BCI
Enrollment Request System
Welcome to the BCI Enrollment Request System! The links below will allow you the opportunity to provide us with the information we need to complete your add coverage or terminate coverage requests.
CLIENTS - SENATE BILL 51 NOTICE:
Employee and dependent policy terminations cannot and will not be back-dated due to Texas Senate Bill 51. If you notify BCI or the insurance company to request a termination of a member’s benefits, the earliest date the request can be processed will be at the end of the month in which the request was submitted. The employer is responsible for the full month’s payment of coverage for the policy holder (employee) and dependents. Senate Bill 51 does not make any provisions or allowances for any insurance company or broker to make exceptions to the rule. Should you have questions or seek administrative services that will keep your company compliant, please visit your Account Manager or Benefit Advisor.
Add Coverage
To add coverage for an employee or an eligible dependent, please have the following information readily available in addition to required completed carrier forms. A carrier enrollment form or application is required for every line of coverage being added. You typically have 31 days from the date of a qualifying life event to add an employee or an eligible dependent to a plan.
Employee Full Name*
Employee Date of Birth*
Employee Date of Hire*
Employee Social Security Number*
Employee Department, Division/Location and Benefit Class, if required
Reason for Adding Coverage*
Coverage Type(s) that apply*
Coverage tier*
Carrier*
Annual Salary, if offering/enrolling in disability or salary-based life insurance coverage
Job Title/Occupation, if offering/enrolling in disability coverage
Carrier Enrollment Form
If you have more than five employees to add, please use this spreadsheet to provide us with the information we need and email it, along with all supporting documents, applications and forms to your assigned Account Manager.
Terminate Coverage
To terminate coverage for an employee or an eligible dependent, please have the following information readily available in addition to required completed carrier forms.
Employee Full Name (include any name changes or hyphenations)*
Original Date of Hire*
Employee Social Security Number*
Reason for Terminating Coverage*
Employment Termination or Event Date*
Benefit(s) Termination Date*
Coverage Type(s) Being Dropped*
The following carriers require a completed form to terminate coverage (click on the below link to download the appropriate form):
If you have more than five employees to terminate, please use this spreadsheet to provide us with the information we need and email it, along with all supporting documents, applications and forms to your assigned Account Manager.