Application Instructions







 

    

AEA MEMBERS

BLUE CROSS/BLUE SHIELD OF ARIZONA

Listed below is information concerning the completion of your application. By following these guidelines, you will experience fewer problems in the  processing of your application.  You may also complete the application on-line and download the AEA membership verification form on our website www.gfgbenefits.com

  1. IMPORTANT!  AEA Members are not listed on the application unless they are applying for coverage for their children only or they are not covered by the school’s group health insurance.

  2. Child Only Applications:  The parent is listed as the applicant, any children under the  age of 18 may be on the same application.  A child over the age of 18 must be on his/her own application as the applicant, and sign the application.  He/she is considered an individual and an application fee is required.
  3. Your application is not a guarantee of insurance!  It is only an application for insurance.  Please do not cancel your present plan until you are notified of your BLUE CROSS approval.
  4. Please answer all questions completely.  For all YES answers be sure to provide dates, details and doctor’s names and addresses.  Use a pen with dark ink and DO NOT erase or white out information.  Cross out and initial any mistake or you may call our office for a new application.
  5. If you choose monthly payment by pre-authorized premium withdrawal from your checking account, please complete the “Sure Pay” form,  attach a blank voided check, and send it back to us along with the application.
  6. The applicant, the spouse and any person over the age of 18, if to be insured, must each sign and date the application.  A $20 application fee is required, make check payable to “BLUE CROSS”.  (NO fee for children only applications).  Be sure to include your AEA Membership Verification Form. Then return all materials to Glass Financial Group, Inc., in the enclosed envelope.

If you have any questions concerning the application, please feel free to contact Linda at:  (602) 952-1202.  She will be happy to assist you.  

**  You will not receive the discount if the AEA Membership Verification form  is not returned with the application.  **

1/2004