Group Health Plans
Ancillary Products
Benefit Differential Products
BlueEdge Spending Accounts
Pharmacy
Blue Distinction Centers for Specialty Care
The Value-Based Care Approach
Blue Access for Employers
Health Care Fraud
Member Resources
Forms for Small Group Products (Groups of 2-50)
Forms for Mid-Market Group Products (Groups of 51-150)
Forms for Large Group Products (Groups of 151+)
Forms for Medicare Products
Forms for Ancillary Products
Form Finder
Here are some commonly used forms for enrolling and maintaining your employer group coverage with Blue Cross and Blue Shield of New Mexico (BCBSNM).
To review and sign your request now electronically, select the sign now option below. Or you can download and save the form, to review and sign at a later date.
| Form Name | Digital Form | Download |
|---|---|---|
| 2022 Application for Medicare Supplement Insurance Coverage – Use this application when applying for a Medicare Supplement plan with an effective date on or after April 1, 2022. | N/A | download form |
| 2021 Application for Medicare Supplement Insurance Coverage – Use this application when applying for a Medicare Supplement plan with an effective date on or after April 1, 2021. | N/A | download form |
| Medicare Supplement Notice of Replacement Form | N/A | download form |
| Medicare Supplement Other Coverage Questionnaire | N/A | download form |
| Medicare Supplement ezBlue Payment Option Authorization Form | N/A | download form |
| Form Name | Digital Form | Download |
|---|---|---|
| Annual MSP Employer Acknowledgement Form (EAF) with Instructions on Completing the Form | N/A | download form |
| Information Regarding the MSP Statute | N/A | download PDF |
| MSP Fact Sheet | N/A | download PDF |
| Form Name | Digital Form | Download |
|---|---|---|
| Medicare Coordination of Benefits Form | N/A | download form |
| Form Name | Digital Form | Download |
|---|---|---|
| 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 | download form |
| Standard Authorization Form and other HIPAA Privacy Forms | N/A | N/A |
