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Web the provider can submit an enrollment form themselves, or instruct their vendor to access the change healthcare self. Web here’s what you need to know. Web for group medical benefits, if the health insurance portability and accountability act of 1996 (hipaa) applies, you must include. You may request a free paper copy of your application and/or enrollment information by contacting us at. Web health, dental, and vision enrollment/change form. Form is only to be used for new employees or qualifying event. Web eha health and dental enrollment form new application (complete all sections except section c. If you are an actively working federal employee and want to become a member of the blue cross.