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Enrollment Forms 

Quotit Paper - PDF

Scroll down for what you need - Alphabetical Order by Insurance Company

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ONLINE Enrollment Tools - Instructions 

Email us for link to get your applications going

PRO-Apply-Flyer
Employee Guide_Pro Apply
Pro Apply_Intake Form
PRO-Apply_-BROKER_Information
User Guide_Pro Enroll_Broker

 

Blue Cross Small Group
 Administration & Renewal  Information & Tools

Employer Portal
Learn More

 

Easy Renew your Group Coverage

We are in the process of updating this page for 2019.  Just email us, if you need something.  [email protected]

Employer Application

Employer Application – fillable

SG Attestation Form

Attestation Determining Group Size

Guaranteed Association Attestation Form

Eligibility Statement

Conditions of Enrollment/Start-Ups/PEO

Information Change Form

Terminations

Change of Address

Electronic Debit Payment Form

Authorization Request by Phone for Electronic Check/ACH

Reinstatement Electronic Debit Payment Form

Life Conversion Form

Religious Employer Self-Certification Form

Blue Cross Contact Information

[email protected]

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Documents/Forms for employees

Here’s convenient access to the forms and other materials employees will need to make any changes to their plan(s). You’ll find the most essential documents and forms below, many of them conveniently translated into a variety of languages. Whether you need employee applications, change forms or claim forms, this is your one-stop location.

Plan information

Here you’ll find a wealth of information to help you with renewal decisions. Simply select a link below to dive into rate guides, drug lists, benefit summaries and comparisons, and of course, details on the various plans we offer.

Summary of Benefits and Coverages (SBC)

https://sbc.anthem.com/dps/

Benefit Summaries (for plans effective January 1, 2018)

https://plan-summaries.anthem.com/sobdps/

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Plan Comparison Tool – Prior to ACA Compliant

Blue Cross Small Group Customer Service (800) 627-8797.

Other Customer Service Contact Info

Website Tech Support  888.268.4361

EOC Gold Select HMO

 

Forms

More * Renewal Site *  forms on Blue Cross Website

 

Off Anniversary Changes

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