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2018 BCBSTX Small Group Setup Paperwork

Employer Email Template


Send this email to employer clients who are signing up with BCBSTX to let them know what paperwork they’ll need to submit with their employer application.

Download the email template by clicking the button below.

As an alternative, you can copy the text below, modify the language as necessary, add the attachments, and email to your clients.

Body of Email:

Dear :


Thank you for your interest in a Small Group BCBSTX policy. Attached are the documents required to submit to BCBSTX for your small group coverage. The first four documents completed are related to the employer. Note that the company name is the name on your Schedule C, Articles of Incorporation, Partnership Agreement, or Corporation papers/Stock. Below is a description of each of the documents attached.


Employer Application: Complete the employer application as best you can-if you are not sure you can leave some areas blank and we can call back to get the information. It is most important that you sign/date the applicable forms in all appropriate places. Note that there is one application to use if you are offering a Blue Advantage HMO plan and one to use if you are not. 


EGI Form: The EGI form is required to communicate the # of employees to see if you are COBRA, TEFRA, ETC. You may be a group of just 3 people-husband and wife owners on a schedule C (self-employed) with one employee and thus the employee count would be 1 on the EGI. You count all employees including those that waive coverage and even those that are part-time. Waivers are important. Persons that are involved in a partnership (file tax form K1) do count as employees. We can assist with the determination of the number to enter. But it is important to sign/title/date the 3rd page.


Texas Supplement Form: This form is used when members of a group are not listed on the latest Quarterly Unemployment Form that is filed with the Texas Workforce Commission (TWC). This Quarterly Unemployment form is required to prove that you are offering health insurance to all eligible employees. If anyone has termed that is on the report, you mark termed and the date. If they are part-time and not eligible for health coverage, you mark them as part-time on the TWC. The eligible employees/owners must complete a form either accepting the coverage or waiving the coverage. Often owners of S corporation, LLCs, or single owners are not on the TWC as they take a draw instead of a payroll check. These owners are to be listed on the Supplemental form. It is also used to indicate any new employees that are not on the TWC report. Besides listing them on the form, you also need to provide a W4 and payroll history showing income tax and FICA withholding.


Ownership Documents: Official documents proving ownership-Articles of Incorporation, Partnership Agreement, Tax form Schedule C for sole proprietor, Corporation papers/Stock ownership are all examples of documents to prove ownership to enroll the owners. These documents will require the State seal to prove authenticity.


Employee Enrollment/Waiver Form: The next form is the employee enrollment/waiver form that needs to be completed by all employees that work 30 hours or more and/or owners of the business. All employees must complete an application whether they are taking the group coverage or waiving the group coverage. For example, one enrollee may be Medicare, so they waive the coverage and the other enrollee takes the coverage. This form is also in the employee packet that is sent separately for distribution to the employees to inform them of the plan(s) being offered and the cost/benefits.


Small Group Checklist: The next document is a one page checklist so you can be sure to include all necessary paperwork to avoid delays in issuing your group policy. Do NOT send to the address on this form, but follow instructions below to return to us for processing.


Electronic Funds Transfer (EFT): The next document is a form so your initial premium payment can be drafted once the group policy has been approved. Do not send a check. This will not set up ongoing bank draft for future premium, but is used only for the initial premium.


The last page is from the quote where the plan(s) selection was made and requires your signature/date.


All of the documents above can be scanned and emailed back to us through our secure email system or faxed to us at .


Please don’t hesitate to call/email, if you have any questions/concerns. If the agent you are working with is not available when you call, please ask to speak to any other agent so your question(s) can quickly be answered. This helps to reduce time wasted with phone tag. We do want to try and get all paperwork completed as soon as possible and submitted to us no later than 10 days prior to the requested effective date to insure that you have your policy and ID cards.


Thank you for working with us and have a great day.

Documents to Include:

Open and save these documents, then attach them to the email.