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Behavioral Health Management

Our Behaviorial Health Management Department focuses on improving the quality of life for people suffering from mental health or substance abuse issues (MHSA) and is a key aspect of a person’s overall health and wellbeing. Learn More >>>

Mental Health Parity

The Mental Health Parity Act is effective October 3, 2009. Click here to learn more about the Act and how it affects you. Learn More >>>

Forms for Large Employer Groups of 50-100 Employees

Download Instructions:

The following applications and forms are in PDF format. Adobe Acrobat Reader software is required to view, print and search these PDF documents. Please download this free software on the Adobe Acrobat Web site. Please note that Blue Cross of Idaho does not provide Technical Support for Acrobat Reader Software. For technical support, please contact Adobe.

APPLICATIONS & FORMS	FORM NO.
Application Cover Sheet for Group Dual Option (HSA)	3-128
Application for Medium/Large Employer Coverage	3-326
ASC Application/ Questionnaire for New Groups	3-437
ASC Group Health/Dental Enrollment Application	3-307
ASC Group Health Enrollment Application	3-305
Employee Census Data	3-468
Employee's Waiver of Health Care Coverage	3-467
Group Questionnaire for New Groups - 51 or more employees	3-471
Large Group Health Application with Health Statement	3-300
Large Group Health Application without Health Statement	3-556
Large Group Health/Dental Enrollment Application with Health Statement	3-301
Large Group Health/Dental Application without Health Statement	3-393
Letter of Record	3-302
Managed Care Group Questionnaire for New Groups 51 or More Employees	3-243
Managed Care ASC Application/Questionnaire for New Groups	3-244
Statewide Schools Large Group Health Application with Health Statement	3-300SWS
Statewide Schools Large Group Health Application without Health Statement	3-556SWS
Statewide Schools Large Group Health/Dental Application with Health Statement	3-301SWS
Statewide Schools Large Group Health/Dental Application without Health Statement	3-393SWS

Resource Center

Find a Provider	Medicare
Prescription Drugs	Medicare Formulary