Small Business Library

Small Business Library

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Documents Library

Note: to download a form, go to "Print", select "Save as PDF," and click "Save".

Current forms and applications, January 1, 2024 to March 31, 2024:
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
Refusal of Coverage 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
Bundled Savings
COBRA and Cal-COBRA Continuation of Coverage
Cal-COBRA Employer Notification of Qualifying Events
Cal-COBRA Takeover
Changes To (2024)  HMO Mirror  |  HMO Off-Exchange  |  PPO Mirror  |  PPO Off-Exchange  |  PPO Savings Off-Exchange  |  Specialty
Changes To (2023)  HMO Mirror  |  HMO Off-Exchange  |  PPO Mirror  |  PPO Off-Exchange  |  PPO Savings Off-Exchange
Changes To medical plan names 2024 | 2023  
CMS Reporting
Conversion to Individual Coverage of Group Life
CVS Mail Order Form
Declaration of Disability of Over Age-Dependent Children
Dental Claim
Dental Implant Benefits
Dental PPO Mapping Document
Direct Elite Rewards
Dismemberment Claim
EFT Banking Changes
Employee Cancellation Notification 
EPIC Hearing Aid
Find A Doctor  English  |  Spanish
Find dental and vision providers of your choice
HIPPA Authorization for Release of Personal and Health Information Form (fillable)
HMO Network Comparison
Identity Theft Protection Services  English  |  Spanish
International Claim Form
Key contacts and estimated times
LifeReferrals 24/7
Mail service prescriptions  
Managing your dental plan online
Managing your vision plan online
Member Guide to Orthodontic Coverage  English  |  Spanish
New Group Submission Checklist
Notice Informing Individual about Nondiscrimination and Accessibility Requirements
Notification of CMS Reporting Requirements
NurseHelp 24/7  English  |  Spanish
Online and Mobile Tools  English  |  Spanish
Owner Eligibility Statement
Pediatric dental and vision FAQs
Pharmacy Reimbursement Form  English  |  Spanish
Plan Cheat Sheet 2024 |  2023  
Plans at a Glance 2024 |  2023  
Premium Only Plan (POP) by HealthEquity
Preventive Health Guidelines  English  |  Spanish 
Print or Order ID Card  English  |  Spanish
Privacy Policy 
Proof of Death
Quick Match Program
Recertification Guidelines
Relaxed Participation
Renewal Guide for Small Group
Sales Guide - Medical Q1 2024 | Q4 2023 | Q3 2023 | Q2 2023  
Sales Guide - Specialty Q1 2024 | Q4 2023 | Q3 2023 | Q2 2023 
Shield Concierge
Small Business Administrator's Guide  2023  |  2022
Small Business service support
Small Group Incentive Program
Small Group Bonus Programs
Small Group Initial Payment Form
Small Group Cancellation Form
Small Group Broker of Record Change
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
Tandem PPO Flyer
Trio HMO Flyer
Teladoc 2024  English  |  Spanish
Teladoc 2023  English  |  Spanish
Tiered Pharmacy Network 
Tivity Health Fitness Your Way  English  |  Spanish
Trio HMO vs Access+
Trio Network Brochure
Trio Qualification Tool
Total Health and Wellness  English  |  Spanish
Underwriting Guidelines 2024 | 2023  
Vaccine List  English  |  Spanish
Value-Based Benefits Plan brochure
Vision Claim
Vision Plan Info Card for CA Members  English  |  Spanish
Wellness Discounts
Wellvolution
Wellvolution Ginger
Wellvolution Headspace
What's New Q1 2024 | Q4 2023 | Q3 2023 | Q2 2023 
Why Blue Shield Fast Facts
Why Blue Shield Small Business
 

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