Carolina Underwriters, Inc.
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Forms

For your convenience, we have placed several downloadable forms that you can print off and fax in to our office at 704-866-8709. Please contact us with any questions.

Group Insurance Census

Health Insurance for Small Business

Enrollment/Health Statement Form - Groups 1-25 Employees

Enrollment/Health Statement Form - Groups 26+ Employees

Employer Risk Appraisal Questionnaire Groups 26+ Employees

Waiver of Health Coverage

Wellpath Group Information Request

 

 

Proudly Representing:
 

® Registered mark of the Blue Cross and Blue Shield Association

 
Carolina Underwriters, Inc.
428 West Main Avenue
Gastonia, NC 28052
Phone: 704-866-8795
704-866-8796
Toll Free:   1-877-866-8795
Fax:   704-866-8709
Email:   cluchfc1@aol.com
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Carolina Underwriters, Inc. is an independent authorized 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 Carolina Underwriters, Inc. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

® - Registered mark of the Blue Cross and Blue Shield Association