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Downloadable Forms for Medicare 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.

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.

Enrollment Forms and Change Forms

Form Name Digital Form Download
Application for Medicare Supplement Insurance Coverage (Guaranteed Issue) N/A download form Acrobat PDF
Application for Medicare Supplement Insurance Coverage (Underwritten) N/A download form Acrobat PDF
Medicare Supplement Notice of Replacement N/A download form Acrobat PDF
Medicare Supplement Other Coverage Questionnaire N/A download form Acrobat PDF
Medicare Supplement ezBlue Payment Option Authorization Form N/A download form Acrobat PDF
Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare N/A download form Acrobat PDF

 

Miscellaneous Forms

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

 

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 Acrobat PDF
Standard Authorization Form and other HIPAA Privacy Forms N/A N/A