Enrollment Request - HEALTH | DENTAL | VISION
Employer Participation & Adoption Agreement
New Health/Dental Division Request
COBRA - Health/Dental | BCBSAL - Handbook
COBRA - Health/Dental/Vision | BCBSAL - Application
HEALTH - Competitor AHP Plan - Benefit Summary Matrix 2024
HEALTH - Competitor AHP Plan - Benefit Summary Matrix 2025
HEALTH - Competitor AHP Plan - Summary of Benefits & Coverage (SBC) 2024
HEALTH - Competitor AHP Plan - Summary Plan Description (SPD)
HEALTH - Economy AHP Plan - Benefit Summary Matrix 2024
HEALTH - Economy AHP Plan - Summary of Benefits & Coverage (SBC) 2024
HEALTH - Economy AHP Plan - Summary Plan Description (SPD)
HEALTH - Value AHP Plan - Benefit Summary Matrix 2024
HEALTH - Value AHP Plan - Benefit Summary Matrix 2025
HEALTH - Value AHP Plan - Summary of Benefits & Coverage (SBC) 2024
HEALTH - Value AHP Plan - Summary Plan Description (SPD)
DENTAL - Benefit Summary Matrix 2023
DENTAL - Benefit Summary Matrix 2025
DENTAL - Summary Plan Description (SPD)
LIFE - Certificate Summary - $10,000 Benefit
LIFE - Certificate Summary - $25,000 Benefit
LIFE - Certificate Summary - $50,000 Benefit
LIFE - Certificate Summary - $100,000 Benefit
LIFE - Evidence of Insurability Form
LIFE - Conversion Coverage Form
VISION - Vision Blue Plan - Benefit Summary Matrix
ACA - Reporting Requirements of ALEs Offering Fully-Insured Health Coverage
ACA - Reporting Requirements of Non-ALEs Offering Fully-Insured Health Coverage
ACA - HCR 1095 Covered Individuals Report Request
ACA - AAASEBF Member Companies Compliance Information
ACA - Sample Cover Letter for DOL Model Exchange Notice
ACA - FLSA Model Notice - For employers that offer a health plan to some or all employees
ACA - FLSA Technical Release 2013-02 - Including both notices for employers with & without plans
BCBSAL - ARPA - COBRA Subsidy Form for Group # 58920 Value health plan Employers (excel file)
BCBSAL - ARPA - COBRA Subsidy Form for Group # 58920 Value health plan Employers (pdf file)
BCBSAL - ARPA - COBRA Subsidy Form for Group # 97720 Competitor health plan Employers (excel file)
BCBSAL - ARPA - COBRA Subsidy Form for Group # 97720 Competitor health plan Employers (pdf file)
BCBSAL - ARPA - COBRA Subsidy Form for Group # 97782 Economy health plan Employers (excel file)
BCBSAL - ARPA - COBRA Subsidy Form for Group #97782 Economy health plan Employers (pdf file)
BCBSAL - Get the Most Out of Your Blue Cross Plan
BCBSAL - Identity Protection Services
BCBSAL Form - Medical Expense Claim
BCBSAL Form - Preadmission Certification
BCBSAL Form - Precertification For Outpatient MRI
BCBSAL Form - Prescription Drug Claim
BCBSAL Form - Prescription Drug Mail-Order
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