Download Forms
Frequently Used Forms
Specialty Claim Forms
- Accidental Dental Claim Form
- Ambulance/Medical Transfer Claim Form
- Assisted Care Nursing Recommendation Claim Form
- Hospital Claim Form
- Orthotics, Orthopedic Shoes and Modifications Claim Form
- Pre-Authorization Request Form
Bank Forms
- Direct Deposit Application Form
- Provider Direct Deposit (for Providers only)
- Pre-Authorized Debit Form (for Individuals)
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.
