Blue cross blue shield cancellation form 2025

1. Click ‘Get Form’ to open the Blue Cross Blue Shield cancellation form in the editor.
2. Begin by entering the 'Group Name' and 'Group Number' at the top of the form. This identifies your organization.
3. For each employee whose coverage is being canceled, fill in their 'Contract Number', 'Employee’s Name', 'Employee’s Address', and 'Last Date of Employment'. Ensure accuracy to avoid processing delays.
4. Review the statements regarding premium payments and expectations of coverage. Confirm that these conditions are met before proceeding.
5. Have an authorized representative sign the form in the designated area, ensuring compliance with all legal requirements.
6. Finally, submit the completed form by faxing it to (225) 298-2988 or mailing it to the provided address for Blue Cross and Blue Shield of Louisiana.

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