Downloadable Forms for Individual Products
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 in portable document format (PDF). To view these files, you may need to install a PDF reader program. Most PDF readers are a free download. One option is Adobe® Reader®.
Current Individual Forms and Documents
|Stock # / Date||Enrollment Forms and Change Forms||New Mexico Form #|
|82798.0914||Health Application/Change in Coverage||N/A|
|475001.1114||Dental Application/Change in Coverage||N/A|
|42781.0812||Blue Transitions Application||N/A|
|Stock # / Date||Account Maintenance Forms||New Mexico Form #|
|M574 10.07||Automatic Pay Form - for members with NMMIP||N/A|
|80661.0914||Automatic Premium Payment Authorization Agreement||N/A|
|Stock # / Date||Miscellaneous Forms||New Mexico Form #|
|CS01 10/07||Coordination of Benefits Form||N/A|
|Stock # / Date||Legal / HIPAA Forms||New Mexico Form #|
|--||Power of Attorney for Health Care - Members can designate someone they trust to make health care decisions if they are unable to do so. Follow instructions on the form.||N/A|
|09.12.14||Standard Authorization Form and other HIPAA Privacy Forms||N/A|