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In this custom section you will find everything you need to help administer, enroll and participate in your employee benefit plans.
Looking for something in particular? Have any suggestions on what we can add here for you?
Let Clint Perry know via email at [email protected]
Looking for something in particular? Have any suggestions on what we can add here for you?
Let Clint Perry know via email at [email protected]
Your Customer Number : W0061122
Blue Shield Employee Enrollment FormUse this form to enroll in your employer's Blue Shield HMO or PPO plans.
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Blue Shield Benefit Summaries
Blue Shield Platinum Full PPO 150 |
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Blue Shield Platinum Access + HMO 25 |
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Other important Blue Shield forms
Blue Shield Medical Claim FormUse this form to request reimbursement on claims that were not fulfilled at the time of service because you did not have your card or were claiming services outside of the network.
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Blue Shield Direct Rx ReimbursementUse this form to request reimbursement on claims that were not fulfilled at the time of service because you did not have your card or were claiming services outside of the network.
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International Claim FormTraveling overseas? Use this form to collect reimbursement for medical claims from international services.
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Employee Termination Form
Use this form to terminate employees from the benefit plan.
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Employee Change Transmittal
Use this form to let Blue Shield know of employee additions or terminations. This form should accompany the employee application, for additions, or the employee termination form, for deletions.
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Cal-COBRA Form
Use this form to notify Blue Shield of Cal-COBRA recipients. You can send this in with termination form.
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Your Guardian group ID: 00779314
Guardian Employee Enrollment Form
Please use this form to enroll in the Guardian Dental PPO plan from your employer. You can also use this form to make changes to your plan such as terminating yourself or dependents from you plan.
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Guardian Benefit SummaryA basic description of you Guardian Dental plan, including information on the Maximum Rollover and College Tuition benefit.
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Contacts
Clint Perry - Unlimited Benefits Representative |
Blue Shield PPO Customer Support |
800-200-3242
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Blue Shield HMO Customer Support |
800-424-6521
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Benefits, Medical Bills & Claims |
Tel: (800) 443-5005
TTY Tel: (800) 241-1823 Blue Shield of California P.O. Box 272580, Chico, CA 95927-2580 |
Blue Shield Cal-Cobra Administration
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Tel: 800-228-9476
Fax: 916-350-7480 Blue Shield of California Cal-COBRA Administration P.O. Box 629009, El Dorado Hills, CA 95762-9009 |
Group Eligibility Customer Service |
800-325-5166
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Guardian Dental Customer Service |
212-598-8000
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Guardian Dental Consumer Complaints |
The Guardian Life Insurance Company of America
7 Hanover Square Guardian Compliance, H-4 New York, NY 10004 Attn: Consumer Complaints |
Helpful Links
Blue Shield Doctor Find
Blue Shield Member Services
Guardian Anytime (Account Management Tool)
Guardian Dentist Finder
Guardian Member Services
Frequently Asked Questions
Q: When do Medical maximums and deductibles reset? |
A: Annual Deductibles, maximums and limits add up throughout the coverage year, then reset and begin again on the anniversary date of your coverage year. In this case, December 1.
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Q: What are qualified events?
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A: If you are eligible to make coverage changes, your changes must be consistent with the change in status
The rules vary for each employer but here are some situations that qualify as a change in status: 1. Your legal marital status changes 2. The number of your eligible children changes 3. You or your spouse lose coverage from a different employer |
Q: What is my member ID number?
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A: Your member ID number is a unique number provided to you by your employer or health plan, or it could be the last four digits of your Social Security number. If you’re not sure, your eye doctor or dental provider can usually access your benefit information with the last four digits of your Social Security number.
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