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Employee Enrollment Kits

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BlueCare PPO

Group Enrollment Kit
Self-Insured Group Enrollment Kit
Plan Overview
Network Map
Notice of Privacy Practices (does not apply to self-insured plans)
Preventive Services (optional for self-insured plans)
Preventive Services Addendum (optional for self-insured plans)
Multi-Tiered Rx Brochure (optional for self-insured plans)
Coinsurance Rx Brochure (optional for self-insured plans)
Enrollment Application

BlueCare QHD PPO

Group Enrollment Kit
Self-Insured Group Enrollment Kit
Plan Overview
Network Map
Notice of Privacy Practices (does not apply to self-insured plans)
Preventive Services (optional for self-insured plans)
Preventive Services Addendum (optional for self-insured plans)
Multi-Tiered Rx Brochure (optional for self-insured plans)
Enrollment Application

BlueCare Custom PPO

Group Enrollment Kit
Self-Insured Group Enrollment Kit
Plan Overview
Network Map
Notice of Privacy Practices (does not apply to self-insured plans)
Preventive Services (optional for self-insured plans)
Preventive Services Addendum (optional for self-insured plans)
Multi-Tiered Rx Brochure (optional for self-insured plans)
Coinsurance Rx Brochure (optional for self-insured plans)
Enrollment Application

BlueCare EPO

Group Enrollment Kit
Self-Insured Group Enrollment Kit
Plan Overview
Network Map
Notice of Privacy Practices (does not apply to self-insured plans)
Preventive Services (optional for self-insured plans)
Preventive Services Addendum (optional for self-insured plans)
Multi-Tiered Rx Brochure (optional for self-insured plans)
Coinsurance Rx Brochure (optional for self-insured plans)
Enrollment Application

BlueCare QHD Custom PPO

Group Enrollment Kit
Self-Insured Group Enrollment Kit
Plan Overview
Network Map
Notice of Privacy Practices (does not apply to self-insured plans)
Preventive Services (optional for self-insured plans)
Preventive Services Addendum (optional for self-insured plans)
Multi-Tiered Rx Brochure (optional for self-insured plans)
Enrollment Application

AffordaBlue

Group Enrollment Kit
Self-Insured Group Enrollment Kit
Plan Overview
Network Map
Notice of Privacy Practices (does not apply to self-insured plans)
Preventive Services (optional for self-insured plans)
Preventive Services Addendum (optional for self-insured plans)
Multi-Tiered Rx Brochure (optional for self-insured plans)
Coinsurance Rx Brochure (optional for self-insured plans)
Enrollment Application

BlueCare Traditional

Group Enrollment Kit
Self-Insured Group Enrollment Kit
Plan Overview
Network Map
Notice of Privacy Practices (does not apply to self-insured plans)
Preventive Services (optional for self-insured plans)
Preventive Services Addendum (optional for self-insured plans)
Multi-Tiered Rx Brochure (optional for self-insured plans)
Coinsurance Rx Brochure (optional for self-insured plans)
Enrollment Application

BlueCare HMO

Group Enrollment Kit
Self-Insured Group Enrollment Kit
Plan Overview
Network Map
Notice of Privacy Practices (does not apply to self-insured plans)
Preventive Services (optional for self-insured plans)
Preventive Services Addendum (optional for self-insured plans)
Multi-Tiered Rx Brochure (optional for self-insured plans)
Coinsurance Rx Brochure (optional for self-insured plans)
Enrollment Application
BlueCare HMO PCP Directory

BlueCare HMO Plus

Group Enrollment Kit
Self-Insured Group Enrollment Kit
Plan Overview
Network Map
Notice of Privacy Practices (does not apply to self-insured plans)
Preventive Services (optional for self-insured plans)
Preventive Services Addendum (optional for self-insured plans)
Multi-Tiered Rx Brochure (optional for self-insured plans)
Coinsurance Rx Brochure (optional for self-insured plans)
Enrollment Application
BlueCare HMO PCP Directory

BlueCare Senior