Group Activity Report (GAR) Form
Use this form to add new dependents to an existing policy, cancel coverage, change plan benefits elections, or transfer subscribers from one group to another within the same account. Please see the back page for further instructions. Be sure to save a copy of your completed form for your records.
Do not use this form if you or your third-party administrator submits enrollment through electronic enrollment files.
If you have any questions, contact your broker or BCBSRI account representative.