Employer Forms
Group Benefits Manager's Manual Comprehensive guidance for handling Group-level changes.
| Form | Purpose |
|---|---|
Group Enrollment
 |
Used for EMPLOYEE updates to enrollment |
| Onilne Group Enrollment Form | Used for NEW ENROLLMENT/HIRES only. |
| Student Certification
|
|
| Incapacitated Dependent
|
Request for coverage, and medical certification |
| Domestic Partner Coverage | |
| Group Membership Update
|
Membership Changes |
| Small Group Certification
|
Small Employer Qualification |
| TVHP Small Group Certification Form |
Form used for certification of a Small Group in TVHP |
| Waiver of Group Health Insurance |
Used by spouses or partners to opt out of BCBSVT coverage |
New Enrollment Instructions Membership Change Instructions
Note: The group enrollment form is used to notify us of membership changes.