Forms

Please see your account manager or broker if the form you need is not listed

Employer Access for Web Enrollment & Updates

Group Underwriting Forms

Prescription Claims Forms

Claims Forms

Eligibility Certification Forms

Direct Purchase Enrollment Forms

Medical & Dental Enrollment Forms for Groups with 101 or more full-time Equivalent Employees

Forms for Small Groups (100 or fewer), Individuals, and Families are available in Blue on Demand

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

Additional Enrollment Forms

Medicare Enrollment Forms