Benefits Connection Exchange

Enrollment Forms      

Benefits Connection applications for Highmark Blue Cross Blue Shield, Aetna, Dental Connection, Vision and HSA Forms are available by clicking on the links below.

These forms may be printed (PDF files), completed forms can be faxed to
302-654-8836 or scanned & emailed to

You may also call our office (302-654-8823) and we will be happy to provide these forms to you.

Highmark BCBS Employee Enrollment/Change/Waiver Form 

Highmark BCBS Group Application  

Aetna Employee Enrollment/Change/Waiver Form

Aetna Group Enrollment Form      


Dental Connection Enrollment Form

VSP Logo Vision Application for VSP Vision                 


 Chamber Membership Application




Return to Homepage
Get A Quote
Button Group Healthcare Plans 
Button Group Dental Plans 
Button Group Vision Plans
Button Workers Compensation
Button Individual Healthcare
Button How To Get A Quote & Enroll
Button Get Enrollment Forms
Button Meet Our Partners
Button See Our Insurance Companies
Button Contact Us        Our Privacy Notice
 Toll Free: 800.486.1244
 Local: 302.654.8823

Insurance Products provided through
AIG Logo
 Broker since 1980
Wilmington, DE 19801








Insurance News

Wed, 21 Mar 2018 16:59:17 +0000
Severe storms that spawned tornadoes damaged homes and downed trees as they...
Wed, 21 Mar 2018 16:29:07 +0000
A federally funded study focusing on two Arkansas cities will serve as an o...
Wed, 21 Mar 2018 16:13:03 +0000
A.M. Best has revised the outlooks to stable from negative and affirmed the...