|
Home  Forms
Forms
Download Instructions :
Adobe
Acrobat Reader software is required to view, print and search these
PDF documents. Please download this free software on the Adobe
Acrobat Web site. Please note that Anthem blue cross of California does
not provide Technical Support for Acrobat Reader Software. For technical
support, please contact Adobe.
Download
A comprehensive overview of the policies and practices
that we enforces to preserve our members' privacy rights as well as
control that will be useful for their health care information, by our
complete Notice of Privacy Practices includes the following: the right
to authorize release of information; the right to limit access to medical
information; protection of oral, written and electronic information;
use of data; and information shared with employers.
- Notice of
Privacy Practices
For the purpose of report termination of employees and dependents,
use this form and modify the addresses for covered employees, or
COBRA/Cal COBRA notifications.
- Patient Claim Form
Health care provider submits the claim straight away to Anthem blue cross
whenever an employee receives services from a health care provider.
In certain circumstances, the employee may be required essentially
to present a claim form. See page 1 of this form for instructions.
- Affidavit
of Domestic Partnership
The employee must finish as well as submit this form with an Employee
Application requesting enrollment if only he offers the domestic
partner eligibility option to their employees and wishes to add
their domestic partner to their plan.
- Cal-COBRA/COBRA and
Medicare Survey
You are about to update Anthem blue cross with your company's Cal-COBRA
or COBRA and Medicare eligibility yearly for the upcoming year and
also for ensuring compliance with state together with federal laws.
|
|
