Group Enrollment and Coverage AgreementGroup Enrollment and Coverage Agreement • June 2nd, 2008 • Michigan
Blue Cross Blue Shield of Michigan (BCBSM) will provide health care coverage to Members, i.e., eligible persons enrolled through the group identified below and participating in the Group's employee welfare benefit plan providing health benefits (Group Health Plan or GHP), subject to the terms of applicable certificates and riders ("Certificates and Riders"), BCBSM's administrative and underwriting requirements, the Group Administrative Guide (Guide) and the following terms and conditions of the Group Enrollment & Coverage Agreement consisting of Part A-Terms and Conditions, Part B-Group Information, and Part C-Coverage Selection (Agreement):
Group Enrollment and Coverage AgreementGroup Enrollment and Coverage Agreement • September 1st, 2006
Enrollment forms (ECOS) for all enrolling employees. Forms must be complete. Please ensure that dates of hire and signatures are included. Medicare and COBRA fields must be completed if applicable.
Group Enrollment and Coverage Agreement (Part A, B & C)Group Enrollment and Coverage Agreement • June 14th, 2010 • Michigan
Enrollment forms (ECOS) for all enrolling employees. Forms must be complete. Please ensure that dates of hire and signatures are included. Medicare and COBRA fields must be completed if applicable.
Group Enrollment and Coverage AgreementGroup Enrollment and Coverage Agreement • January 10th, 2013
Enrollment forms (ECOS) for all enrolling employees. Forms must be complete. Please ensure that dates of hire and signatures are included. Medicare and COBRA fields must be completed if applicable.
Group Enrollment and Coverage AgreementGroup Enrollment and Coverage Agreement • December 27th, 2009 • Michigan
Blue Care Network of Michigan (BCN) will provide health care coverage to eligible persons enrolled through the Group identified below subject to the terms of applicable certificates and riders ("Certificates and Riders"), BCN's administrative and underwriting requirements, the Group Administrative Manual (Manual), a copy of which the Group acknowledges receiving, and the following terms and conditions of this Group Enrollment & Coverage Agreement (Agreement):
Group Enrollment and Coverage AgreementGroup Enrollment and Coverage Agreement • August 27th, 2010
Enrollment forms (ECOS) for all enrolling employees. Forms must be complete. Please ensure that dates of hire and signatures are included. Medicare and COBRA fields must be completed if applicable.
Group Enrollment and Coverage AgreementGroup Enrollment and Coverage Agreement • June 14th, 2010 • Michigan
Blue Cross Blue Shield of Michigan (BCBSM) will provide health care coverage to Members, i.e., eligible persons enrolled through the group identified below (Group) and participating in Group's employee welfare benefit plan providing health benefits (Group Health Plan or GHP), subject to the terms of applicable certificates and riders (Certificates and Riders), BCBSM's administrative and underwriting requirements, the Group Administrative Guide (Guide) and the following terms and conditions of the Group Enrollment & Coverage Agreement consisting of Part A-Terms and Conditions, Part B-Group Information, and Part C-Coverage Selection (Agreement):
Group Enrollment and Coverage AgreementGroup Enrollment and Coverage Agreement • December 28th, 2009 • Michigan
Blue Care Network of Michigan (BCN) will provide health care coverage to eligible persons enrolled through the Group identified below subject to the terms of applicable certificates and riders ("Certificates and Riders"), BCN's administrative and underwriting requirements, the Group Administrative Manual (Manual), a copy of which the Group acknowledges receiving, and the following terms and conditions of this Group Enrollment & Coverage Agreement (Agreement):
Group Enrollment and Coverage Agreement for Stand Alone Blue DentalGroup Enrollment and Coverage Agreement • June 2nd, 2008 • Michigan
Blue Cross Blue Shield of Michigan (BCBSM) will provide dental care coverage to Members, i.e., eligible persons enrolled through the group identified below and participating in the Group's employee welfare benefit plan providing dental benefits (Group Health Plan or GHP), subject to the terms of applicable certificates and riders ("Certificates and Riders"), BCBSM's administrative and underwriting requirements, the Group Administrative Guide (Guide) and the following terms and conditions of the Group Enrollment & Coverage Agreement consisting of Part A-Terms and Conditions, Part B-Group Information, and Part C-Coverage Selection (Agreement):
Group Enrollment and Coverage Agreement for Stand Alone Blue DentalGroup Enrollment and Coverage Agreement • June 2nd, 2008 • Michigan
Blue Cross Blue Shield of Michigan (BCBSM) will provide dental care coverage to Members, i.e., eligible persons enrolled through the group identified below and participating in the Group's employee welfare benefit plan providing dental benefits (Group Health Plan or GHP), subject to the terms of applicable certificates and riders ("Certificates and Riders"), BCBSM's administrative and underwriting requirements, the Group Administrative Guide (Guide) and the following terms and conditions of the Group Enrollment & Coverage Agreement consisting of Part A-Terms and Conditions, Part B-Group Information, and Part C-Coverage Selection (Agreement):
Group Enrollment and Coverage Agreement (Parts A, B & C)Group Enrollment and Coverage Agreement • October 24th, 2012 • Michigan
Coverage will begin on the effective date, contingent upon approval from BCBSM/BCN Underwriting. BCBSM/BCN will send an acceptance letter to the group upon approval.
LARGE GROUP SOLD CHECKLISTGroup Enrollment and Coverage Agreement • December 14th, 2020
Thank you for choosing McLaren Health Plan Community! Please supply all the following items to ensure appropriate processing of your group. Completed paperwork should be submitted 30 days prior to requested effective date.
Group Enrollment and Coverage Agreement (Parts A, B & C)Group Enrollment and Coverage Agreement • June 17th, 2018 • Michigan
Coverage will begin on the effective date, contingent upon approval from BCBSM/BCN Underwriting. BCBSM/BCN will send an acceptance letter to the group upon approval.
Group Enrollment and Coverage AgreementGroup Enrollment and Coverage Agreement • August 27th, 2010
Enrollment forms (ECOS) for all enrolling employees. Forms must be complete. Please ensure that dates of hire and signatures are included. Medicare and COBRA fields must be completed if applicable.
Group Enrollment and Coverage AgreementGroup Enrollment and Coverage Agreement • June 2nd, 2008 • Michigan
Blue Cross Blue Shield of Michigan (BCBSM) will provide health care coverage to Members, i.e., eligible persons enrolled through the group identified below and participating in the Group's employee welfare benefit plan providing health benefits (Group Health Plan or GHP), subject to the terms of applicable certificates and riders ("Certificates and Riders"), BCBSM's administrative and underwriting requirements, the Group Administrative Guide (Guide) and the following terms and conditions of the Group Enrollment & Coverage Agreement consisting of Part A-Terms and Conditions, Part B-Group Information, and Part C-Coverage Selection (Agreement):
Federal Tax ID NumberGroup Enrollment and Coverage Agreement • February 5th, 2012 • Michigan
Blue Care Network of Michigan (BCN) will provide health care coverage to Member's, i.e., eligible persons enrolled through the group identified below (Group) and participating in Group's employee welfare benefit plan providing health benefits (Group Health Plan or GHP) subject to the terms of applicable certificates and riders (Certificates and Riders), BCN's administrative and underwriting requirements, the Group Administrative Guide, (Guide), and the following terms and conditions of the Group Enrollment & Coverage Agreement (Agreement):
Group Enrollment and Coverage Agreement (Parts A, B & C)Group Enrollment and Coverage Agreement • October 24th, 2012 • Michigan
Coverage will begin on the effective date, contingent upon approval from BCBSM/BCN Underwriting. BCBSM/BCN will send an acceptance letter to the group upon approval.
Federal Tax ID NumberGroup Enrollment and Coverage Agreement • August 30th, 2010 • Michigan
Blue Care Network of Michigan (BCN) will provide health care coverage to Member's, i.e., eligible persons enrolled through the group identified below (Group) and participating in Group's employee welfare benefit plan providing health benefits (Group Health Plan or GHP) subject to the terms of applicable certificates and riders (Certificates and Riders), BCN's administrative and underwriting requirements, the Group Administrative Guide, (Guide), and the following terms and conditions of the Group Enrollment & Coverage Agreement (Agreement):
Federal Tax ID NumberGroup Enrollment and Coverage Agreement • August 30th, 2010 • Michigan
Blue Care Network of Michigan (BCN) will provide health care coverage to Member's, i.e., eligible persons enrolled through the group identified below (Group) and participating in Group's employee welfare benefit plan providing health benefits (Group Health Plan or GHP) subject to the terms of applicable certificates and riders (Certificates and Riders), BCN's administrative and underwriting requirements, the Group Administrative Guide, (Guide), and the following terms and conditions of the Group Enrollment & Coverage Agreement (Agreement):
Group Enrollment and Coverage Agreement (Parts A, B & C)Group Enrollment and Coverage Agreement • March 15th, 2017 • Michigan
Coverage will begin on the effective date, contingent upon approval from BCBSM/BCN Underwriting. BCBSM/BCN will send an acceptance letter to the group upon approval.
