Small Business library

Documents library

Current forms and applications, July 1, 2024 to September 30, 2024

Employee application English (PDF, 1.5 MB), Spanish (PDF, 1.6 MB)

Enrollment spreadsheet with Master Group agreement Download (1.2 MB)

Group Change Request English (PDF, 724 KB), Spanish (PDF, 637 KB)

Master Group application English (PDF, 640 KB), Spanish (PDF, 640 KB)

Subscriber Change Request English (PDF, 1.3 MB), Spanish (PDF, 1.4 MB)

Refusal of Coverage English (PDF, 764 KB), Spanish (PDF, 881 KB)

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

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 MirrorPPO Off-Exchange | PPO Savings Off-Exchange | Specialty

Changes to (2023) HMO Mirror | HMO Off-Exchange | PPO MirrorPPO Off-Exchange | PPO Savings Off-Exchange

Changes to medical plan names 2024 | 2023

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

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

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

Sales guide – Medical Q3 2024Q2 2024 | Q1 2024 | Q4 2023

Sales guide – Specialty Q3 2024Q2 2024 | Q1 2024 | Q4 2023

Shield Concierge

Small Business administrator's guide 2024 | 2023

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 - EyeMed: Accessing Your Vision Network

Vision Plan info card for CA members English | Spanish

Wellness discounts


Wellvolution Ginger

Wellvolution Headspace

Employer, what's new Q1 2024 | Q4 2023 | Q3 2023 | Q2 2023

Why Blue Shield fast facts

Why Blue Shield Small Business

© California Physicians' Service DBA Blue Shield of California 1999-2024. All rights reserved. California Physicians’ Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California.