Pacific Blue Cross

Tools

Hot Topics for Plan Administrators

Key Points to completing the Enrollment Form

BBD Online Information

Group Insurance Contribution Report

Pacific Blue Cross - CaresNet

Administration Forms

Group Insurance Enrollment (Fillable) Original signature required at BBD offices.

Employee Report Form

Change of Name

Beneficiary Designation (Fillable) Original signature required at BBD offices.

Dependent Status Change (Fillable)

Partial Waiver (Fillable)

Reinstatement of Waived Benefits (Fillable)

Claim Forms

Disability Claim Forms:

Pacific Blue Cross - Short Term Disability Claim Form

Health and Dental Claim Form:

Pacific Blue Cross - Extended Health Care Claim Form

Pacific Blue Cross - Dental Claim Form

Payment Options

Pre-Authorized Payment Plan Form