Group Insurance Inc. Agent Tool

• BCBS New Business Checklist
• BCBS Employer Application for Group Coverage
• BCBS Employee Application/Change Form
• BCBS Medical Guide Questionnaire
• BCBS Coverage Cancellation Form
• BCBS Continuation of Coverage (HMO)
• BCBS Continuation of Coverage (PPO)
• BCBS Other Coverage Questionnaire
• BCBS Authorized Delegate Form
• BCBS Custom Eligibility Form
• BCBS Group Health Questionnaire   
• Prospective Group Questionnaire

• Coventry New Case Submission Checklist
• Coventry Employer Application for Group Coverage
• Coventry Employee Application 2-19 Employees
• Coventry Employee Application 20-35 Employees
• Coventry Employee Application 36+ Employees
• Coventry 2011 Plan Grid
• Coventry 2011 Pharmacy Plan Grid
• Coventry Employer Risk Appraisal Questionnaire 36 +

• Employer Application
• Enrollment 2-25
• Enrollment 26-99
• New Business Checklist 2-50
• New Business Checklist 51-99
• Employee Change Form
• Eligibility Certification Form
• ACH Authorization

• UHC Employer Application for Group Coverage (2-50)
• UHC Key Accounts Employer Application for Group Coverage (51+)
• UHC Health Addendum to Key Accounts Employer Application (51+)
• UHC Employee Enrollment 2-5 Lives
• UHC Employee Enrollment 6-25 Lives
• UHC Employee Enrollment 26-50 Lives
• UHC Employee Enrollment 51-99 Lives