Click here to order our 16-page, full-color enrollment guide, which introduces new clients and members to all of our medical, pharmacy and wellness programs.
|Average Employee Count Calculation||Medical Loss Ratio employee count.|
|Group Enrollment Agreement||To be signed and completed for coverage|
|Small Group Certification:
|To be completed for NEW small group enrollment (see below)|
|Small Group Certification: Requalifications||To be completed for small group REQUALIFICATIONS|
|Small Group Certification: Transfers||To be completed for small group TRANSFERS|
|Group Enrollment and Changes||Used to enroll new members, change coverage, or cancel membership.|
|BlueCare Access Enrollment/Change Form||BlueCare Access Enrollment form for subscribers.
NOTE: Use this form ONLY if you have BlueCare Access coverage.
|Waiver of Group Health Insurance Benefits||To be completed and signed ONLY if coverage is being waived.|
|2013 Enrollment Guide||
Electronic version of our printed enrollment guides.