BlueChoice HealthPlan

CarolinaADVANTAGE Forms

(You will need the Adobe Acrobat Reader to view or print some of the items on this page.)     

Signing up a new small group? These are the forms you need for a new small group submission.

Dual Options

Forms Needed for a Group with 2-19 Employees

Forms Needed for a Group with 20-50 Employees

Enrollment Application and Change Form

Group Size Review 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.)

Plan Details (including Underwriting Quick Reference Guide)

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)