Employee Enrollment Application - BCBSFL - Florida Blue 2026

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Click ‘Get Form’ to open the Employee Enrollment Application in the editor.
Begin with Section A: Current Information. Fill in your Group Name, Division #, and Group #. Ensure you enter the Effective Date of Coverage and Date of Hire accurately.
Proceed to Section B: Employee Information. Enter your Social Security Number, Last Name, First Name, and other personal details like Street Address and Phone Number.
In Section C: Health Coverage Level and Plan Information, select your desired health coverage option. If applicable, provide your BlueOptions Plan # or any other relevant plan numbers.
Complete Section D: Vision Coverage Level by selecting your vision coverage preference. Remember to sign and date where indicated.
For Section E: Dependent Information, list any dependents as required. Use a separate sheet if necessary.
Finally, review Section F: Other Health Insurance Information for accuracy before signing in Section G to confirm acceptance of coverage.

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Versions	Form popularity	Fillable & printable
2019	4.5 Satisfied (76 Votes)
2014	4.4 Satisfied (160 Votes)
2013	4.3 Satisfied (133 Votes)

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How long is open enrollment in Florida Blue?

Its more important than ever to have health insurance. We want to be sure youre up to date and know where to find help and guidance during this Open Enrollment Period from November 1, 2025 January 15, 2026.

Is BCBS FEP the same as Florida Blue?

Were passionate about helping people and communities achieve better health. Florida Blue is a part of the GuideWell family of companies. Together, were committed to making a meaningful difference in the health of all Floridians.

Is the Blue Cross Blue Shield of Florida the same as Florida Blue?

GuideWell, formally GuideWell Mutual Holding Corporation (holding company for Florida Blue), is a mutual insurance holding company primarily focused on health insurance in Florida. It was created in 2013 by a reorganization initiated by Florida Blue, a member company of the Blue Cross Blue Shield Association.

Is BCBSFL the same as Florida Blue?

Blue Cross and Blue Shield of Florida, Inc. (BCBSF) is now Florida Blue. The new name, new logo and tagline In the pursuit of health are all part of the companys transition to a health solutions company with an overarching mission to help the people of Florida and their communities achieve better health.