RESOURCE CENTER

Installation Forms
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Paperwork Submission Deadlines for 2014 Effective Dates
Alert 656 has been updated to include SHOP paperwork requirements. Groups, new & existing, electing CBC SHOP products must submit all paperwork to CBC by the 15th of the month prior to effective date. There will not be an extension on this deadline.
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Certification of Group Size
The Certification of Group Size form should be used when a group’s enrollment does not match their true group size for rating purposes. CBC reserves the right to void any prior quotes if the group size crosses over/under 50 employees.
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Certification of Group Eligibility to Combine
This form is required to be completed with corporate tax docs for each entity anytime more than one company qualifies to combine. The form needs to be included with the final paperwork submitted to CBC sales.
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11.07.2012
New Business Submission Deadlines (2013)
CBC has updated their deadlines for preliminary rate requests and paperwork submission. Rate requests must be submitted by noon on date indicated, and then paperwork by the date indicated. (this is a more leniate deadline than 2012)
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10.30.2012
Employee Enrollment form (for PPO 1-2-3 plans)
Enrollment form to be completed by employee, for a PPO 1-2-3 plan submission. This form cannot be used for existing group or new business. *released 8/2012
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10.30.2012
Application for 2-50 Group Benefits
Enrollment form to be completed by employer with 2-50 eligible employees, for new or renewal. Contains verbiage for CAAC. *released 8/2012
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10.30.2012
Employee Enrollment form (2-50 size)
Enrollment form to be completed by employee, for a NEW business submission. This form cannot be used for existing group or PPO 1-2-3 plans. *released 8/2012
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10.30.2012
Waiver form
To be completed by employees who wish to waive group coverage, due to spousal, Medicare, or government coverage. *Released 8/2012
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10.25.2012
Checklist for MUW Submission (2-50 size)
CBC generated detailed checklist for MUW submission for groups 2-50. Please be advised that CBC will only accept paperwork as one complete package. If items are missing it will be rejected and group may be pushed to next effective date.
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10.25.2012
Checklist for Changes to Existing Business (2-50 size)
CBC generated detailed checklist for benefit changes for existing groups 2-50. Please be advised that CBC will only accept paperwork as one complete package. If items are missing it will be rejected and group may be pushed to next effective date.
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10.25.2012
Checklist for New Business Submission (2-50 size)
CBC generated detailed checklist for new business submissions for groups 2-50. Please be advised that CBC will only accept paperwork as one complete package. If items are missing it will be rejected and group may be pushed to next effective date.
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09.24.2012
MLR Questionnaire
Required for new business beginning with 11/1/12 effective dates. This form helps CBC obtain required information important to determining future MLR rebate status.
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09.21.2012
Blue Cross Dental-Vision Enrollment Form (released 8/2012)
Enrollment form to be completed by employer, when adding members to a Blue Cross Dental or Blue Cross Vision plan.
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05.21.2012
Value Based Benefits - Setup Form
CBC launched Value Based Benefits on 7/2012 for large groups with 100+ employees. Employers can choose from 6 health incentive programs. The form is required to setup a group with the program.
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03.23.2012
New Group Submission Deadlines
CBC releases submission deadlines for new group business with May 1st effective dates and forward. Brown & Brown should receive all required paperwork at least 2 days prior. Incomplete paperwork will NOT be accepted, and group pushed to next date.
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