Forms & Documents

Employer access for web enrollment and updates

Online Enroll & Update -- Access Request Form
- Full access
- Inquiry only
- Remove administrator
Add or Remove Group Numbers

Group underwriting forms

Claims forms

Eligibility certification forms

Enrollment forms

Medical and dental enrollment forms (101+ full-time equivalent employees)

Forms for small groups (100 or fewer), individuals, and families are available in Blue on Demand

Choose application based on whether the product requires a primary care physician
Select the plans your group offers from the dropdown(s) under Medical and Dental Plan Selection

Additional enrollment forms

Medicare enrollment forms

Medicare Supplement Enrollment FormOpen a PDF
Excellus BCBS HMO / PPO / Medicare Supplement Disenrollment
Enroll, change or cancel coverage for a Medicare Advantage or Medicare Supplemental member

2026 enrollment applications

Small group sales materials

Medical sales tools and resources

At-a-glance products and benefits*

Rochester region

Q1: Effective 1/1/27 - 3/31/27
- Placemat
- Booklet

Q2: Effective 4/1/27 - 6/30/27
- Placemat
- Booklet

Q3: Effective 7/1/27 – 9/30/27
- Placemat
- Booklet

Q4: Effective 10/1/27 – 12/31/27
- Placemat
- Booklet

Syracuse region

Q1: Effective 1/1/27 - 3/31/27
- Placemat
- Booklet

Q2: Effective 4/1/27 - 6/30/27
- Placemat
- Booklet

Q3: Effective 7/1/27 – 9/30/27
- Placemat
- Booklet

Q4: Effective 10/1/27 – 12/31/27
- Placemat
- Booklet

Albany, Mid-Hudson, Utica region

Q1: Effective 1/1/27 - 3/31/27
- Booklet
- Booklet

Q2: Effective 4/1/27 - 6/30/27
- Placemat
- Booklet

Q3: Effective 7/1/27 – 9/30/27
- Placemat
- Booklet

Q4: Effective 10/1/27 – 12/31/27
- Placemat
- Booklet

Member brochures

Dental sales tools and resources

Dental at-a-glance charts

Vision sales tools and resources

Wellbeing tools and resources

ThriveWell

* Rates shown are subject to approval by the New York State Department of Financial Services (NYS DFS)

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