Below please find the online version of our Group Enrollment Checklist. Quick links are provided to assist you with locating additional forms necessary for group submission.
Please click here to print a hard copy of the Large Group Enrollment Checklist to use when submitting new groups.
Cut Off Submission Dates:
All forms must be completed and received no later than the 20thof the month prior to the effective date.
Any missing information will delay members being loaded to our membership system and generation of ID cards.
Requested Effective Date:
In order to process your request as quickly as possible, please submit the documents listed below.
Premium Check payable to: Blue Cross Blue Shield of Georgia (Premium = Sold Rates X Number of Enrolled Lives)
Premium Check payable to: GGL (Separate check necessary only if selling voluntary life, STD, LTD or Term Life insurance that is based off of salary or classes.)
Group Master Application (51+) (use for medical, dental and vision)
Section IV – Indicate the plan number for all plans elected. The HMO plan cannot be sold as a single option, the group must also select a plan with an out-of-network benefit.
Employee Waiting Period (EWP) – Indicate in days not months. EWP cannot exceed 180 days.
Employer contribution percentage – Must be at least 50% of the single Employee cost.
Employees waiving coverage must complete & sign the application & check the Refusal of Coverage section. The Other Insurance Information section should also be completed. The Special Enrollment Rights form is to be left with the employer & cannot be accepted in lieu of the signed applications.
Participation requirements: The greater of 50% of the total eligible employees or 75% of eligible employees excluding those covered by spouses.