(847) 592-0941     Email Us     Contact Sheet

Plan Changes for In-Force Groups


Benefit Plan Selection Forms: Please contact the Group Service Team at 847.605.1200 to get details on when plan changes are allowed and paperwork is due.

2018 Billing Method Form Only needed if your group is changing their billing method. Example: If they are currently Age Rated and are staying Age rated, there is no need to fill out this form.

Employee Application will be required for any employees changing plans or joining during open enrollment. If they are an existing member or not on an ACA Metallic plan the medical questions are not required.

Medicare Secondary Payer Form is required upon renewing with BCBS.  Please fax to our office at 847.605.1494 for proper processing.

Prescription Drug Forms


Rx Claim Form
Rx Info

Administrative Forms for In-Force Groups


Enrollment Change Request Form (EB4633 6/10)
Sample Broker of Record Letter
Medical Claim Form
Dental Claim Form
International Claim Form (N13-04-086)
Member PHI Release Form
Affidavit of Domestic Partnership
Statement of Termination of Domestic Partnership (20560 2/07)
Tax Information on Health Benefits for Domestic Partnership (20559 2/07)

Looking for earlier forms?


Contact Us

Resource Brokerage LLC
1501 East Woodfield Road, Ste 110e
Schaumburg, IL 60173
Toll Free: 1-800-605-7566
General Phone: (847) 605-1200

Group

Phone: (847) 592-0941
Fax: (847) 605-1494

Individual

Phone: (847) 598-6006
Fax: (847) 605-1331

Life, Annuity, LTC, DI & CI

Phone: (847) 598-6005
Fax: (847) 619-9592

Testimonials

"I've been on both sides of the aisle - as a client and as a vendor. From my experiences I feel qualified to state that your product knowledge, training and sales expertise, and understanding of the client's needs were exceptional and invaluable to my selling success. Whenever I had questions (and there were many!) you responded very quickly and in many instances, gave me additional ideas that helped with the sale."

"I am looking forward to many, many additional sales with your help!"

"Great job prepping this case for us. I completed initial review on Thursday and have been able to approve this morning (4 business days) !"

About Us - Who We Are

Resource Brokerage is one of the Midwest’s leading brokerage general agencies providing brokers a choice of Group Benefits, Major Medical, Life, Annuities, DI, LTC and Linked Benefits all in one place. Brokers work with a team of dedicated professionals who specialize in the lines of business they support. These teams also constantly undergo training and education with a focus on credentials that mean the most to our industry. Our management team is led by seasoned industry professionals with true brokerage experience and the know-how to help get things done for our brokers.