BCBSTX Amendment Form
Send this to the client if the group would like to make any changes to its existing coverage. It must be uploaded through BAP (or JME can upload for you) at least 30 days before the group’s renewal date.
Subject
Amendment Form for Your BCBSTX Renewal – Action Needed
Body
Dear [Client Name],
As we discussed, your group would like to make the following changes for your upcoming Blue Cross Blue Shield of Texas (BCBSTX) renewal effective [Month] 1, 2025:
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[List the specific changes here, e.g., “Add dental coverage, move from composite to age-rated premiums, and update the new hire waiting period from 60 to 30 days.”]
Attached is the BCBSTX amendment form. You’ll notice that most of the form is blank — that’s expected. Only the sections related to the changes listed above need to be completed; everything else can be left blank.
Please do the following:
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Review the form carefully to make sure the proposed changes are correct.
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Complete any required details in the sections for the changes we discussed.
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Sign and date the signature page.
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If your group is offering an HMO option, please also sign the last page of the form.
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Return the completed and signed form to me at least 30 days before your renewal date so we can submit it to BCBSTX for processing.
If you have questions while reviewing the form, please email me or call me at [phone number]. Once I receive the signed form, I’ll confirm it’s ready and make sure it’s submitted on time.
Thank you, and I look forward to finalizing your 2025 benefits.
Best regards,
[Your Name]
[Your Contact Information]