Downloadable Forms

Participant Forms

The following forms are available to print, fill out, and fax or mail to BCBSTX. 

• Disabled Dependent Authorization Form - English
• Disabled Dependent Authorization Form - Spanish
• Enrollment, Change and Declination Form - English
• Enrollment, Change and Declination Form - Spanish
• HIPAA Standard Authorization Form - English
• HIPAA Standard Authorization Form - Spanish
• Medical Claim Form (Domestic) - English
• Medical Claim Form (Domestic) - Spanish
• Medical Claim Form (International) - English
• Medical Claim Form (International) - English
• Member Rewards HCA Expense Form - TRS-ActiveCare Primary, TRS-ActiveCare Primary+ and TRS-ActiveCare 2
• Member Rewards HCA Expense Form - TRS-ActiveCare HD
• Out-of-State Dependent/Attestation Form - English
• Out-of-State Dependent/Attestation Form - Spanish
• Transition of Care Form - English
• Transition of Care Form - Spanish