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Annual Group Information Form Submission
Annual Group Information Form Submission

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Due to various state and federal regulations, Excellus BlueCross BlueShield is required to obtain certain information regarding your group on an annual basis. As your health insurance provider, we know this information as it relates to the members you have with us, but we may not have an accurate understanding of this information as it applies to all of your employees. We appreciate your cooperation in providing this information. If needed, we may use this information to generate a Master Group Agreement.

Our Annual Group Information Form eFile gives you one more way to submit your enrollment to us. Using our formatted Adobe PDF file template, you can easily enter and submit your group information online. Additional Important Information.
How to Submit Your Annual Group Information Form eFile:

Step 1:

Save the Annual Group Information Form (AGIF) template to your computer. You will need the Adobe Acrobat Reader to work with this file.
If your group has individuals with retirees who are offered a Medicare Advantage or a Retiree Health Plan product with our health plan, please complete and submit the Medicare Questionnaire.

Step 2:

Follow these instructions to prepare your AGIF file for submission.

Step 3:

Use the button link below to upload and submit your completed file using our secure, encrypted online submission form:

If you have any questions, please contact your account consultant, broker, or Chamber Trust & Association administrator.
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