Downloadable Forms

The forms posted below are available as PDF files. If you do not have Adobe® Reader®, download it free of charge at Adobe's site.

• Standard Claim Form 

• BlueCard Worldwide® International Claim Form 

• Impaired Dependent Certification Form 

• Coordination of Benefits Form 

• Medicare Coordination of Benefits Form 

• 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.

• Standard Authorization Form and other HIPAA Privacy Forms

If you wish to use one of these forms, please click on the appropriate link above, print the form, fill it out, and mail it to:

NMPSIA DSU
Blue Cross and Blue Shield of New Mexico
P.O. Box 27630
Albuquerque, NM 87125-7630

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