Marine Exchange Of Southern California Employee Benefits
Marine Exchange Of Southern California Employee Benefits
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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 Change Form 7-1-25 (pdf)Download
Blue Shield New Employee Enrollment Form 7-1-25 (pdf)Download
Blue Shield_RefusalOfCoverageForm 7-1-25 (pdf)Download
Humana Enrollment Form CA-73000-1124 (1) (PDF)Download
Guardian Disability and Life Insurance Application 2025 (pdf)Download
Guardian New Employee Enrollment Kit with Application 2025 (pdf)Download
Guardian Beneficiary Change Form 2025 (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

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