Services

McCumber Insurance Services

Forms - Click on the links below to download PDF forms

Medical Forms - Spanish

Blue Cross:

Enrollment Form
Addition Form

Blue Shield:

Enrollment Form
Refusal of Coverage Form

Health Net:

Enrollment Form
Mail Order Pharmacy Form

Kaiser:

Enrollment Form
Student Certification Form

Medical Forms - English

Blue Cross:

Enrollment Form
Addition Form
Employee Change Info Form

Blue Shield:

Enrollment Form
Refusal of Coverage Form

Health Net:

Enrollment Form
Mail Order Pharmacy Form
Overage Dependent Certification Form

Kaiser:

Enrollment Form
Account Change Form
Cobra Enrollment Form
Full Time Student Status Form
Student Certification Form

Temporary Membership ID Form
Termination and Transfer Form

Dental Forms - English

Liberty Dental:

Enrollment Form
Termination Request Form
CA 50 Enrollment Form
CA 80 Enrollment Form
Kern County Provider Listing

Vision Forms - English

AIBT/Superior Vision:

Employee Change Form
Employee Enrollment Form
Employee Termination Form

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