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Documents & Forms

We've put together the most common documents and forms you might need for things like filing claims or reviewing your coverage. Start by choosing what kind of insurance you have from the list below.

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Medicare Supplement (BlueElite) Not sure if this is your plan? Medicare Supplement is also known as BlueElite^SM and should be listed on your Member ID card.

Benefits and Coverage

These documents contain information about your benefits, network and coverage.

BlueElite Preferred Hospital Incentive Information
One Touch® Free Blood Glucose Monitor Voucher
Outline of Benefits
Prior Authorization Forms
The Accountable Alliance Some BlueElite members may save money when they receive inpatient hospital care at a facility that participates in The Accountable Alliance. Visit this page to search for a participating facility.

Billing

Use these forms if you'd like BlueCross to accept bank draft payments.

Bank Draft Form

Enrollment

Use this form to help you enroll in a plan.

Your Rights

You'll find notices and forms in this section to help you understand your rights and responsibilities, and make requests related to those rights.

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Documents & Forms

Medicare Supplement (BlueElite) Not sure if this is your plan? Medicare Supplement is also known as BlueEliteSM and should be listed on your Member ID card.

Medicare Supplement (BlueElite) Not sure if this is your plan? Medicare Supplement is also known as BlueElite^SM and should be listed on your Member ID card.