FIND A FORM

Prefer to submit your health insurance claim by mail?
Note: Review of your form and potential reimbursement will be slower than online submissions.

• Medical/Dental Claim Form | Download PDF
• Claim Inquiry Form | Download PDF
• Pharmacy Claim Form | Download PDF
• Blue Cross Blue Shield Global Core International Claim Form | Download PDF
• Travel Benefit Claim Form | Download PDF(Review your benefit documentation or call Customer Service to confirm you are eligible)

Sales Brochures

• 2023 Small Group Product Guide (Business with 2-50 employees)
• 2017-2018 Level Funding ASO (Business with 25-99 employees)

Applications

• Dental Product Application
• Dental Product Application (Spanish)
• Medicare Supplement Application

Short-Term Plans Up to 90 Days (without Rx)

• Download Application
• Download Application (Spanish)

Short-Term Plus Plans Up to 365 Days (with Rx)

• Download Application
• Download Application (Spanish)

Prior Authorization

Member Forms