Member documents & forms
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Commonly used forms
Medical claim form
Request reimbursement for eligible health care services received.
Vision claim form (Medicare)
Request reimbursement for eligible eye care services you've received. For members of Medicare plans.
Vision claim form (Commercial)
Request reimbursement for eligible eye care services you've received. For members with an individual and family or employer vision plan.
Authorization for Disclosure of Health Information online form
Authorize Blue Cross to give information about you to someone else.
Download PDF version of form
Premium payment direct deposit form
Set up automatic monthly premium payments from your checking or savings account with Pay-It-Easy.
BlueRide transportation request form
Rides to eligible medical appointments for members with a Medical Assistance (Medicaid) plan.*
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*Restrictions and Conditions apply.