Forms and Documents

Forms and other documents for your benefits program

The table below lists a variety of forms that are useful to you in administering your employee benefits program. Please click on the document name below to save the file to your hard drive.

Company	File and Description
	ShoberEBS Employee Demographic Census Worksheet Excel spreadsheet to enter data about each employee. This document is used to prepare a benefit analysis for an employer.
	BCBSNC Application for Coverage Coverage application for companies with 1 to 50 employees.
	BCBSNC Application for Coverage Coverage application for companies with 51 to 249 employees.
	BCBSNC Enrollment and Change Application (1 to 25) Form to enroll or change enrollment with health questions for 1 to 25 employees.
	BCBSNC Enrollment and Change Application (25 or more) Form to enroll or change enrollment for 25 or more employees.
	BCBSNC Employer Risk Appraisal Form Form to evaluate employer risk for group medical.
	BCBSNC Decline Coverage Form Employee declination of coverage form.