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