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EmployerAccess Enrollment Documents

Please contact your Agent/Broker and/or Marketing Representative regarding any of the following paperwork prior to submittal.  
Please fax all documents to 1-888-470-6598 and include a cover page with Group name, Group number, Contact name, and Contact email address. 
Enrollment Documents 
EmployerAccess Enrollment Eligibility Checklist
EmployerAccess Username Policy and Usage Agreement
EmployerAccess Internet Eligibility Agreement
Third Party Agreement
Employer Access Web Enrollment Acknowledgement Form
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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.