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.)
-
Appointment of Personal Representative Form
-
Authorization to Release Medical Information
-
Benefits Registration Form
-
Blue Shield Claim Form - Provider Who Does Not Bill
-
Blue Shield/PPO International Claim Form
-
Blue Shield UCBT OTC COVID Test Reimbursement Form for Actives and Non-Medicare Retirees
-
Blue Shield UEBT OTC COVID Test Reimbursement Form for Actives and Non-Medicare Retirees
-
Dismemberment and Loss of Sight Form
-
Kaiser/Kaiser Dual Reimbursement Form
-
Medical Benefits (Shingles Vaccination, Hearing Aid, CBD Oil, COVID OTC) Reimbursement Form
-
Medicare Advantage Reimbursement Claim Form and Instructions
-
Sick Leave/Disability Extension Form Packet