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Tim Wiedman Associates
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Client Services for Blue Cross
Forms for Michigan Blue Cross and Indiana and Ohio Anthem Blue Cross:
For additional infomation from Michigan Blue Cross and Blue Shield, visit their website at http://www.bsbcm.com.
For additional infomation from Indiana and Ohio Anthem Blue Cross and Blue Shield, visit their website at http://www.anthem.com.

The following forms are for new groups setting up their plans. These should be returned to Tim Wiedman Associates:
Employee Application (Indiana and Ohio)
Employee Application (Michigan)
Employer Application (Indiana and Ohio)
Employer Application (Michigan)

To add a new employee, or change the status (ie add/remove child, etc) for established groups, use the appropriate employee app above. After completion, fax to us at (260) 248-2558. To terminate an employee from the plan, call us at (800) 967-6205. When adding a new employee, be sure to complete the request within the time allowed for your waiting period. If you do not remember your waiting period, please contact us at (800) 967-6205.

Note: These forms are in Adobe Portable Document Format (PDF). In order to view PDF files, you will need the Adobe Acrobat Reader. The reader is available for downloading free of charge at http://www.adobe.com/products/acrobat/readstep.html.