The following transaction types cannot be submitted through Blue Shield’s Benefits Management Tool. Please download the appropriate form (below) and submit it to Blue Shield as indicated:
Enrolling employees who are younger than 16 years of age or 70 years and older
To enroll an employee who is younger than 16 years of age or 70 years and older, please complete this Employee Application (Form C12914) and submit it via email or fax.
Employee or dependent enrollment outside of 90-day retroactive period
To enroll an employee or dependent outside the 90-day retroactive period, please complete this Employee Application (Form C12914) and submit it via email or fax.
Cal-COBRA (California Continuation Benefits Replacement Act) must be managed outside of Blue Shield Benefits Management. When a covered employee has an event that qualifies them for coverage under Cal-COBRA, please complete this Employer Notification of Qualifying Events Under Cal-COBRA (Form C13140) and submit to Blue Shield for approval via email.
Urgent same-day access-to-care enrollment request
For urgent requests, complete the following steps:
Within four hours, Blue Shield will email the requestor a confirmation that the enrollment is complete. Once this email is received, the doctor's office can contact Blue Shield for verification. The confirmation email will contain the subscriber’s ID number, which can be used as proof of coverage.
Off-cycle specialty benefits adds/buy-up
To submit a specialty benefits buy-up (plan add) outside your open enrollment period, please complete this Request for Contract Change Form (C15782) and submit it via email or fax.
Away From Home Care for HMO members
To manage coverage under the Away From Home Care® program, please call the Away From Home Care team at (800) 622-9402.