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Signing up a new small group? These are the forms you need for a new small group submission.
Enrollment Application and Change Form
Master Group Application (2-50 Employees)
New Group Checklist
Personal Health Statement (Each employee applying for coverage must complete this form if his or her group has between 2-19 eligible employees.)
Series II, III and IV Dual Option Sign Off Sheet (If an employer wishes to offer his or her employees a choice of two Series II, III or IV plans, he or she should select the plans and sign this form).
Small Group Request for Coverage
These forms are for Companion Life coverage.Companion Life is a separate life insurance company that does not provide BlueChoice HealthPlan products or services. Companion Life is solely responsible.
Companion Life Group Application (20-50 employees)
Companion Life Joint Employer Group Insurance Trust Application (2-19 employees)
