RESOURCE CENTER

Client Service Forms
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2017 Renewal & Savings Forms (2-50 size)
IBC branded renewal form to be completed by employer for existing 2-50 eligible business. For employers making changes to the 2017 Metallic Blue Solutions products.
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2017 Employee (2-50 size) Enrollment/Change form
Employee enrollment/change form to be used by someone who wishes to enroll into an IBC metallic tier plan, beginning with 1/1/17. Application can also be used to add/delete dependents, or change benefits. Also applies to group Medigap enrollments.
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2017 Application for 2-50 Small Employer Coverage
IBC branded installation form to be completed by employer for new 2-50 eligible business. Includes new plan designes for 2017.
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2017 Small Employer Group application for BlueSaver HSA
This application and checklist should be used with employer groups when the broker cannot complete HSA setup through RO AM. New customers and any customers newly selecting a qualified high-deductible health plan can generaly have accounts opened auto
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2017 Small Employer Group application for BlueSaver HRA
The Small/Mid-Size Group HRA is a notional account which does not require any pre-funding. Please make sure you review the Spending Account Invoicing Guide to become familiar with the claims invoicing process which the employer can manage through the
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10.01.2016
FutureScripts mail-order form
Form to be completed by member and provider for mail-order prescription
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05.18.2016
IBXpress letter
Letter required to grant broker access to IBXpress. (doubles as a BOR letter) Please place letter on group's letterhead, have owner/officer sign; send completed letter to your account manager.
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2016 Renewal & Savings Forms (Blue Solutions)
IBC branded renewal form to be completed by employer for existing 2-50 eligible business. For employers making changes to the 2016 Metallic Blue Solutions products.
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2016 Employee (2-50 size) Enrollment/Change form
Employee enrollment/change form to be used by someone who wishes to enroll into an IBC metallic tier plan, beginning with 1/1/16. Application can also be used to add/delete dependents, or change benefits. Also applies to group Medigap enrollments.
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2016 Application for 2-50 Small Employer Health Benefits (released 10/2015)
IBC branded installation form to be completed by employer for new 2-50 eligible business. Includes new plan designes for 2016. Can also be used for Blue Choice products (private exchange/defined contribution)
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IBXpress Update - Change member PCP on IBXpress
You can now change PCP for client on IBXpress. Simply log in to the employer portal at ibxpress.com, click on the Assist Employees tab, and choose the Change Primary Care Physician link.
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Contact Information Change Form for Employer Groups
This form is for any administrative changes to existing IBC employer groups, including: address changes, contact name changes, contact phone/fax/email changes, group name changes, and MSP status. Some changes may require additional documentation.
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2015 Employee (2-50 size) Enrollment/Change form
Employee enrollment/change form to be used by someone who wishes to enroll into an IBC metallic tier plan, beginning with 1/1/15. Application can also be used to add/delete dependents, or change benefits. Also applies to group Medigap enrollments.
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Waiver of Coverage Form
To be completed by an eligible employee waiving coverage. Only acceptable waivers of coverage are: spousal coverage, Medicare/Medicaid, Federal coverage, and Dependent on parent plan. Exchange coverage is not valid waiver.
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2015 Renewal & Savings Forms (Blue Solutions)
IBC branded renewal form to be completed by employer for existing 2-50 eligible business. For employers making changes to the 2015 Metallic Blue Solutions products.
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