Marine Exchange Of Southern California Employee Benefits
Marine Exchange Of Southern California Employee Benefits
  • Home
  • Forms
  • Blue Shield Providers
  • Humana Dental Providers
  • More
    • Home
    • Forms
    • Blue Shield Providers
    • Humana Dental Providers

  • Home
  • Forms
  • Blue Shield Providers
  • Humana Dental Providers

Enrollment and Change Forms

Click on the link to download the latest enrollment and subscriber change forms.  

Submit completed forms to Michelle Maldonado or send them to agent

 Warren Klein by fax (760) 203-4338 or email  kleininsurance@dc.rr.com 

Blue Shield Employee Application and Change Form 2024 - 2025 (pdf)Download
Guardian Disability and Life Insurance Application 2024 (pdf)Download
Humana - Employee-Application 2024 (pdf)Download

Downloads

Blue Shield Evidence Of Coverage Documents 12-2023

Blue Shield Platinum HMO 0_20 Evidence Of Coverage 7-1-24 (pdf)

Download

Blue Shield Gold 0_35 PPO Evidence Of Coverage 7-1-24 (pdf)

Download

Copyright © 2025 Marine Exchange Of Southern California Employee Benefits - All Rights Reserved.

Powered by

This website uses cookies.

We use cookies to analyze website traffic and optimize your website experience. By accepting our use of cookies, your data will be aggregated with all other user data.

Accept