CA Blue Shield C12687 2018 free printable template
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Application for
Blue Shield of California
Medicare Supplement plans
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1 Provide ALL requested information and print clearly in blue or black ink.
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How to fill out CA Blue Shield C12687
01
Obtain the CA Blue Shield C12687 form from the official website or your healthcare provider.
02
Fill in your personal information including your name, address, telephone number, and date of birth.
03
Provide your Blue Shield member identification number.
04
Indicate the type of coverage you are applying for or updating.
05
Complete any additional sections regarding beneficiaries, if applicable.
06
Review the form for accuracy and completeness.
07
Sign and date the form at the designated space.
08
Submit the form as instructed, either electronically or by mailing it to the specified address.
Who needs CA Blue Shield C12687?
01
Individuals who are applying for or updating their health insurance coverage with Blue Shield.
02
Members who need to make changes to their insurance information, such as adding dependents.
03
Patients seeking coverage for specific medical services or treatments covered by Blue Shield.
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What is CA Blue Shield C12687?
CA Blue Shield C12687 is a specific form used for reporting health insurance information related to California Blue Shield.
Who is required to file CA Blue Shield C12687?
Health insurance providers, specifically those offering plans under Blue Shield of California, are required to file CA Blue Shield C12687.
How to fill out CA Blue Shield C12687?
To fill out CA Blue Shield C12687, individuals or entities must provide required information such as policyholder details, coverage specifics, and any claims submitted, adhering to the guidelines provided in the form instructions.
What is the purpose of CA Blue Shield C12687?
The purpose of CA Blue Shield C12687 is to ensure compliance with state health coverage reporting requirements and to provide necessary data to the state regarding insurance coverage.
What information must be reported on CA Blue Shield C12687?
Information that must be reported on CA Blue Shield C12687 includes the subscriber's personal details, policy number, coverage dates, and additional details related to premium payments and claims.
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