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2010 Cuba Chamber Open Enrollment Letter
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BCBS of WNY Application and Change form
Used for all new enrollments as well as existing member changes. This should be submitted along with the appropriate underwriting documentation. Please call our office for details.
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BCBS of WNY Small Group Enrollment Form
This form must be completed by all new groups with two or more employees enrolling in Community Blue plans through the Cuba Chamber of Commerce
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BCBS of WNY Enrollment Form
This application must be completed when enrolling in a Community Blue plan through the Cuba Chamber of Commerce.
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BCBS of WNY Health Plans for Cuba Chamber
New 2010 plans and rates for BCBS POS 7100, Community Blue 206, and Community Blue 206 HMO Plus Plans in the Cuba Chamber. Please note these plans require special underwriting and participation requirements. Please call for details.
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BCBS of WNY Frozen Plans for Cuba Chamber
2010 rates for the existing BCBS of WNY HMO 104 Plus, POS 150D, Traditional Blue 901 plans. These plans are currently frozen and only available to groups that currently offer them in their portfolio.
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BCBS of WNY Underwriting for Groups
Please use this underwriting for all groups in the Cuba Chamber when enrolling in a plan through BCBS.
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BCBS of WNY Underwriting for Sole Proprietors
Please use this underwriting for all sole proprietors in the Cuba Chamber when enrolling in a plan within BCBS of WNY.
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Independent Health Chamber Application
Please use this enrollment form for all enrollments or changes in a chamber plan.
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Independent Health Group Membership/Information Form
This form must be completed by all new groups enrolling in Independent Health plans through the Cuba Chamber of Commerce.
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Independent Health Flex Fit Plans for Cuba Chamber
New 2010 plans and rates for Independent Health FlexFit Select Active, Family, and Independent Plans in the Cuba Chamber. Please note these plans require special underwriting and participation requirements. Please call for details.
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Independent Health HIPAA Form
Authorization to disclose protected health information.
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Independent Health Underwriting for Groups
Please use this underwriting for all groups in the Cuba Chamber when enrolling in a plan through Independent Health.
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Independent Health Underwriting for Sole Proprietors
Please use this underwriting for all sole proprietors in the Cuba Chamber when enrolling in a plan through Independent Health.
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Bene-Care Cancellation Form
Please use this form for all cancellation requests.
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