Blue Cross and Blue Shield of IL Group Health Documents

Group Product Resource Link

DocumentDownloadYear
Group Health Quoting Worksheet Download
IL Group Blue Choice Options Provider Download2019
Grandfathered Health Plan Fact Sheet Download2013
Producer of Record Transfer Form & Instructions Download2021
BlueCard PPO Member Flier Download2016
Medical Claim IL Download
Guide To Pulling a SBC Download2021

Group Enrollment

Visit Group Enrollment Section

Includes documents for groups 2-50 and 51+ Group size.
Group Enrollment

DocumentDownloadYear
2023 BPS - Benefit Plan Selection Form Download2023
2022 BPS - Benefit Plan Selection Form Download2022
2021 BPS - Benefit Plan Selection Form Download2021
Employee Enrollment and/or Waiving Application Download2021
Enrollment Change Request Form (Must be submitted 30 days prior to renewal effective date) Download2018
ACA Grandfathered Plan Fact Sheet Download2013

DocumentDownload
Sample Waiver Of Coverage Download
Statement Of Grandfathered Status Download
Medicare Part D- What Employers Need to Consider Download
Patient Product Disclosure Notice Download
Uniform Glossary SBC Download
Employee Notice Of Exchange View Link
Employee Penalties and Related Reporting View Link
COBRA Model Election Notice Download
COBRA Model General Notice Download
Compliance Checklist for Small Employers Download
Sample Illinois State Continuation Notice Download
ERISA General Requirements View Link
Employer Health Care Arrangements View Link
HIPPA Special Enrollment Notice Download
WHCRA Enrollment Notice Download
WHCRA Annual Notice Download

Carrier

Group Resources

Commission Schedules

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