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Frequently Used Forms

Specialty Claim Forms

Bank Forms

Travel Forms

For Emergency Health Claims, submit the:

For Trip Cancellation Claims, submit the:

For Baggage Claims, submit the:

Disability Benefit Claim Forms

Three forms are required for an application: an Employee's Statement, Employer's Statement (including a Job Analysis or a detailed job description), and an Attending Physician's Statement.

Please note: Not all plans cover all benefits so some of these forms may not apply to you. To confirm what benefits are covered under your plan, click My Coverage within mybluecross or contact us.