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3900 East Prague Post Office Box 3060 Spokane, WA 99220-3060 509/536-4500 FAX 509/532-6562 Group Enrollment Change Form (Do not use this form to enroll new subscribers) Subscriber Name: Social Security

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What is premera member change form?

The premera member change form is a document used to notify Premera Blue Cross of any changes to a member's personal information, such as address, phone number, or marital status.

Who is required to file premera member change form?

Any Premera Blue Cross member who needs to update their personal information is required to file the premera member change form.

How to fill out premera member change form?

To fill out the premera member change form, you need to provide your current information, as well as the updated information. This can be done online through the Premera Blue Cross member portal or by contacting their customer service.

What is the purpose of premera member change form?

The purpose of the premera member change form is to ensure that Premera Blue Cross has accurate and up-to-date information for its members, which is essential for providing appropriate healthcare coverage and communication.

What information must be reported on premera member change form?

The premera member change form typically requires the reporting of personal information, such as name, address, phone number, date of birth, and any changes to that information.

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