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hi everyone now were going to show you how to complete the blue cross blue shield health insurance enrollment form the form is highlighted with the required fields that need your completion beginning with the epo pcp selection which is your plan that you are selecting of the four plans we offer so youre going to check off one of these boxes either platinum gold gold cdhp or silver cdhp the next fields are your demographic information last name first name mailing address including city state and zip code your phone number your email address which could be your bsd or a personal email if you choose your date of birth gender marital status and social security number you will also need to include a pcp which is your primary care providers name you do not need to fill in the npi number if you dont know what it is you can simply put the providers name and check off whether or not you are a current patient the next field is your health coverage type which simply is if you are choosing si