Small Group Enrollment Form

New / Existing Customers

With our easy to use Online Group Enrollment Form you can enroll employees in a simple, fast and convenient manner. Use the tool to create a group account and / or add employees to your existing group account. Once you've created a group account, you can submitted applications for each employee.

We want your feedback! Share your comments, questions, concerns or suggestions by emailing us at WebMaster@bcbsvt.com. Remember, your feedback helps us create tools more suited to your needs.

Note: The online group enrollment form is a 3rd party application.

Group Application / Create Account

Login & Resume Your Application

Email Address
Password