Annual Group Information Form
For a full comprehensive guide of Annual Group Information Forms, please refer to the following instructional PDF's:
For Small Groups:
You can now submit your group information 1 of 2 ways:
Fill out and submit your group information electronically with our Group Information Form
If you do not currently have access to the online AGIF tool, please submit a request through our secure eForm
Download and complete online Group Information FormOpen a PDF
Once your form is complete, please email the form to: firstname.lastname@example.org
For Large Groups:
You can download and complete your form and send to your broker or account representative.
Download and complete Group Information FormOpen a PDF
Additional Important Information:
Due to various state and federal regulations, Excellus BlueCross BlueShield is required to obtain certain information regarding your group on an annual basis. As your health insurance provider, we know this information as it relates to the members you have with us, but we may not have an accurate understanding of this information as it applies to all of your employees. We appreciate your cooperation in providing this information. If needed, we may use this information to generate a Master Group Agreement.
If you have any questions please contact your account consultant or call 1-888-817-2700.
Modal for Additional Group Information