Forms

• 2023 Employer Health Insurance Product Guide Groups Size 2 to 50

• April 2023 Employer Health Insurance Product Guide Groups Size 51 or More

• April 2023 Employer Health Insurance Product Guide Balanced Funding

• January 2023 Employer Health Insurance Product Guide Groups Size 51 or More

• January 2023 Employer Health Insurance Product Guide Balanced Funding

• 2022 Employer Health Insurance Product Guide Groups Size 1 to 50

• April 2022 Employer Health Insurance Product Guide Groups Size 51 or more

• April 2022 Employer Health Insurance Product Guide Balanced Funding

• January 2022 Employer Health Insurance Product Guide Groups Size 51 or more

• January 2022 Employer Health Insurance Product Guide Balanced Funding

• Census for Groups Size 2 Plus

• 2023 Enrollment Census for 1 to 50

• 2023 Enrollment Census for 51 to 99

• 2023 Enrollment Census for Balanced Funding

• 2022 Enrollment Census for 1 to 50

• 2022 Enrollment Census for 51 to 99

• 2022 Enrollment Census Balanced Funding

• ACH Payment Form

• New Group Checklist

• Sole Proprietor Partner or Corporate Officer Statement

• Common Ownership Form

• New Member Benefit Access Overview

• Domestic Partner Affidavit

• Employer Application

• Employee Application

• Employee Application Spanish

• Group Certification Document

• Medical Claim Form

• Dental Claim Form

• BlueDental Prevention Plus1 Submission Form

• COBRA Application

• Employer Application

• Employee Application

• Employee Application Spanish

• Instructional PDF for Machine Readable Files

• BCBSAZ Machine Readable Files

• American Specialty Health Machine Readable Files

• Davis Vision Machine Readable Files

• Mental Health Parity Disclosure Request Form

• Your Rights and Protections Against Surprise Medical Bills

• Your Rights and Protections Against Surprise Medical Bills in Spanish

• Notice of Privacy Practices