer Questionnaire | Download (Fillable) |
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Employer Services (800) 325-5166
Blue Shield of California
PO Box 272540
Chico, CA 95927-2540
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Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California.