BDG

the Benefits Design Group, LLC

...your key to benefits solutions

Forms for Your Convenience

We have provided a number of “used often” forms here for the convenience of our existing and new clients.  These forms are arranged by company first and then by type.  Please contact us if the form you are looking for is not here.

 

Anthem Blue Cross & Blue Shield

· Health Care Provider Online Directory Link

· Employee Enrollment Form (PDF) (For Groups with 2-50 Employees)

· Employee Change Form (PDF)

· Employee Termination Form (PDF)

· Medical Claim Form (PDF)

· Prescription Claim Form (PDF)

· Prescription Mail Order Form (PDF)

 

 

UnitedHealthCare

· Health Care Provider Online Directory Link

· Employee Enrollment & Change Form (PDF) (For Groups with 2-9 Employees)

· Employee Enrollment & Change Form (PDF) (For Groups with 10-50 Employees)

· Employee Enrollment & Change Form (PDF) (For Groups with 50+ Employees)

· Additional Dependents Form (PDF) (use when there is 2+ children in family)

· Medical Claim Form (PDF)

· Prescription Claim Form (PDF)

· Prescription Mail Order Form (PDF)

· Dental Claim Form (PDF)

 

 

Medical Mutual of Ohio

· Health Care Provider Online Directory Link

· Employee Enrollment & Change Form (PDF) (For Groups with 1-19 Employees)

· Employee Enrollment & Change Form (PDF) (For Groups with 20+ Employees)

· Medical Claim Form (PDF)

· Prescription Claim Form (PDF)

· Prescriptions Covered Under Medical Insurance Claim Form (PDF)

· Prescription Mail Order Form (PDF)

· Dental Claim Form (PDF)

· Vision Claim Form (PDF)

· Hearing Claim Form (PDF)

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