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Page 1 of 4 Page 2 of 4 Page 3 of 4 Page 4 of 4 A Blue Cross Medicare Advantage Plan from Keystone Health Plan East EMPLOYER GROUP APPLICATION/CHANGE FORM. Benefits Administration Guide Medavie Blue Cross Group Life Benefits for up to date information on this benefit as well as the appropriate application forms, Prior Group Coverage with Blue Cross and Blue Shield of Illinois. a Division of Health Care Service Corporation, Benefit Levels Group Information Form. Learn about accessing government sponsored programs administered by Alberta Blue Cross. Non-group Forms for group plan members. Benefit Application.

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