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The Builders Exchange Open Enrollment Letter
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Excellus Group Enrollment / Change Form
Used for all new coverages as well as contract changes.
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Excellus Healthy Blue Application
Use this application to enroll in one of the new Healthy Blue plans through Excellus Blue Cross Blue Shield.
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Excellus Healthy Blue and Simply Blue Plans for The Builders Exchange
New 2010 plans and rates for Excellus BCBS HB-C-44, SB-C-4, and HB-HDHP-2 for The Builders Excange. Please note these plans require special underwriting and participation requirements.
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Excellus EPO and HMO Plans for The Builders Exchange
New 2010 plans and rates for Excellus BCBS Blue EPO Option 11 and Blue Choice HMO Value and Select for The Builders Excange. Please note these plans require special underwriting and participation requirements.
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Excellus Underwriting for The Builders Exchange
Full underwriting must be submitted for any changes or applications for Excellus products.
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MVP Enrollment Form
Please use this enrollment application when enrolling an employee in an MVP product.
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MVP Underwriting for Employer Groups
These documents must be submitted with all new employer groups applying for MVP Plans.
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MVP HMO Copay Plans for The Builders Exchange
New 2010 plans and rates for MVP NEHD07S, COC-25, and COC 25/40 for The Builders Excange. Please note these plans require special underwriting and participation requirements.
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MVP Trivantage and Preferred EPO Plans for The Builders Exchange
New 2010 plans and rates for MVP Trivantage T01S, E0041S, and E0046S for The Builders Excange. Please note these plans require special underwriting and participation requirements.
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MVP Trivantage and Hybrid Plans for The Builders Exchange
New 2010 plans and rates for MVP Trivantage T03S, E0016S, and E0050S for The Builders Excange. Please note these plans require special underwriting and participation requirements.
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Bene-Care Cancellation Form
Please use this form for all cancellation requests.
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