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New Options for Affordable Health Insurance

Forms for Small Employer Groups of 2-50 Employees

 
Download Instructions:
The following applications and forms are in PDF format.  Adobe Acrobat Reader  software is required to view, print and search these PDF documents. Please download this free software on the Adobe Acrobat Web site. Please note that Blue Cross of Idaho does not provide Technical Support for Acrobat Reader Software. For technical support, please contact Adobe. 

 

APPLICATIONS & ENROLLMENT FORMS

 FORM NO.

Application Cover Sheet for Group Dual Option (HSA)

3-128

Application for Small Employer Coverage

3-470

Employee Census Data

3-468

Employee's Waiver of Health Care Coverage

3-467

Group Questionnaire for New Groups 2-50 Employees

3-469

Idaho Small Employer Application Cover Sheet

3-366

Managed Care Group Questionnaire for New Groups 2-50 Employees

3-242

  Universal Idaho Small Employer Application

3-017