Plan Administrator Access Request Form

Plan Administrator Access Request

A Plan Administrator is the person(s) who administers Pacific Blue Cross Benefit Plans for the employees/members covered by those Plan(s). Administration would include processing the enrollments, changes, cancellations, requesting replacement ID cards or booklets, following up on employee/member questions about coverage or claims issues and may also include reconciling/paying monthly PBC invoices.

If you are a Plan Administrator who handles these tasks for your group, and would like to register for secure access to this section, please complete the access request form below.

Once we verify you are eligible, we will send you a welcome email with instructions to activate your ADMINnet account.

*First Name:

*Last Name:

*Title:

*Company:

*Policy Name:

*Policy Number(s):

If you are requesting access to only part of the policy, please indicate the division, subdivision and/or class required.

Division(s):

Subdivision(s):

Class(es):

*Email:

*Confirm Email:

*Business Phone:

PBC Acct Mgr:

Submit Request