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.

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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.

Evidence of Coverage

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


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

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.

Annual Notice of Changes

The Annual Notice of Changes describes the changes to your plan’s costs and benefits from the previous year.