All forms require Adobe Acrobat Reader. Click on the "Acrobat Reader" button to download this free reader if you do not already have it.

Blue Cross and Blue Shield of North Carolina
Employee Application & Change Form (1-24 Employees)
Employee Application & Change Form (25+ Employees)
Decline of Coverage Form
Employer Risk Appraisal Form

United Healthcare
UHC Enrollment/Change Form 50 Plus Employees
UHC Enrollment/Change Form 1-50 Employees
UHC Health Insurance Claim Form
UHC Prescription Drug Reimbursement Form
UHC Underwriting Guidelines for NC Small Business
UHC Dental Claim Form

Wellpath
Enrollment/Change Form 1-25 Employees
Enrollment/Change Form 26 Plus Employees
Risk Appraisal Questionnaire 26 Plus Employees
Wavier of Health Coverage Form
 
   

Home | About Us | Articles | Glossary | Carriers | News | Map | Forms | Contact Us

Jerry Gregory & Associates
2413-3 Robeson St.
Fayetteville, NC 28305
(910) 486-4900      fax (910) 486-4700

Deborah Locklear
deborah@jerrygregory.org
  
Jerry Gregory and Associates is an independent authorized producer/agency licensed to sell and promote products from Blue Cross and Blue Shield of North Carolina (BCBSNC).  The content contained in this site is maintained by Jerry Gregory and Associates.  Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

site design by Biz Tools One of Fayetteville