Florida blue employee enrollment application 2026

1. Click ‘Get Form’ to open the Florida Blue Employee Enrollment Application in our platform.
2. Begin with Section A: Current Information. Fill in your Group Name, Division #, Group #, Effective Date of Coverage, Date of Hire, Location #, Employee #, Package #, Job Title, and Work Status. Ensure all details are accurate for proper processing.
3. Move to Section B: Employee Information. Enter your Social Security Number, Last Name, First Name, Street Address, M.I., Birth Date, City, County, Phone Number, Physician Name/ID (if applicable), Sex, State and Zip Code. Select your Marital Status and provide any optional information regarding Existing Patient status and Language of Preference.
4. In Section C: Health Coverage Level and Plan Information, choose your desired health coverage level and plan options. If you are refusing coverage at this time, indicate that clearly.
5. Proceed to Section D: Vision Coverage Level and Plan Information. Similar to health coverage selection, choose your vision coverage level or refuse it if necessary.
6. Complete Section E: Dependent Information by listing all dependents accurately. Attach a separate sheet if needed.
7. Fill out Section F: Other Health Insurance Information if applicable. This is crucial for claims processing.
8. Finally, review and sign the application in Section G: Acceptance of Coverage to confirm your understanding of the terms before submitting.

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