Blue Access for Employers

Downloadable Forms

Click on any of the links below to view and print these documents. Most of this information is available as PDF files. You will need the Adobe® Reader® to view the following forms; download it free of charge from Adobe's site .

Group Contracts and Applications

Group Master Contract Provisions for BCBSNM Products

English 

Group Master Application

English 

Group Proxy Form

English 

Enrollment/Change Forms

Group Enrollment/Change Application

English   Spanish 

Application for Blue Transitions Temporary Individual Coverage

English 

Affidavit of Domestic Partnership

English 

Away From Home Care® Guest Membership Application — for HMO members only

English 

Request for Coverage for Mentally or Physically Impaired Dependents

English 

Coordination of Benefits Forms

Coordination of Benefits Form

English 

Medicare Coordination of Benefits Form

English 

Medicare Secondary Payer (MSP) Information and Form

Annual MSP Employer Acknowledgement Form with Instructions on Completing the Form

English 

Information Regarding the Medicare as Secondary Payer Statute

English 

MSP Fact Sheet

English 

Legal/HIPAA Privacy Forms

Power of Attorney for Health Care Form — Designate someone you trust to make health care decisions if you are unable to do so. Follow instructions on the form.

English 

Standard Authorization Form and other HIPAA Privacy Forms

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