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BlueChoice Opt-Out Open Access
If you need a form that is currently not available online, please call Member Services at the telephone number on your ID card.
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Vision Claim - Davis |
(BlueVision, BlueVision Plus) |
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BlueCard Worldwide International Claim |
(For care received out of network area) |
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Student Certification |
For Maryland residents (excluding Prince George's and Montgomery Counties) |
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Student Certification |
For Maryland (Prince George's and Montgomery Counties only), D.C. and VA residents |
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Disability Certification |
For Maryland residents (excluding Prince George's and Montgomery Counties) |
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Disability Certification |
For Maryland (Prince George's and Montgomery Counties only), D.C. and VA residents |
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| As a convenience for members, we are providing links to the Maryland Attorney General's Web site to access information on Advance Directives and Living Wills. |
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Viewing and printing this document requires Adobe Acrobat Reader, which can be downloaded free from the Adobe site.
Members can use the claim forms for services rendered by in-area or out-of-area non-participating providers. Participating providers are responsible for filing claims for their services.
Claim forms should not be used for services rendered through any discount Dental or Vision program or for the Options program for alternative therapies. The discount is applied by the provider at the time of service for such programs.
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