Here are some commonly used forms for conducting business with Blue Cross and Blue Shield of New Mexico (BCBSNM). To access more downloadable forms, please log in to Blue Access for Producers (BAP).
The forms below are available as PDF files. 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. Downloaded this free of charge at Adobe's site .
- Application for Individual Temporary Insurance Coverage
- Application for Individual Medical and Dental Insurance Coverage
- Application for Medicare Supplement Insurance Coverage (Underwritten)
- Application for Medicare Supplement Insurance Coverage (Guaranteed Issue)
- Group Enrollment/Change Application — English Spanish
- Affidavit of Domestic Partnership
- Request for Coverage for Mentally or Physically Impaired Dependents
- Small Group Important Timelines — (eff. 1/1/2014)
Account Maintenance Forms
- Automatic Premium Payment Authorization Agreement — for members with Blue Transitions, BlueDirect, BlueChoice, BlueChoice Plus, Number One, and NM Major Med
- Automatic Pay Form — for members with NMMIP
- Medicare Supplement Payment Option Authorization Form
- Other Coverage Questionnaire
- Medicare Supplement Notice of Replacement
- Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare
Coordination of Benefits Forms
Medicare Secondary Payer Information and Form
- Annual MSP Employer Acknowledgement Form with Instructions on Completing the Form
- Information Regarding the Medicare as Secondary Payer Statute
- MSP Fact Sheet
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.