Our forms are updated regularly, so please use the most current version to avoid processing delays.

For questions, call the number on the back of your ID card.

Authorized Delegate

This form is used for you to give Blue Cross permission to share your protected health information with another person or company.

Other Coverage Questionnaire

Important note: You need to provide this information once every two calendar years in order for us to process your claims. If we do not have a current form on file for you and any dependents, we cannot process any of your claims.