Employer Forms and Applications

Employer Forms and Applications

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


Master Group Application

Note: Microsoft Edge is not recommended for viewing or downloading these forms.

Effective 1/1/2023
English (Fillable) 1.3 MB
Spanish (Fillable) 697 KB
Chinese (Fillable) 863 KB
Vietnamese (Fillable) 815 KB
Persian (Fillable) 815 KB

 

Effective 1/1/2022
English (Fillable) 1.8 MB
Spanish (Fillable) 1.5 MB
Chinese (Fillable) 2.2 MB
Vietnamese (Fillable) 1.8 MB
Persian (Fillable) 1.6 MB

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
English (Fillable) 545 KB
Spanish (Fillable) 551 KB
Chinese (Fillable) 733 KB
Vietnamese (Fillable) 561 KB
Persian (Fillable) 691 KB

Effective 1/1/2022
English (Fillable) 948 KB
Spanish (Fillable) 972 KB
Chinese (Fillable) 691 KB
Vietnamese (Fillable) 1 MB
Persian (Fillable) 957 KB

Employee Change/Cancellation Transmittal
Submit a monthly summary of employee cancellations and/or changes.
Download
Employer Questionnaire Download  (Fillable)

 

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  • Producer Services (800) 559-5905

    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.