Forms Directory
See below for a general list of forms that can be downloaded or printed. Please use the search bar or filter buttons to find a specific form. (Some forms may only be found behind your secure participant login.)
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Adopted or Step Child Verification Form
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Appointment of Personal Representative Form
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Authorization to Disclose Specific Protected Health Information (PHI)
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Authorization to Release Medical Information
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Benefits Registration Form
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Blue Shield Claim Form - Provider Who Does Not Bill
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Blue Shield PACT OTC COVID Test Reimbursement Form for Actives and Non Medicare Retirees
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Blue Shield/PPO International Claim Form
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Blue Shield UCBT OTC COVID Test Reimbursement Form for Actives and Non-Medicare Retirees
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Blue Shield UEBT OTC COVID Test Reimbursement Form for Actives and Non-Medicare Retirees
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CA State Disability Insurance Form (EDD)
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Death Beneficiary Designation Change Form