Group applications and quoting forms

• Group Life / STD Applications
• Employee Enrollment/Waiver Form
• Employee Add Dependent/Change Request Form
• Employee Termination Form
• Ccertification of Dependency Form

• Quote Request Form
• Census Form 1 - 50 Employees
• Census Form 51+ Employees
• Small Group (2-25) Health Questionnaire (English)
• Small Group (2-25) Health Questionnaire (Spanish)
• Diagnosis Detail Form (English)
• Diagnosis Detail Form (Spanish)
• Renewal Alternate Request Form

• 2024 Broker Small Employer Medical Dental and Vision Underwriting Guidelines
• 2024 Large Employer Group Medical Dental and Vision Underwriting Guidelines for Brokers and Agents

Brokers must be fully appointed with BCBST to receive a group quote. 

BlueCross Blue Cross Blue Shield of Tennessee will issue multiple quotes for groups of 2+ employees. Each quote will be based on the information furnished by the broker and the plan designs requested. If an agent-of-record letter is received with a new quote request, no additional quotes will be released to other agents on the group.

For groups of 2-150 eligible participants, requests for quotes should be submitted on the QuickQuote form to the appropriate regional sales office (fax or email). Quote requests requiring no additional information normally will be completed and returned within two business days by fax or email.

For groups of 151 or more eligible participants, contact your assigned Account Sales Executive or the Regional Sales Office for specific information required.

Tennessee brokers will submit quotes and receive sales assistance from the sales region in which their agency is located. Brokers located outside of Tennessee will work with the region in which the group prospect is located.