Our most frequently requested forms are available in Adobe Acrobat PDF format. You will need the Adobe Acrobat Reader to view the following forms; download it free of charge from Adobe's site. Just click on the appropriate form below, print the form, fill it out, and mail it in.
- Standard Claim Form (PDF)
- BlueCard Worldwide® International Claim Form (PDF)
- Student Certification Form (PDF)
- Request for Coverage for Mentally or Physically Impaired Dependents (PDF)
- Coordination of Benefits Form (PDF)
- Medicare Coordination of Benefits Form (PDF)
- Power of Attorney for Health Care Form (PDF) — Designate someone you trust to make health care decisions if you are unable to do so. Follow instructions on the form.
- Standard Authorization Form and other HIPAA Privacy Forms
