Blue Cross Blue Shield Enrollment
Group Health

Small Group Enrollment Forms

Checklist

2026 Benefit Program Application – BPA (for effective dates of 1.1.2026 and later)

2026 Benefit Plan Selection – BPS (for effective dates of 1.1.2026 and later)

Employer Group Information- EGI

Employee Application Enrolling

Employee Application Waiving

OR you can use Enrollment Spreadsheet- Please contact your Broker Service Specialist at MIBS for a copy

Owners Certificate (if applicable)

Mid Market 51+ Enrollment Forms

Mid-Market New Business Checklist

Benefit Program Application-BPA

Benefit Plan Selection- BPS

Employer Group Information- EGI

Employee Application Enrolling

Employee Application Waiving