Downloadable Forms

The following forms are available to print, fill out, and fax or mail to BCBSNM. They are provided 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 

• Group Enrollment/Change Application — English 

• Group Enrollment/Change Application — Spanish 

• Student Certification Form 

• Request for Coverage for Mentally or Physically Impaired Dependents 

• Coordination of Benefits Form 

• Medicare Coordination of Benefits Form 

• Notice & Certification of Non-New Mexico Residency 

• 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

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