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3 HEALTH INSURANCE CLAIM FORM Send Completed Claim Form To: Blue Cross and Blue Shield of Illinois P.O. Box 805107 CHICAGO, IL 60680-4112 PLEASE PRINT OR TYPE CLEARLY NOTICE TO ALL PARTIES COMPLETING
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What is bcbs form eb4928?
BCBS form eb4928 is a form used by Blue Cross Blue Shield to collect data on individuals covered under employer-sponsored group health insurance plans.
Who is required to file bcbs form eb4928?
Employers who offer Blue Cross Blue Shield group health insurance plans to their employees are required to file bcbs form eb4928.
How to fill out bcbs form eb4928?
To fill out bcbs form eb4928, you need to provide information about the employer, the covered individuals, their dependents, and the type of coverage they have.
What is the purpose of bcbs form eb4928?
The purpose of bcbs form eb4928 is to collect data on employer-sponsored group health insurance plans offered by Blue Cross Blue Shield, including information on the coverage provided and the individuals covered.
What information must be reported on bcbs form eb4928?
Information that must be reported on bcbs form eb4928 includes the employer's name, address, and identification number, the covered individuals' names, Social Security numbers, and coverage details, such as the type of plan and premium amounts.
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