2020 BCBSLA Form
Print
Modified on: Mon, Jul 6, 2020 at 4:48 PM
|
|
In this message:
Group Forms Updates
The following Blue Cross and Blue Shield of Louisiana and HMO Louisiana, Inc. group forms have recently been updated and are posted on AccessBlue, Forms Online.
Please begin using these revised forms immediately. The previous versions of these forms have been removed from Forms Online and will not be accepted after July 14, 2020.
Employee Enrollment/Change Form
2020 Employee Enrollment/Change Form [01MK5336 R06/20]
2020 Employee Enrollment/Change Form (fillable) [01MK5336 R06/20]
2020 Employee Enrollment/Change Form (Spanish) [01MK5336 R06/20]
Group Member Enrollment Guide
2020 Group Member Enrollment Guide [01MK5510 R06/20]
2020 Group Member Enrollment Guide (Spanish) [01MK5510 R06/20]
Coverage Cancellation Form
2020 Coverage Cancellation Form [23XX3160 R06/20]
2020 Coverage Cancellation Form (fillable) [23XX3160 R06/20)]
2020 Coverage Cancellation Form (Spanish) [23XX3160 R06/20]
Notice about How We Collect, Share and Protect Your Information
Blue Cross and Blue Shield of Louisiana, HMO Louisiana, Inc. and Southern National Life Insurance Company, Inc. have updated our notice about How We Collect, Share and Protect Your Information. We know that our customers expect us to keep their personal and financial information safe and secure!
We share this notice when new members purchase certain insurance products and when we make revisions to it. The notice is provided in accordance with the Gramm-Leach-Bliley-Act (GLBA).
Effective Date: July 1, 2001
Revised Date: Feb. 1, 2020 |
|
|
Did you find it helpful?
Yes
No
Send feedback Sorry we couldn't be helpful. Help us improve this article with your feedback.
