Forms

Enrollment forms

Find standard enrollment forms for medical, dental, vision, and life plans across all group sizes, including Cal-COBRA, COBRA, and prescription coverage.

Member additions, changes, and cancellation forms

Access forms for subscriber changes and terminations, employer notifications of qualifying events, continuity of care and disability. As well as conversion and declaration forms.

Member claims forms

For the simplest claims management experience encourage members to log into blueshielca.com. For analog form needs see medical, dental, vision, and life forms for all group sizes.

© California Physicians' Service DBA Blue Shield of California 1999-2024. All rights reserved. California Physicians’ Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California.

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