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||To be used for transitioning members who are being treated for a life threatening/disabling or degenerative condition, are in their 2nd or 3rd trimester of pregnancy, have an upcoming surgery OR are on a medication that the previous insurer has given prior approval for.|
|Online Group Enrollment Form||Used for NEW ENROLLMENT/HIRES only.|
|Incapacitated Dependent||Request for coverage, and medical certification|
|Domestic Partner Coverage|
|Group Membership Update||Membership Changes|
|MSP Step-by-Step Guide for Small Group Employer Exception||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: Requalification||Small Employer Qualification for REQUALIFICATIONS|
|Small Group Certification: Transfer||Small Employer Qualification for TRANSFERS|
|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 and Change Form||Form for a group subscriber's changes|