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EmployerAccess Enrollment Documents

PW_B145362
 
Please contact your Agent/Broker and/or Marketing Representative regarding any of the following paperwork prior to submittal.  
For Small Groups (2-50 Employees), documents should be faxed to: 1-877-245-8127  
For Large Groups (51 or more Employees), documents should be faxed to: 1-888-470-6598  
Enrollment Documents 
EmployerAccess Enrollment Eligibility Checklist  - Traditional Health Plans
EmployerAccess Enrollment Eligibility Checklist - Lumenos Health Plans
EmployerAccess Username Policy and Usage Agreement
EmployerAccess Internet Eligibility Agreement
EmployerAccess Internet Eligibility Agreement: BOR
Internet Eligibility Agreement Appendix A
Internet Eligibility Agreement Appendix B
Third Party Agreement
Employer Access Web Enrollment Acknowledgement Form
© 2013 BlueCross BlueShield of Georgia
Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.