see all offices

RBG, MIAMI - FORMS
FLORIDA BLUE RELEASED DOWNLOAD
Employer Enrollment
*Renewal Only* Grandfathered Plan ER Cert Form

Description:
Renewals Only (pdf , 114k)

8/30/2013   Download
*Renewal Only* SG ER Amendment Form

Description:
Employer Amendment Form - Renewals Only (pdf , 52k)

5/5/2014   Download
SG Employer Eligibility Form

Description:
Form to determine product size (pdf , 54k)

5/5/2014   Download
Administration
Benefit Admin Authorization Form (70265-1010)

Description:
Form req for Blue Biz, Blues enroll and View and Pay Invoice (pdf , 221k)

5/5/2014   Download
Claims
HIPPA Authorization Form
8/30/2013   Download
Medical Claim Form
8/30/2013   Download