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Blue Choice

CarolinaADVANTAGE Forms

Small Group Submission

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)

Medical Loss Ratio Survey

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 Producers' Quick Reference Guide)

Small Group Request for Coverage

Life Insurance

These forms are for Companion Life coverage. Because Companion Life is a separate company from BlueChoice HealthPlan, Companion Life will be responsible for all services related to this coverage.

Companion Life Group Application (20-50 employees)

Companion Life Joint Employer Group Insurance Trust Application (2-19 employees)