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Online Tools for Producers
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.
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 |
|---|---|---|
| Group Enrollment Application/Change Form – use this form to apply for group coverage or make changes to an existing BCBSNM policy | sign now | download form |
| Group Enrollment Application/Change Form – Spanish | N/A | download form |
| 2023 Enrollment Package – includes Benefit Program Application (BPA), EGI Form, and Artifacts Documentation for new accounts effective 1/1/23 and after | sign now | N/A |
| 2023 Benefit Program Application (BPA) for New Small Groups 2-50 – for new accounts effective on or after 1/1/2023 | sign now | download form  download form |
| 2023 Benefit Program Application (BPA) Amendment for Small Groups 2-50 – for renewing accounts with anniversary dates on or after 1/1/2023; use this form to amend the original BPA | sign now | download form download form |
Employer Group Information (EGI) Form – this form must be submitted with the BPA |
N/A |
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| 2022 Enrollment Package – includes Benefit Program Application (BPA), EGI Form, and Artifacts Documentation for new accounts effective 1/1/22 and after | sign now | N/A |
| 2022 Benefit Program Application (BPA) for New Small Groups 2-50 – for new accounts effective on or after 1/1/2022 | sign now | download form download form |
| 2022 Benefit Program Application (BPA) Amendment for Small Groups 2-50 – for renewing accounts with anniversary dates on or after 1/1/2022; use this form to amend the original BPA | sign now | download form download form |
HSA Employer Setup Form – Benefit Wallet® – Submit an electronic copy of this form for each employer wishing to elect HSA integration with BenefitWallet. |
N/A | download form |
Benefit Wallet® Benefits Design Guide for FSA, HRA and Commuter Spending Accounts – Submit an electronic copy of this form for each employer wishing to elect FSA integration with BenefitWallet. |
N/A | download form |
HSA Employer Setup Form – Flex – Submit an electronic copy of this form for each employer wishing to elect HSA integration with Flex. |
N/A | download form |
FSA Employer Setup Form – Flex – Submit an electronic copy of this form for each employer wishing to elect FSA integration with Flex. |
N/A | download form |
HSA/FSA Employer Setup Form – HealthEquity® – Submit an electronic copy of this form for each employer wishing to elect HSA and/or FSA integration with HealthEquity. |
N/A | download form |
HSA/FSA Employer Setup Form – HSA Bank® – Submit an electronic copy of this form for each employer wishing to elect HSA and/or FSA integration with HSA Bank. |
N/A | download form |
Consumer Directed Health Accounts Enrollment and Change Form – Use this form to collect employee FSA elections if sending enrollment through BCBSNM to BenefitWallet, HealthEquity or HSA Bank. |
N/A | download form |
| Census Import Template | N/A | download form  |
| COBRA Agreement Form | N/A | download form |
| COBRA Endorsement B – Waiver of COBRA Administrator | N/A | download form |
| Common Ownership Form – Small Group | N/A | download form |
| Disabled Dependent Authorization Form (for Group Plans) – Members with an employer-sponsored health plan should use this form to request continuation of coverage on their existing policy for a dependent who is incapable of self-support because of mental or physical impairment. Mail or fax the completed form to BCBSNM (see address and fax number at the top of the form). You can also use this form to add a disabled dependent to a new policy (include this completed form when you submit your enrollment application). | N/A | download form |
| Supplemental Employment Verification Form | N/A | download form |
| Form Name | Digital Form | Download |
|---|---|---|
| Group Enrollment Application/Change Form – use this form to apply for group coverage or to make changes to an existing BCBSNM policy | sign now | download form |
| Group Enrollment Application/Change Form – Spanish | N/A | download form |
| 2023 Important Benefit Changes/Uniform Modification Notice – identifies some of the most important benefit plan changes for the upcoming 2023 coverage year | N/A | download letter |
| 2023 Benefit Program Application (BPA) for New Small Groups 2-50 – for new accounts effective on or after 1/1/2023 | sign now | download form download form |
| 2023 Benefit Program Application (BPA) Amendment for Small Groups 2-50 – for renewing accounts with anniversary dates on or after 1/1/2023; use this form to amend the original BPA | sign now | download form download form |
| 2022 Benefit Program Application (BPA) for New Small Groups 2-50 – for new accounts effective on or after 1/1/2022 | sign now | download form download form |
| 2022 Benefit Program Application (BPA) Amendment for Small Groups 2-50 – for renewing accounts with anniversary dates on or after 1/1/2022; use this form to amend the original BPA | sign now | download form download form |
| 2022 Important Benefit Changes/Uniform Modification Notice – identifies some of the most important benefit plan changes for the upcoming 2022 coverage year | N/A | download letter |
| Affidavit of Domestic Partnership | sign now | download form |
| COBRA Agreement Form | N/A | download form |
| COBRA Endorsement B – Waiver of COBRA Administrator | N/A | download form |
| Statement of Termination of Domestic Partnership | 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 flier |
| MSP Fact Sheet | N/A | download fact sheet |
| Form Name | Digital Form | Download |
|---|---|---|
| Coordination of Benefits Form | N/A | download form |
| Producer of Record Transfer Form | N/A | download form |
| 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 |
| Power of Attorney for Health Care – Spanish | N/A | download form |
| Standard Authorization Form and other HIPAA Privacy Forms | N/A | N/A |
