- Small Business
- + Large Business
- Membership At A Glance
- Domestic Partner Eligibility
- Employee Enrollment
- Enrollment Basics
- Enrollment FAQ's
- Open Enrollment
- Probationary Periods
- + Special Enrollments
- Adding A Dependent
- Coverage Updates
- Membership Cancellation Instructions
- Membership Change Instructions
- MRC Widget GuideLines
- Employee Benefits
- + Newsletters
Group Benefits Manager's Manual Comprehensive guidance for handling Group-level changes.
|Average Employee Count Calculation||Medical Loss Ratio employee count.|
Used for employee updates to enrollment
Note: Application forms must be accompanied by a copy of the Summary of Benefits and Coverage (SBC) when provided to an employee enrolling in an employer group plan that has renewed on or after October 1, 2012.
|BlueCare Access Enrollment/Change Form
BlueCare Access Enrollment form for subscribers.
Note: Use this form only if you have BlueCare Access coverage.
|Continuity of Care
Members can complete this form electronically through the Member Resource Center (under "My Forms")
|For new members receiving treatment for a chronic medical, mental health or substance abuse condition or pregnant and are in their 2nd or 3rd trimester. Completion of this form will ensure a seamless transition of health care and pharmacy needs.|
|Online Group Enrollment Form||Used for new enrollment/hires only.|
||Request for coverage, and medical certification|
|Domestic Partner Coverage|
|Group Membership Update
|MSP Step-by-Step Guide for Small Group E...
||Step-by-step guidance on how to apply for a small employer exception from Medicare coordination of benefits contractor.|
|Small Group Certification
||Small Employer Qualification|
|Small Group Certification: New Group
||Small Employer Qualification for new groups|
|Small Group Certification: Requalificati...
||Small Employer Qualification for requalifications|
|Small Group Certification: Transfer
||Small Employer Qualification for transfers|
|Small Group Enrollment and Change Form||Used to submit a change or to enroll an employee in small group coverage|
|Waiver of Group Health Insurance||Used by spouses or partners to opt out of BCBSVT coverage|
|Credibility Analysis||Important notice concerning prescription drug coverage|
|Creditable Coverage Simplified Determination||Important notice concerning prescription drug coverage|
|Creditable Notice (Word Doc)||Important notice concerning prescription drug coverage|
|Non-Creditable Notice (Word Doc)||Important notice concerning prescription drug coverage|
|CMS Creditable Coverage Guidance||Important notice concerning prescription drug coverage|
|Group Subscriber Medicare Supplement Application||Form for a group subscriber's changes|