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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Appointment of Personal Representative Form
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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/PPO International Claim Form
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Dismemberment and Loss of Sight Form
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Kaiser/Kaiser Dual Reimbursement Form
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Medical Benefits (Shingles Vaccination, Hearing Aid, CBD Oil) Reimbursement Form
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Medicare Advantage Reimbursement Claim Form and Instructions
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PACT Life and Accidental Death Claim Application
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UCBT Life and Accidental Death Claim Application
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UEBT Active Other Insurance Information (OII) Form