- Text Size:
Please select a form from the table below. These forms are all PDFs and will require Adobe Acrobat Reader to open.
| Forms |
|---|
BlueCard Worldwide International Claim  (for members receiving care outside of the U.S.) |
| Disability Dependent Certification Form |
| HIPAA Authorization Form for Information Release |
| HIPAA Designation of Personal Representive (expires when policy terminates) |
| HIPAA Revocation Form for Information Release (expires a year from date of signature) |
| Medical/Vision Claim Form |
| PCP Selection - Point of Service (POS) |
*Viewing & printing this form requires Adobe Acrobat Reader. Download it free from the Adobe site.
