Regence Blue Cross BlueShield of Utah 2-50

When you choose Regence, you’re getting a health care partner. One that can help with your needs every step of the way, from quick health information to answers about claims, and from online wellness programs to one-on-one help with serious health conditions.
Our team of customer service specialists, case managers and health care professionals are devoted to helping you reach your health care goals.

New Business Submission forms:

Employer Forms-

2015 Group Application

ACH Form

  • This is optional

Wage and Tax Sample

Letter in Lieu Template

  • Complete this if they do not currently have a wage and tax. We will need other documentations as well. Please contact our staff for additional information.

Employee Forms-

2015 Utah Universal Application

2015 Employee Coversheet-ACA

2015 Employee Choice Coversheet


Please note these are the 2015 forms. Any previous forms will need to be requested. For rates for Blue Cross please contact our staff.


Servicing Forms:

Employee changes-

Employee Termination Form

  • Terminations or deletions

New Hire-

2015 Utah Universal Application

2015 Employee Coversheet-ACA


Provider Search:

Please click the below link for an up-to-date provider search.

BX- Network


Marketing/Sales Material:

Employee Choice-

All of Blue Cross’s small-group products can be offered through Employee Choice, an option that lets employers offer up to five different plans. Employees can pick the one that’s right for them.

2015 Employe Choice

  • A short video about employee choice and how this will benefit your employer groups.


On the road? BlueCard provides the health benefits that make members feel at home. Members have access to the largest network of doctors across the country and worldwide—without a referral.



Group dental plan highlights 2015


The forms posted on this page are for 2015. If you are interested in any forms for previous years or any pre-ACA plan forms please contact our staff.

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