Applying for group conversion coverage
You must apply to BCN for this coverage. You must apply within 30 days of the day your coverage through your employer ends. There can be no lapse of time between the end of your current group coverage and the beginning of your group conversion coverage.
To apply, complete the Nongroup/Group Conversion, Enrollment, Change of Status form (42K PDF) and return it to Blue Care Network with the written notification of your coverage ending and payment for the first two months' premium. Make your check payable to Blue Care Network.
For COBRA coverage
You apply for this coverage through your group. You must apply within 60 days of loss of coverage. Ask your group benefits representative for enrollment information.
page modified 09/23/2011