Forms

The following downloadable forms have been provided for your convenience. 

• Medical Claim Form
• Prescription Drug Forms
• GBP Supplemental Information (Primary Care Physician (PCP) Selection) Forms
• HIPAA Authorization Form to Disclose PHI
• Transitional Benefits
• BlueCard Worldwide (for out of country claims)

Many documents on this web site require Acrobat Reader software. If you currently don't have the software, you can get a free copy from the  Adobe Systems Incorporated Web site.