Small business employee enrollment form blue shield of california 2025

1. Click ‘Get Form’ to open the small business employee enrollment form in the editor.
2. Begin by indicating the reason for your application in the designated section. Choose from options like 'New group enrollment' or 'Open enrollment' and fill in the relevant dates.
3. In Section 1a, select your preferred health plan from the list provided. Ensure you check one option that best suits your needs.
4. Proceed to Section 1b if applicable, where you can select any specialty benefits offered by your employer. Complete the attached Specialty Benefits Employee Benefit Selection Form if necessary.
5. Fill out Section 2 with subscriber information, including personal details such as name, Social Security number, and contact information.
6. Complete Sections 3 and 4 for HMO provider assignments and dependent information, ensuring all required fields are filled accurately.
7. Review all sections for completeness before signing at the end of the form to acknowledge that all information is correct.

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