Forms and Information for TRS-ActiveCare Benefits Administrators
- Blue Access for Employers (account maintenance and billing)*
- Blue Access for Employers Security Form
- Blue Access for Employers Confidentiality Agreement
- 2008-2009 Plan Highlights Revised!
- 2009-2010 Plan Highlights
- Online Supply Form (submit online)
- Claim Form
- Transitional Care Request Form
- COBRA Transmittal Form
- Application to Split Premium
- 2008-2009 Employee Enrollment Presentation (PowerPoint)
- 2009-2010 Employee Enrollment Presentation (PowerPoint)
- New ActiveCare 1, 2 and 3 ID Card Formats (for new hires and maintenance only; no re-issue)
- Continuation Coverage Rights Under COBRA (current)
- Continuation Coverage Rights Under COBRA (effective Sept. 1, 2009)
- General Notice of Special Enrollment Rights and Preexisting Condition Exclusion
- Notice of Privacy Practices
*For Blue Access for Employers technical support, call 1-888-706-0583.
