2025 BCBSTX Small Group Paperwork

Send this to the client when they have made the decision to enroll in BCBSTX Small Group coverage.

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Thank you for your interest in a Small Group BCBSTX policy. The first 3 attached forms are to be completed and are related to the employer. The company name is the name on your Articles of Incorporation, Partnership Agreement, Schedule C, or Corporation papers/Stock.

Complete the Small Group Benefit Program Application (BPA) as best you can. If you are not sure about a field you can leave those 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. Page 16 is the optional Proxy form since BCBSTX is a mutual company. If you are not doing an HMO plan as one of your options, you can skip the last two pages of the attached BPA.
The Employer Group Information (EGI) form is required to communicate the # of employees to determine if you are COBRA, TEFRA, ETC. You count all employees including those that waive coverage and even those that are part-time. Waivers are important. Persons who are involved in a partnership (file tax form 1065 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 5th page.
The Texas Supplemental form is required 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 quarterly unemployment return. The eligible employees/owners must complete a form either accepting the coverage or waiving the coverage. Often owners of S corporation and LLCs are not on a quarterly unemployment report, 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 (check stub or report) showing income tax and FICA withholding.
Official documents proving ownership – Articles of Incorporation, Partnership Agreement, Schedule C and Corporation/Stock ownership are all examples of documents to prove ownership to enroll the owners. These documents will require the State seal to prove authenticity.
The last 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.

Please don’t hesitate to call or email if you have any questions. We do want to get all paperwork completed as soon as possible and submitted to us no later than 10 days prior to the requested effective date to allow for review and processing so you have your group policy and ID cards before coverage begins.

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