Downloadable Forms
Our most frequently requested forms are available in Adobe Acrobat PDF format. Just click on the appropriate form and print it out, then fill out the form and mail it in.
You will need the Adobe® Reader® to view the following forms. This can be downloaded free of charge at Adobe's site 
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Enrollment/Change Forms
- Application for Blue Transitions Temporary Individual Coverage
- Application for Individual Medical Insurance with Option for Term Life and Dental Insurance for BlueDirect and BlueEdge Individual HSA Plans
- Application for Medicare Supplement Policies
- Group Enrollment/Change Application — English Spanish
- Dental Enrollment Application/Change Form for Groups
- Away From Home Care® Guest Membership Application — for HMO members only
- Student Certification Form
- Request for Coverage for Mentally or Physically Impaired Dependents
Account Maintenance Forms
- Automatic Premium Payment Authorization Agreement — for members with Blue Transitions, BlueDirect, BlueChoice, BlueChoice Plus, Number One, and NM Major Med
- Medicare Supplement Payment Option Authorization Form
- Automatic Pay Form — for members with NMMIP
Claim/Mail-Order Forms
- Standard Claim Form
- BlueCard Worldwide® International Claim Form
- Dental Claim Form
- Vision Claim Form
- Prescription Drug Claim Form
- PrimeMail Prescription Drug Mail-Order Form — English Spanish
Coordination of Benefits Forms
Legal/HIPAA Privacy Forms
- Power of Attorney for Health Care Form — Members designate someone they trust to make health care decisions if they are unable to do so. Follow instructions on the form.
- Standard Authorization Form and other HIPAA Privacy Forms
If your clients have questions about any of our individual or group plans, they can call BCBSNM at (505) 837-8787 or toll-free at 1-800-672-9700.
Prospective Producers: To apply to become a contracted producer, see our Prospective Producers page.
