Downloadable Forms for Mid-Market Groups (NRSG)
(51-100 Employees)

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.

These downloadable forms are for use with non-regulated small group products.

Enrollment Forms and Change Forms

Form Name	Digital Form	Download
2017 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
2017 Group Enrollment Application/Change Form – Spanish	N/A	download form
Affidavit of Domestic Partnership	sign now	download form
Away From Home Care Guest Membership Application	N/A	download form
Disabled Dependent Certification Form	sign now	download form
Statement of Termination of Domestic Partnership	N/A	download form

Medicare Secondary Payer (MSP) Form and Information

Form Name	Digital Form	Download
Annual MSP Employer Acknowledgement Form with Instructions on Completing the Form	N/A	download form
Information Regarding the Medicare as Secondary Payer Statute	N/A	download form
MSP Fact Sheet	N/A	download form

Miscellaneous Forms

Form Name	Digital Form	Download
Coordination of Benefits Form	N/A	download form
Medicare Coordination of Benefits Form	N/A	download form

Legal / HIPAA Forms

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