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.

Medicare Member Materials for 2024 will be available by 10/15/23. This includes Annual Notice of Coverage (ANOC), Evidence of Coverage (EOC), Summary of Benefits and Formularies.

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Medicare Advantage (BlueAdvantage) Not sure if this is your plan? Medicare Advantage includes BlueAdvantage SM Diamond, Ruby, Garnet and Sapphire which should be listed on your Membership ID card.


Use this form if you'd like to submit a claim.


Use this form if you'd like BlueCross to accept bank draft payments.

Benefits & Coverage

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

Grievances & Appeals

Use these forms to file an appeal about coverage or payment decision, or to file a grievance if you have concerns about your plan, providers or quality of care.

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.